Sleep patterns and glycemia in adults with cystic fibrosis-related diabetes: a remote pilot study

Cystic fibrosis-related diabetes (CFRD) is a common and serious complication of cystic fibrosis (CF) that leads to worse clinical outcomes. Sleep disturbance is prevalent in CF and may represent a modifiable contributor to dysglycemia in CFRD, however concurrent real-world assessments of sleep and glycemia are limited.

This was a fully remote, 10-day observational study to evaluate the feasibility of at-home phenotyping of sleep and glycemia in adults with CFRD. Participants were recruited nationwide and completed continuous glucose monitoring, wrist actigraphy, validated surveys, and at-home fingerstick hemoglobin A1c collection. Feasibility was assessed with study completion and enrollment rates. Descriptive analyses characterized sleep and glycemic measures, and exploratory analyses assessed their relationship.

Thirty patients (43.7 ± 12.3 years; 83.3% female; 93.3% White) were enrolled, yielding 100% completion and 96.8% enrollment. Broadly, 76.7% of participants reported poor overall sleep quality; in terms of sleep disorders, 46.7% endorsed clinically significant insomnia symptoms, 30% were at high risk for obstructive sleep apnea, and 16.7% met criteria for definite restless legs syndrome. Time in range (TIR) did not differ across sleep categories. Actigraphy estimates indicated median (Q1, Q3) sleep duration of 7.5 h (6.5, 8.1) and sleep efficiency of 87.5% (83.9, 89.3). Among the actigraphy measures, longer sleep onset latency was significantly correlated with lower TIR.

This study demonstrates the feasibility of fully remote physiological phenotyping in CF research and highlights sleep patterns as a potential contributor to metabolic health in CFRD.