Sleep on It: Sleep and Executive Function in Pediatric Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) is an increasingly prevalent pediatric chronic illness characterized by devastating metabolic dysfunction for which there is no cure. Attaining independent mastery in disease management is critical for developing youth with increasing social independence. Previous research has linked sleep to glycemic regulation and T1DM management behaviors. The purpose of this study was to examine the impact of fragmented sleep (actigraphy fragmentation index [Acti SFI] and polysomnography N1%) on visual, verbal, and behavior measures of executive function that may have implications for disease management in a sample of youth with T1DM. Multiple regression analysis found that Acti SFI and N1% significantly predicted visual and behavioral executive functioning; though, there was an unexpected differential effect of N1% compared to Acti SFI. Examining glycemic regulation as a moderator, via continuous glucose monitoring (CGM), revealed that glycemic control (CGM %Target) significantly moderated the effect of N1% on visual executive functioning, indicating that poor glycemic control may create relative cognitive vulnerability to sleep fragmentation. There was an unexpected finding that in youth with the best glycemic control, increased Acti SFI was associated with higher scores on a measure of verbal fluency. This study is the first to examine differential utility in measures of sleep fragmentation associated with executive functioning in youth with T1DM. Given notable glycemic dysregulation in the present study sample, results highlight a need to better understand how sleep impacts developing executive functioning skills in this population, with a focus on supporting executive functioning skills related to diabetes management behaviors. Continued future research exploring an actigraphy sleep fragmentation index, physically restless sleep, and their relationship to diabetes management behaviors is also recommended