Abstract
Background: Glycemic derangement has been linked to sleep disruption. However, the impact of glycemic derangement on sleep pattern among children with type 1 diabetes (C-T1D) remains unraveled. Aim: To assess the effect of nocturnal hyperglycemia and clinically significant-hypoglycemia on sleep pattern among C-T1D. Methodology: Thirty C-T1D were compared to 30 age and sex matched healthy siblings. Patients having other organ disease that might cause sleep disorders or on medications causing sleep disturbance were excluded. History included diabetes-duration, type and dose of insulin therapy, chronic diabetic- complications, and manifestations of sleep disorders. Epworth Sleepiness Scale -Child Adolescent(ESS-CHAD) was used. Continuous-glucose monitoring system(CGMS) and overnight polysomnography(PSG) were done and analyzed. Results:C-T1D had significantly lower sleep efficiency and significantly higher arousal-index(AI), periodic-limb movement- index(PLMI) and apnea-hypopnea index(AHI) compared to controls. Moreover, they had significantly longer sleep-onset latency, light sleep percentage and shorter rapid eye- movement(REM) percentage than controls. According to nocturnal CGMS readings, 15 C-T1D had nocturnal hyperglycemia(50%), 6 experienced clinically significant(CS) hypoglycemia(20%), 2 had level-1 hypoglycemia(6.7%) and 7 were within the normoglycemic range(23.3%). C-T1D experiencing nocturnal CS hypoglycemia had significantly higher stage 3 sleep(P=0.004) than controls. On the other hand, C- T1D experiencing nocturnal hyperglycemia had significantly higher sleep onset latency(P=0.013), light sleep %(P<0.001) and AI(P<0.001) than controls. Nocturnal CS hypoglycemia was positively correlated to deep sleep duration, while hyperglycemia was correlated to number of awakenings, sleep-onset latency, and light sleep duration. Conclusion: CS hypoglycemia is associated with sleep deepening, while hyperglycemia is associated with increased light sleep, sleep onset latency, AI among C-T1D.
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