0818 Comorbid obstructive sleep apnea and insomnia in type 2 diabetes: Association with diabetes-related distress and glycemic control

Abstract

Abstract Introduction It is unclear how comorbid insomnia and sleep duration may influence diabetes-related distress and glycemic control in adults with obstructive sleep apnea (OSA) and type 2 diabetes (T2D). This analysis examined whether diabetes-related distress mediates the associations of OSA and insomnia severity with glycemic control in adults with T2D and OSA based on sleep duration. Methods This study was a secondary analysis of merged baseline assessment data from two clinical trials of adults (N=240) with self-reported T2D and OSA. OSA (apnea-hypopnea index ≥ 5) was determined by a home sleep study. Participants completed questionnaires to elicit insomnia severity, diabetes-related distress, sleep duration, daytime sleepiness, and global sleep quality. Sleep duration was classified as normal (>6 h) or short (≤ 6h). Glycemic control was measured by HbA1c (%). Mediation analyses with bootstrapped samples were employed after controlling for sociodemographic covariates in participants with normal and short sleep durations. Results More participants (mean age 57.8 years; 49.6% female; 65% White; 56.3% post high school education, mean HbA1c 7.93%) had short sleep duration (n=128; 53.5%) than normal sleep duration (n=111, 46.5%). Participants with short sleep duration had significantly worse sleep quality, daytime sleepiness, insomnia, and HbA1c levels compared to those with normal sleep duration (all p<.05). In participants with normal sleep duration, insomnia severity was associated with diabetes-related distress (b=0.942, p=0.008); diabetes-related distress did not mediate the association between insomnia severity and HbA1c (indirect effect [IE]=0.013, 95% CI: -0.003, 0.036). In participants with short sleep duration, insomnia severity was significantly associated with diabetes-related distress (b=1.470, p< 0.001), and diabetes-related distress mediated the association between insomnia severity and HbA1c (IE=0.023, 95% CI: 0.001, 0.053). Regardless of sleep duration, OSA severity was not associated with diabetes-related distress or HbA1c. Conclusion Only among participants with short sleep duration, comorbid insomnia significantly contributes to greater diabetes-related distress, which leads to higher HbA1c levels. Short sleep duration in persons with insomnia could be a potential mechanism involved in the association between diabetes-related distress and glycemic control in adults with T2D and OSA. Support (if any) The NIH (R01- DK0960281; K24-NR016685) and the CTSI grants (UL1-RR024153; UL1-TR000005) funded the parent studies