OBJECTIVE Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. RESULTS Variability in sleep duration was individually most strongly associated with HbA1c (β = 0.239; P = 0.002; R 2 = 4.9%), followed by total sleep duration (U-shaped: β = 1.161/β2 = 1.044; P = 0.017/0.032; R 2 = 4.3%), subjective sleep quality (β = 0.191; P = 0.012; R 2 = 3.6%), variability in midsleep time (β = 0.184; P = 0.016; R 2 = 3.4%), and sleep efficiency (β = -0.150; R 2 = 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. CONCLUSIONS Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.

中文翻译：

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2型糖尿病患者的睡眠和HbA1c：最重要的睡眠特征是什么？

目的睡眠不足已被确定为2型糖尿病（T2D）患者血糖控制不良的危险因素。由于可以通过多种方式来表征最佳睡眠，因此我们评估了哪些睡眠特征与糖化血红蛋白A1c（HbA1c）最相关。研究设计和方法总共172例T2D患者完成了为期7天的腕部书法和睡眠问卷。线性回归分别用于评估睡眠指标（总睡眠时间，睡眠时间，中度睡眠时间，中度睡眠时间变化，睡眠效率，主观睡眠质量和主观失眠症状）与HbA1c之间的关联。结果睡眠时间的变异性与HbA1c的相关性最强（β= 0.239； P = 0.002； R 2 = 4.9％），然后是总睡眠时间（U形：β= 1.161 /β2= 1.044; P = 0.017 / 0.032; R 2 = 4.3％），主观睡眠质量（β= 0.191; P = 0.012; R 2 = 3.6％），睡眠时间的差异（β= 0.184； P = 0.016； R 2 = 3.4％）和睡眠效率（β= -0.150； R 2 = 2.3％）。睡眠时间和主观失眠症状与HbA1c无关。总的来说，睡眠时间，总睡眠时间和主观睡眠质量的变异性与HbA1c显着相关，共同解释了HbA1c变异的10.3％。校正协变量的分析提供了相似的结果，尽管关联强度通常降低并且显示总睡眠时间和主观睡眠质量与HbA1c最为相关，共同解释了HbA1c差异的6.0％。结论总体而言，睡眠可能是T2D患者重要的可改变因素。防止减少睡眠可能是T2D以睡眠为中心的管理的主要重点。