TY - JOUR
T1 - Sleep and HbA1c in patients with type 2 diabetes
T2 - Which sleep characteristics matter most?
AU - Brouwer, Annelies
AU - Van Raalte, Daniel H.
AU - Rutters, Femke
AU - Elders, Petra J.M.
AU - Snoek, Frank J.
AU - Beekman, Aartjan T.F.
AU - Bremmer, Marijke A.
N1 - Funding Information: Funding. This study is supported by Fonds Psy-chische Gezondheid/MIND and Diabetes Fonds Nederland. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. A.B. conceived of the researchquestionaddressed,performedanalyses, and drafted the manuscript. D.H.v.R. and F.R. Publisher Copyright: © 2019 by the American Diabetes Association. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - OBJECTIVE Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. RESULTS Variability in sleep duration was individually most strongly associated with HbA1c (b 5 0.239; P 5 0.002; R2 5 4.9%), followed by total sleep duration (U-shaped: b 5 1.161/b2 5 1.044; P 5 0.017/0.032; R2 5 4.3%), subjective sleep quality (b 5 0.191; P 5 0.012; R2 5 3.6%), variability in midsleep time (b 5 0.184; P 5 0.016; R2 5 3.4%), and sleep efficiency (b 5 20.150; R2 5 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. CONCLUSIONS Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.
AB - OBJECTIVE Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. RESULTS Variability in sleep duration was individually most strongly associated with HbA1c (b 5 0.239; P 5 0.002; R2 5 4.9%), followed by total sleep duration (U-shaped: b 5 1.161/b2 5 1.044; P 5 0.017/0.032; R2 5 4.3%), subjective sleep quality (b 5 0.191; P 5 0.012; R2 5 3.6%), variability in midsleep time (b 5 0.184; P 5 0.016; R2 5 3.4%), and sleep efficiency (b 5 20.150; R2 5 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. CONCLUSIONS Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.
UR - http://www.scopus.com/inward/record.url?scp=85077016710&partnerID=8YFLogxK
U2 - https://doi.org/10.2337/dc19-0550
DO - https://doi.org/10.2337/dc19-0550
M3 - Article
C2 - 31719053
SN - 0149-5992
VL - 43
SP - 235
EP - 243
JO - Diabetes Care
JF - Diabetes Care
IS - 1
ER -