The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

Abstract

Objective Sleep is important for diabetes-related health outcomes. Using a multidimensional sleep health framework, we examined the association of individual sleep health dimensions and a composite sleep health score with hemoglobin A1c (HbA1c) and depressive symptoms among African American adults with type 2 diabetes. Methods Participants (N = 257; mean age = 62.5 years) were recruited through local churches. Wrist-worn actigraphy and sleep questionnaire data assessed multidimensional sleep health using the RuSATED framework (regularity, satisfaction, alertness, timing, efficiency, duration). Individual sleep dimensions were dichotomized into poor or good sleep health and summed into a composite score. HbA1c was assessed using the DCA Vantage™ Analyzer or A1CNow® Self Check. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression models examined the association of individual sleep dimensions and composite sleep health with HbA1c and depressive symptoms. Results Higher composite sleep health scores were associated with a lower likelihood of having greater than minimal depressive symptoms (PHQ-9 ≥ 5) (odds ratio [OR] = 0.578, 95% confidence interval [CI] = 0.461–0.725). Several individual sleep dimensions, including irregularity (OR = 1.013, CI = 1.005–1.021), poor satisfaction (OR = 3.130, CI = 2.095–4.678), and lower alertness (OR = 1.866, CI = 1.230–2.833) were associated with a greater likelihood of having depressive symptoms. Neither composite sleep health scores nor individual sleep dimensions were associated with HbA1c. Conclusions Better multidimensional sleep health is associated with lower depressive symptoms among African American adults with type 2 diabetes. Longitudinal research is needed to determine the causal association between multidimensional sleep health and depressive symptoms in this population. Trial Registry ClinicalTrials.gov identifier NCT04282395.

Exploring the Interplay Between Stress, Sleep, and Health: A Special Issue Commemorating the Contributions of Dr. Martica Hall

“…Several articles also highlight the dynamic nature of sleep during critical periods across the life span (9) and multidimensional conceptualizations of sleep health (10), ideas and methodologies championed by Tica. We are also quite certain that Tica would have applauded the focus on social determinants of sleep and sleep health disparities (11–14) and the links between sleep and heart rate variability (15,16). Collectively, these articles fill in critical pieces of the theoretical framework pioneered by Tica, beginning with her dissertation work and developed throughout her illustrious career.…”