Sleep Quality and Its Association with Glycemic Control Indices in Children with Type 1 Diabetes: A Cross-sectional Study

Abstract

Background: The relationship between sleep and diabetes is bidirectional. Sleep disturbances can be triggered by clinical and psychosocial factors, including glycemic fluctuations, nightmares, parental nocturnal monitoring, and comorbid mood disorders. Conversely, disrupted sleep architecture affects metabolic homeostasis by modulating insulin sensitivity and cortisol secretion, thereby influencing blood glucose levels and glycemic indices in patients with diabetes. Objectives: Given the increasing prevalence of diabetes in children, the importance of sleep management in diabetes control, and the limited research in pediatric populations, this study aimed to investigate the association between glycemic control parameters and sleep quality in children with type 1 diabetes receiving care. Methods: This cross-sectional analytical study included 195 children and adolescents aged 12 - 18 years who had had type 1 diabetes for more than 1 year. After written informed consent was obtained from the parents of eligible participants, 60 children with good sleep scores and 135 with poor sleep scores were assessed as two groups based on Pittsburgh Sleep Quality Index (PSQI) scores (validity, 86.5%; reliability, 89.5%). Patients with chronic diseases, mental disorders, sedative or anticonvulsant use, confirmed psychiatric disorders, or treatment nonadherence were excluded. Age, sex, Body Mass Index (BMI), age at diabetes onset, diabetes duration, frequency of nocturnal blood glucose monitoring by parents, fasting blood sugar (FBS), HbA1c, recent diabetic ketoacidosis (DKA) episodes, daily insulin dosage (IU/kg), and PSQI score were recorded. Data were entered into SPSS version 19. Results: Subjective sleep quality, sleep latency, male sex, and higher BMI were independently associated with higher FBS levels. Similarly, subjective sleep quality, sleep efficiency, daytime dysfunction, male sex, and higher BMI were independently associated with higher HbA1c levels in the multivariate logistic regression analysis. Mean HbA1c and FBS levels, as well as the frequency of recent DKA episodes, were significantly higher in children with poor sleep than in those with good sleep (P < 0.001, P < 0.001, and P = 0.003, respectively). The proportion of children with abnormal HbA1c levels in the poor sleep group was approximately twice that in the good sleep group (P < 0.001). The poor sleep group had a higher proportion of children with a BMI below the 5th percentile (P = 0.006). Diabetes duration was also significantly longer in the poor sleep group (P = 0.021). Conclusions: This study demonstrates a significant association between sleep quality and glycemic control parameters. The results suggest that patients with suboptimal glycemic control are more likely to experience poor sleep quality.