Increased Risk of Obstructive Sleep Apnea and Poor Sleep Quality Among Older Adults With Type 1 Diabetes: The DCCT/EDIC Study

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.