Increased Risk of Obstructive Sleep Apnea and Poor Sleep Quality Among Older Adults With Type 1 Diabetes: The DCCT/EDIC Study
Catherine L. Martin, Matthew Bott, William H. Herman, Barbara H. Braffett, Victoria R. Trapani, Ionut Bebu, Harsha Karanchi, Jean M. Lawrence, Jennifer Sherr, Gayle M. Lorenzi, Pearl G. Lee, David M. Nathan, Ronald D. Chervin, Rose A. Gubitosi-Klug,OBJECTIVE
To investigate the prevalence of sleep problems and their risk factors among older adults with type 1 diabetes.
RESEARCH DESIGN AND METHODS
Participants with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study completed validated questionnaires to assess sleep-related problems, including risk of obstructive sleep apnea (OSA) (intermediate/high risk: STOP-Bang ≥3), poor sleep quality (Pittsburgh Sleep Quality Index >5), and mild or greater levels of excessive daytime sleepiness (Epworth Sleepiness Scale >10). Logistic regression models assessed the odds of each sleep problem by demographic and clinical variables, glycemia, and diabetes complications.
RESULTS
In 963 participants (52% male, mean [SD] age 64 [7] years) with type 1 diabetes (mean [SD] duration 43 [5] years), diagnosed OSA and current positive airway pressure device use were reported by 29% and 19% of participants, respectively. Increased OSA risk was present in 64%, poor sleep quality in 43%, and daytime sleepiness in 10% of participants. Each 1% absolute increase (11 mmol/mol) in current or mean HbA1c was associated with 15% to 20% higher odds of any sleep problem. In models adjusted for age, sex, BMI, and mean HbA1c, cardiovascular autonomic neuropathy was associated with higher odds of intermediate/high OSA risk, and albuminuria and severe hypoglycemia were associated with higher odds of poor sleep quality.
CONCLUSIONS
OSA risk and poor sleep quality were common among DCCT/EDIC participants. Sleep assessments for older individuals with long-standing type 1 diabetes and research to identify mechanisms to explain the observed associations are warranted.