Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis.
The association between inadequate sleep and type 2 diabetes has garnered much attention, but little is known about sleep and type 1 diabetes (T1D). Our objectives were to conduct a systematic review and meta-analysis comparing sleep in persons with and without T1D, and to explore relationships between sleep and glycemic control in T1D.



Studies were identified from Medline and Scopus. Studies reporting measures of sleep in T1D patients and controls, and/or associations between sleep and glycemic control, were selected.



A total of 22 studies were eligible for the meta-analysis. Children with T1D had shorter sleep duration (mean difference [MD] = -26.4 minutes; 95% confidence interval [CI] = -35.4, -17.7) than controls. Adults with T1D reported poorer sleep quality (MD in standardized sleep quality score = 0.51; 95% CI = 0.33, 0.70), with higher scores reflecting worse sleep quality) than controls, but there was no difference in self-reported sleep duration. Adults with TID who reported sleeping >6 hours had lower hemoglobin A1c (HbA1c) levels than those sleeping ≤6 hours (MD = -0.24%; 95% CI = -0.47, -0.02), and participants reporting good sleep quality had lower HbA1c than those with poor sleep quality (MD = -0.19%; 95% CI = -0.30, -0.08). The estimated prevalence of obstructive sleep apnea (OSA) in adults with TID was 51.9% (95% CI = 31.2, 72.6). Patients with moderate-to-severe OSA had a trend toward higher HbA1c (MD = 0.39%, 95% CI = -0.08, 0.87).



T1D was associated with poorer sleep and high prevalence of OSA. Poor sleep quality, shorter sleep duration, and OSA were associated with suboptimal glycemic control in T1D patients.
Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sreutrak10800@gmail.com.
Sirimon
S
Reutrakul
Section for Clinical Epidemiology and Biostatistics, Faculty of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Ammarin
A
Thakkinstian
Section for Clinical Epidemiology and Biostatistics, Faculty of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Thunyarat
T
Anothaisintawee
Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Sasipas
S
Chontong
Hypoxia Pathophysiology (HP2) Laboratory, INSERM U1042, Grenoble Alpes University, and Endocrinology Department, University Hospital, Grenoble, France.
Anne-Laure
AL
Borel
Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA.
Michelle M
MM
Perfect
Endocrinology and Diabetes Division, Medicine Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Carolina Castro Porto Silva
CC
Janovsky
Department of Pneumology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Romain
R
Kessler
eSwiss Medical & Surgical Center, St. Gallen, Switzerland.
Bernd
B
Schultes
Department of Internal Medicine 2, Thuringia Clinic Saalfeld, "Georgius Agricola", Saalfeld/Saale, Germany.
Igor Alexander
IA
Harsch
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
Marieke
M
van Dijk
INSERM U-987, Centre d'Evaluation et Traitement de la Douleur, CHU Ambroise Pare, APHP, Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, Versailles, France.
Didier
D
Bouhassira
Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
Bartlomiej
B
Matejko
Institute for Endocrine Discovery and Clinical Care & Department of Health Studies, University of Chicago, Chicago, IL, USA.
Rebecca B
RB
Lipton
Division of Allergy Immunology and Rheumatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Parawee
P
Suwannalai
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Naricha
N
Chirakalwasan
Department of Internal Medicine, Regional Hospital of Feldbach-Fürstenfeld, Fürstenfeld, Austria.
Anne-Katrin
AK
Schober
Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA.
Kristen L
KL
Knutson
D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Glycemic control; Meta-analysis; Obstructive sleep apnea; Sleep duration; Sleep quality; Type 1 diabetes
Psychiatry Res. 1989 May;28(2):193-213
2748771
J Pediatr. 2000 Aug;137(2):233-8
10931417
Diabet Med. 2013 Mar;30(3):e115-22
23181742
Arch Endocrinol Metab. 2015 Feb;59(1):71-8
25926118
Am J Respir Crit Care Med. 2004 Jun 1;169(11):1231-7
15044204
Ann Neurol. 1985 Apr;17(4):391-5
4004160
Sleep Med. 2014 Dec;15(12):1490-9
25441750
Sleep. 2012 Jan 01;35(1):81-8
22215921
Diabetes Care. 2010 Nov;33(11):e142
20980421
Ann Intern Med. 1999 Oct 5;131(7):485-91
10507956
Clin Respir J. 2011 Jul;5(3):165-72
21679352
Lancet Diabetes Endocrinol. 2014 Feb;2(2):133-40
24622717
Diabetologia. 2011 Aug;54(8):1967-76
21573904
Sleep. 1981 Sep;4(3):263-78
7302457
Diabetes Care. 2010 Jul;33(7):1573-7
20357381
Proc Natl Acad Sci U S A. 2008 Jan 29;105(4):1107-8
18212114
Proc Natl Acad Sci U S A. 2008 Jan 22;105(3):1044-9
18172212
Diabetes Care. 2000 Jul;23(7):934-42
10895843
Ann N Y Acad Sci. 2014 Apr;1311:151-73
24628249
J Pediatr Psychol. 2013 Jun;38(5):506-17
23475831
J Pediatr. 2003 Feb;142(2):163-8
12584538
J Appl Physiol (1985). 2009 May;106(5):1538-44
19265062
Lancet. 1999 Oct 23;354(9188):1435-9
10543671
Ann Intern Med. 2012 Sep 4;157(5):336-47
22777524
J Diabetes Investig. 2015 Jul;6(4):460-4
26221525
PLoS Comput Biol. 2015 Apr 09;11(4):e1004125
25855969
BMC Endocr Disord. 2014 Oct 10;14:83
25303963
Diabetes Care. 2014;37(1):39-43
24356596
Diabetes. 2010 Sep;59(9):2126-33
20585000
Front Neurol. 2012 Aug 13;3:126
23015803
Pediatr Diabetes. 2009 Aug;10(5):321-8
19067887
PLoS One. 2013 Sep 13;8(9):e74195
24058527
Diabetes Care. 1993 Dec;16(12):1579-87
8299453
J Diabetes Sci Technol. 2013 Sep 01;7(5):1337-45
24124962
Diabetologia. 2000 Jun;43(6):696-702
10907113
Front Endocrinol (Lausanne). 2014 Aug 11;5:119
25157241
Sleep. 2015 Jun 01;38(6):843-4
26039963
Proc Am Thorac Soc. 2008 Feb 15;5(2):136-43
18250205
Diabetes Care. 2013 Oct;36(10):2902-8
23715755
JAMA. 2002 May 15;287(19):2563-9
12020338
Diabet Med. 2010 Nov;27(11):1328-9
20950392
Diabet Med. 2015 Jan;32(1):90-6
25186832
Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):801-15
21112027
Diabetes Care. 2004 Dec;27(12):2942-7
15562211
Sleep Health. 2015 Mar;1(1):40-43
29073412
Pediatrics. 2012 Sep;130(3):e714-55
22926176
Diabetes Res Clin Pract. 2012 Nov;98(2):302-11
23010555
Psychoneuroendocrinology. 2015 May;55:48-58
25720348
Biol Res Nurs. 2012 Jan;14(1):48-54
21278167
Diabetes Care. 2014 Jul;37(7):2034-54
24935775
Diabetes Care. 2008 Jun;31(6):1183-8
18299444
JAMA. 2015 Jan 6;313(1):45-53
25562265
Clin Physiol Funct Imaging. 2008 Sep;28(5):312-7
18462437
Neuropediatrics. 2005 Apr;36(2):98-103
15822022
Diabet Med. 2008 Feb;25(2):232-5
18290864