Sleep apnoea risk in nearly two-thirds of older adults with long-standing type 1 diabetes

Design

Cross-sectional analysis within a prospective cohort (DCCT/EDIC)

Population

963 adults with type 1 diabetes, mean age 64, mean duration 43 years

Primary outcome

Prevalence of sleep apnoea risk, poor sleep quality and daytime sleepiness

Effect

64% intermediate/high OSA risk; 43% poor sleep; 15–20% higher odds per 1% HbA1c

Diabetes Care reported a cross-sectional questionnaire study in 963 DCCT/EDIC participants, mean age 64 and mean diabetes duration 43 years. Validated instruments measured sleep apnoea risk (STOP-Bang), sleep quality (Pittsburgh Sleep Quality Index) and daytime sleepiness (Epworth).

29% already had diagnosed sleep apnoea and 19% used positive airway pressure. 64% screened at intermediate or high risk, 43% had poor sleep quality and 10% daytime sleepiness. Each 1% higher HbA1c was associated with 15–20% higher odds of any sleep problem. Cardiovascular autonomic neuropathy was linked to apnoea risk, and albuminuria and severe hypoglycaemia to poor sleep quality.

Sleep apnoea is usually framed as a type 2 diabetes and obesity problem. These data suggest older people with type 1 diabetes carry a high burden too, and much of it may be unrecognised. The design cannot say whether poor glycaemia disturbs sleep or the reverse.

Ask about snoring, witnessed apnoeas and sleep quality in older type 1 patients, particularly those with autonomic neuropathy or recurrent severe hypoglycaemia.

• Ask older type 1 patients about snoring, witnessed apnoeas and unrefreshing sleep
• Use STOP-Bang as a quick screen; a score of 3 or more warrants a sleep study referral
• Consider sleep apnoea when a patient has cardiovascular autonomic neuropathy
• Ask about sleep quality in patients with recurrent severe hypoglycaemia or albuminuria

Why it matters

Sleep apnoea is not only a type 2 diabetes and obesity problem.

Don't overread it

This was cross-sectional — it cannot show that poor glycaemia causes sleep problems or that treating sleep improves HbA1c.

The statistics, in plain English

"Intermediate or high risk" on STOP-Bang is a screening result, not a diagnosis; the tool is sensitive but over-calls, so the true prevalence is lower than 64%. The HbA1c link is an adjusted association from one time point.

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