The impact of fear of hypoglycaemia on sleep in adolescents with type 1 diabetes

Abstract

Aims: Fear of hypoglycaemia (FOH) can contribute to impaired sleep for adults with type 1 diabetes (T1D) and parents of children with T1D, although it is unknown how FOH may affect sleep for adolescents with T1D. This study examines the relationship between adolescent FOH and sleep and assessed the influences of continuous glucose monitor (CGM) and insulin pump use. Methods: Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep (Pittsburgh Sleep Quality Index, PSQI). Analyses included linear and logistic regression, t-tests and Fisher's exact tests. Results: Participants included 95 adolescents (52 female) with a median (IQR) age of 16.5 (15.3-17.7) years and a T1D duration of 5.7 (2.5-9.6) years. Analyses showed increased FOH-Worry subscale scores were associated with reduced sleep duration (β = −0.03, p = 0.042, adjusting for BMI z-score, race and ethnicity) and increased sleep disturbances (OR = 1.1, p = 0.038, adjusting for race and ethnicity). Frequent CGM users had longer sleep duration (average 7.5 h) compared with infrequent or non-CGM users (average = 6.8 h; p = 0.029), and pump users had overall improved sleep health as determined by PSQI score (p = 0.019). Technology use did not have significant interactions in the relationships between FOH and sleep duration or sleep disturbances. Conclusions: Worrying about hypoglycaemia was associated with impaired sleep for adolescents with T1D. Diabetes technology users have some sleep improvements, but CGM and pump use do little to alter the relationship between FOH and sleep outcomes.

Effect of fear of hypoglycaemia on sleep quality of patients with type 2 mellitus diabetes: The mediating role of alexithymia

“…The results revealed a strong negative correlation between FoH and sleep quality after adjustments for numerous confounders. The findings of our study were consistent with those of the research conducted on an American adolescent population [ 39 ]. FoH places a major psychological burden on individuals with DM and can affect sleep quality [ 40 ].…”

Being fearless

“…The authors found that, in 95 adolescents, the worry subscale of fear of hypoglycaemia was associated with sleep duration and that users of continuous glucose monitoring slept for longer. 4 Importantly, the use of continuous glucose monitoring and pumps, while improving some metrics of sleep, did not interact with the relationship between fear of hypoglycaemia and sleep. This underlines the message that technologies are an adjunct to support and education for fear of hypoglycaemia and, while they can reduce worry and help people to have better sleep, they do not fundamentally change the underlying fear.…”

“…In this issue, the impact of fear of hypoglycaemia on sleep for adolescents with type 1 diabetes is described. The authors found that, in 95 adolescents, the worry subscale of fear of hypoglycaemia was associated with sleep duration and that users of continuous glucose monitoring slept for longer 4 . Importantly, the use of continuous glucose monitoring and pumps, while improving some metrics of sleep, did not interact with the relationship between fear of hypoglycaemia and sleep.…”