Nocturnal glycemic variability and sleep architecture in children and adolescents with type 1 diabetes: A multi-night home sleep study

Type 1 diabetes (T1D) may disrupt sleep through several mechanisms, including glycemic variability (GV). Few studies have examined nightly GV and its association with sleep architecture. We examined associations between nocturnal GV and sleep architecture in children and adolescents with T1D during the first 4 h of sleep, when stage N3 is most prominent.

In this prospective observational study, 62 participants with T1D contributed 233 nights of continuous glucose monitoring and home sleep testing. Linear mixed-effects models examined associations between nocturnal GV, time in hypo- and hyperglycemia, and sleep parameters, adjusting for age, sex, insulin pump type, weekday/weekend, and mean glucose when appropriate.

Participants were 53.2% female, with a mean age of 12.8 years (SD 2.9). GV was not associated with N3 duration. SD of sensor glucose was associated with lower sleep efficiency (-1.8 percentage points, p = 0.045). Any detected glucose <3.0 mmol/L was associated with lower sleep efficiency (-8.5 percentage points, p = 0.04) and increased wake after sleep onset (+1.8 min, p = 0.01). In age-stratified analyses, severe hyperglycemia (>14 mmol/L) in adolescents was associated with more N2 sleep (+24.1 min, p = 0.001) and less N3 sleep (-14.3 min, p = 0.049). Insulin pump modality did not modify associations.

Nocturnal GV appeared more strongly related to sleep continuity than to N3 sleep. Findings were broadly consistent in whole-night analyses, with the largest effects observed at extreme glucose values.