Poor Sleep Quality and Obstructive Sleep Apnea Common in Older Adults With Type 1 Diabetes: Study

To systematically determine the occurrence of sleep disorders and identify the metabolic and vascular risk factors behind them, researchers used a total of 963 older adults with established Type 1 diabetes from the ongoing DCCT/EDIC observational study follow-up study. Three different clinically validated screening tests were employed to measure the different parameters of night time sleep disorder: STOP-Bang test for intermediate to high risk of obstructive sleep apnea (a score of 3 or more), Pittsburgh Sleep Quality Index (PSQI) for poor sleep quality (a score of more than 5) and Epworth Sleepiness Scale (ESS) for presence of moderate or greater degree of excessive daytime sleepiness (a score of more than 10).

Multivariable logistic regression models were used by researchers to measure the adjusted odds of each individual sleep disorder among various demographic variables, longitudinal glycemic control and diabetic microvascular or neuropathic complications.

Key findings:

• The statistical analysis in 963 DCCT/EDIC subjects (52% males; average age 64±7 years; duration of diabetes 43±5 years) revealed high levels of undiagnosed sleep disorder along with certain correlations with metabolism.
• Previously known obstructive sleep apnea was identified in 29% of subjects, while PAP treatment currently used by 19% of participants.
• Screening showed the presence of moderate-to-severe OSA risk in 64%, poor sleep in 43%, and daytime sleepiness in 10% of participants.
• Every increase by 1% (11 mmol/mol) in current and averaged HbA1c value was related with 15-20% higher chances to suffer from any kind of sleep disorder.
• In the multivariable model with adjustment for age, biological gender, BMI and HbA1c the independent predictors of increased chances of OSA risk were the presence of autonomic neuropathy, while increased chances of poor sleep were predicted by the presence of albuminuria and hypoglycemia.

In summary, the findings from the DCCT/EDIC cohorts show that an increased risk of obstructive sleep apnea and poor sleep quality are common among older individuals with type 1 diabetes. The key findings from the study indicate that it is critical to integrate sleep assessments as part of diabetes management and to explore the neuro-metabolic pathways connecting blood glucose levels and complications to sleep disturbances.

Reference:

Catherine L. Martin, Matthew Bott, William H. Herman, Barbara H. Braffett, Victoria R. Trapani, Ionut Bebu, Harsha Karanchi, Jean M. Lawrence, Jennifer Sherr, Gayle M. Lorenzi, Pearl G. Lee, David M. Nathan, Ronald D. Chervin, Rose A. Gubitosi-Klug, DCCT/EDIC Research Group; Increased Risk of Obstructive Sleep Apnea and Poor Sleep Quality Among Older Adults With Type 1 Diabetes: The DCCT/EDIC Study. Diabetes Care 2026; dc261678. https://doi.org/10.2337/dc26-1678