title: Disturbed subjective sleep characteristics in adult patients with long-standing type 1 diabetes mellitus.
abstract: OBJECTIVE
  Decreased sleep duration and/or impaired sleep quality negatively influence glucoregulation. The aim of this study was to assess subjective sleep characteristics in patients with type 1 diabetes, to relate sleep characteristics to long-term glycaemic control and to assess possible risk factors for impaired sleep.
  
  
  METHODS
  We studied 99 adult patients with type 1 diabetes (55 men, 44 women, duration of diabetes 26.9 ± 1.2 years) and 99 age-, sex- and BMI-matched non-diabetic controls. Subjective sleep characteristics were assessed by validated questionnaires, i.e. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Berlin Questionnaire. Glucoregulation was assessed by HbA(1c) values. Clinical variables were obtained from medical charts. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS). Peripheral polyneuropathy was assessed by neurological examination and quantitative sensory testing.
  
  
  RESULTS
  Of the patients with type 1 diabetes, 35% had subjective poor sleep quality compared with 20% of the control participants (p = 0.021). A higher proportion of the patients with type 1 diabetes were at increased risk for obstructive sleep apnoea (OSA) (17.2% vs 5.1%, p = 0.012). There was no significant association between individual sleep characteristics and HbA(1c) values. On logistic regression analysis, the HADS depression score, presence of peripheral polyneuropathy, habitual snoring and other sleep disturbances (e.g. hypoglycaemia) were independently associated with poor sleep quality.
  
  
  CONCLUSIONS
  Adult patients with long-standing type 1 diabetes mellitus have disturbed subjective sleep quality and a higher risk for OSA compared with control participants. Subjective sleep disturbances are part of the complex syndrome of long-standing type 1 diabetes.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. mvandijk2@lumc.nl
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
authors.forename: E
authors.initials: E
authors.lastname: Donga
authors.forename: J G
authors.initials: JG
authors.lastname: van Dijk
authors.forename: G J
authors.initials: GJ
authors.lastname: Lammers
authors.forename: K W
authors.initials: KW
authors.lastname: van Kralingen
authors.forename: O M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: E P M
authors.initials: EP
authors.lastname: Corssmit
authors.forename: J A
authors.initials: JA
authors.lastname: Romijn
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000503:physiopathology* / Q000523:psychology