Friday, 6 January 2012

Sleep Woes Tied to Blood Sugar Levels in Diabetic Kids

Sleep Woes Tied to Blood Sugar Levels in Diabetic Kids

Children with type 1 diabetes may be more likely to have sleep problems that worsen not only their blood sugar control, but also their quality of life, researchers found.

Diabetic children with more nightly apnea events had significantly higher glucose levels and spent more time in hyperglycemia than young type 1 diabetics without sleep disturbances, Michelle Perfect, PhD, of the University of Arizona in Tucson, and colleagues reported online in Sleep.

And those who reported being sleepier during the day had more trouble in school and worse quality of life, they found.

"Despite adhering to recommendations for good diabetic health, many youth with type 1 diabetes have difficulty maintaining control of their blood sugars," Perfect said in a statement. "We found that it could be due to abnormalities in sleep, such as daytime sleepiness, lighter sleep, and sleep apnea. All of these make it more difficult to have good blood sugar control."

Some work has shown that sleep can impact glucose regulation. In particular, slow-wave, or deep sleep, may be important in glucose maintenance and insulin sensitivity, the researchers said. In fact, some studies have shown that sleep architecture may be altered in diabetes patients, and they may spend more time in lighter stages of sleep and in the REM stage, and less time in deeper sleep.

Yet most research in this area has focused on adults with type 2 diabetes, not young people with type 1 disease, they noted.

So Perfect and colleagues assessed 50 type 1 diabetes patients ages 10 to 16 -- 40 of whom had polysomnography data -- and in part of the study, compared them with 40 matched controls.

They found that kids with an apnea-hypopnea index score of 1.5 events per hour or greater had higher blood glucose levels on continuous glucose monitoring (CGM) and a spent greater percentage of time at night in hyperglycemia (P=0.021 for both).

With regard to sleep architecture, when compared with healthy controls, youth with type 1 diabetes spent more time in N2 sleep, or lighter sleep (P=0.003), and less time in N3 sleep, or deeper sleep (P=0.011), particularly during the first half of the night, Perfect and colleagues wrote.

Those with diabetes also experienced more central apnea events per hour (P=0.029), although there were no significant differences in total apnea events, the researchers said.

Perfect and colleagues found that spending less time in N3 sleep, or deep sleep, was associated with higher HbA1c levels (P=0.003), and that more time spent in N2 sleep, or a lighter sleep, was associated with higher HbA1c levels (P<0.001), higher glucose levels (P=0.014), and more time in hyperglycemia (P=0.03).

The researchers also found that self-reported daytime sleepiness was linked with compromised psychosocial functioning.

For instance, greater daytime sleepiness was significantly associated with worse grades in school (P<0.001), reduced disease-related quality of life (P=0.004), more diabetes-related worry (P=0.005), and greater depressive symptoms (P=0.027).

Self-reported sleep problems also were related to lower scores on state standardized tests of reading, the researchers found, and spending more time in N2 sleep, or lighter sleep, was associated with worse scores on state math tests.

The findings regarding school performance "should serve as an impetus for future research to better understand the role of sleep in altering school functioning in youth with diabetes," the researchers wrote.

The researchers concluded that the study "adds to the burgeoning evidence that sleep-disordered breathing may result in higher glucose levels," but that further study is needed -- particularly a longitudinal trial to discern whether sleep problems affect glucose control, or if dysregulated glucose contributes to sleep problems in young type 1 diabetics.

They added that clinicians should routinely ask about sleep habits in this population as part of routine care.

The study was limited by its small population, and because it didn't control for insulin dosage. Also, it precluded analysis of the effects of severe sleep-disordered breathing on this population.

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