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Introduction
Diabetes Mellitus type 1 (DM1) is one of the most common chronic health conditions in youth, with over 18,000 new cases diagnosed each year, and the prevalence is increasing. (Hamman et al, 2014) The recommended treatment regimen is complex and demanding, including frequent blood glucose monitoring, insulin administration (via injections or pump), careful tracking of diet and activity levels, and frequent insulin adjustments. (American Diabetes Association, 2015)
Adherence to this regimen is linked with better glycemic control and reduces the risk for acute and long-term medical complications. (Hood et al, 2010) However, adolescents and young adults with DM1 are at increased risk for deteriorating glycemic control, with only 16% of adolescents (age 1317) and 25% of young adults (age 1825) meeting targets for glycemic control. (Miller et al, 2015)
Sleep is a crucial determinant of psychological, emotional, and physical health, and evidence suggests that reduced sleep efficiency may be associated with poorer diet quality, obesity, hypertension, diabetes and cardiovascular disease (Grander et al, 2014).
Sleep has also been associated with non-medical outcomes such as poor judgment, lack of motivation, inattention (Harrison et al, 2000), motor vehicle crashes (Pizza et al, 2010), and lower academic achievement (Curcio et al, 2006).
Inadequate sleep in adolescence is due to a combination of biological processes, modern lifestyles, and obligations (Owens et al, 2014). Some studies have found that socioeconomic status and schooling positively affect with sleep efficiency (Marco et al, 2011). Furthermore, social pressures and poor environmental conditions may negatively affect sleep efficiency in lower socioeconomic groups (Knutson et al, 2013).
Body mass index (BMI) has also been associated with sleep problems, with over weight and obese individuals sleeping less than their counter parts (Al Hazzaa et al, 2014). Obesity leads to increased intra-abdominal pressure, and this mechanism has been implicated in sleep disorders (Rodrigues et al, 2014).
Sleep Disordered Breathing (SDB) has primarily been examined in adults with DM2. (Aronsohn et al, 2010) As the severity of SDB increases, there is an association with poor glucose control (Punjabi et al, 2004) and complications of diabetes, such as neuropathy. (Bottini et al, 2003).increased frequency and longer apneas, in particular central apneas, in young children (ages 5 to 11 years) with DM1 compared to healthy children, also, participants with poorly controlled diabetes (hemoglobin A1c e 8.0%) had more frequent and longer apneas compared with patients with better controlled diabetes and controls.(Villa et al, 2000)
Inadequate amounts of sleep and SDB may be particularly problematic for individuals with DM1 (Perfect et al, 2010). However, the relationship between sleep quantity and quality with children with DM1 is largely unstudied.
Sleep architecture may be altered in adults with DM1. In some studies, diabetic patients spent more time in lighter stages of sleep (N1 and N2) (Jauch-Chara et al, 2008), Rapid Eye Movement (REM) and less time in Slow Wave Sleep (SWS). (Pallayova et al, 2010), in contrast, other studies with children with DM1 did not show a difference in sleep architecture compared to healthy participants. However, these studies demonstrated that patients with DM1 had more frequent and longer awakenings. (Matyka et al, 2000)
In this study, we hypothesize that DM1 can affect sleep architecture in the children.
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