Research Article|Articles in Press

Sleep health dimensions are associated with next-day symptoms in young adults with type 1 diabetes

Published:December 23, 2022DOI:



      We investigated intra-individual reciprocal associations between sleep health dimensions (individual and composite) and symptoms among young adults with type 1 diabetes (T1D).

      Design and measurements

      Cross-lagged multilevel models were used to analyze electronic diary-reported sleep and symptom patterns over 7 days at waketime in 42 young adults with T1D. Sleep health dimensions included regularity, satisfaction, alertness, timing, efficiency (percentage of time spent asleep), and duration (total sleep time) and symptoms included mood, fatigue, and pain. Covariates included biological sex and age.

      Setting and participants

      We recruited young adults (mean age 21.5 ± 2.1 years, HbA1c 6.8%, 85% female, 10% gender minority) with T1D for at least 6 months and no other major medical or psychiatric comorbidity from social media platforms, the College Diabetes Network, and ResearchMatch.


      On days with a better sleep health composite, participants reported lower next-day symptoms (higher mood, lower fatigue, and lower pain) and on days when participants reported lower symptoms, participants reported better sleep health (as a composite). Several individual sleep health dimensions led to lower next-day symptoms (eg, higher satisfaction, alertness, and efficiency and higher mood); however, symptoms were no longer predictive of next-day sleep when controlling for prior day sleep.


      Optimal sleep health is an antecedent of fewer next day symptoms. Sleep health dimensions likely have positive additive effects on lower symptoms as some of the individual sleep health dimensions were not significantly associated with some symptoms among young adults with T1D.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Sleep Health: Journal of the National Sleep Foundation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Moderie C
        • Van der Maren S
        • Dumont M.
        Circadian phase, dynamics of subjective sleepiness and sensitivity to blue light in young adults complaining of a delayed sleep schedule.
        Sleep Med. 2017; 34: 148-155
        • Lenz ER
        • Pugh LC
        • Milligan RA
        • Gift A
        • Suppe F.
        The middle-range theory of unpleasant symptoms: an update.
        Adv Nurs Sci. 1997; 19: 14-27
        • Griggs S
        • Conley S
        • Batten J
        • Grey M.
        A systematic review and meta-analysis of behavioral sleep interventions for adolescents and emerging adults.
        Sleep Med Rev. 2020; 54: 1-9
        • Amaral FG
        • Turati AO
        • Barone M
        • et al.
        Melatonin synthesis impairment as a new deleterious outcome of diabetes-derived hyperglycemia.
        J Pineal Res. 2014; 57: 67-79
        • Buysse DJ.
        Sleep health: can we define it? Does it matter?.
        Sleep. 2014; 37: 9-17
        • Arbuckle RA
        • Humphrey L
        • Vardeva K
        • et al.
        Psychometric evaluation of the Diabetes Symptom Checklist-Revised (DSC-R)—a measure of symptom distress.
        Value Health. 2009; 12: 1168-1175
        • Bryden KS
        • Dunger DB
        • Mayou RA
        • Peveler RC
        • Neil HA.
        Poor prognosis of young adults with type 1 diabetes: a longitudinal study.
        Diabetes Care. 2003; 26: 1052-1057
        • Baglioni C
        • Spiegelhalder K
        • Feige B
        • Nissen C
        • Berger M
        • Riemann D.
        Sleep, depression and insomnia—a vicious circle?.
        Curr Psychiatry Rev. 2014; 10: 202-213
        • Monk TH
        • Reynolds CF
        • Kupfer DJ
        • et al.
        The Pittsburgh sleep diary.
        J Sleep Res. 1994; 3: 111-120
        • General Assembly of the World Medical Association
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        J Am Coll Dent. 2014; 81: 14-18
        • Fucito LM
        • Bold KW
        • Van Reen E
        • et al.
        Reciprocal variations in sleep and drinking over time among heavy-drinking young adults.
        J Abnorm Psychol. 2018; 127: 92-103
        • Geoghegan P
        • O'Donovan MT
        • Lawlor BA.
        Investigation of the effects of alcohol on sleep using actigraphy.
        Alcohol Alcohol. 2013; 48: 126-127
        • Farabi SS
        • Carley DW
        • Quinn L.
        Glucose variations and activity are strongly coupled in sleep and wake in young adults with type 1 diabetes.
        Biol Res Nurs. 2017; 19: 249-257
        • Griggs S
        • Redeker NS
        • Jeon S
        • Grey M
        Daily variations in sleep and glucose in adolescents with type 1 diabetes.
        Pediatr Diabetes. 2020; 21: 1493-1501
        • Wagner J
        • Tennen H
        • Wolpert H.
        Continuous glucose monitoring: a review for behavioral researchers.
        Psychosomat Med. 2012; 74: 356-365
        • Rusu A
        • Bala C
        • Ciobanu D
        • Cerghizan A
        • Roman G.
        Sleep quality and sleep duration, but not circadian parameters are associated with decreased insulin sensitivity in Type 1 diabetes.
        Chronobiol Int. 2019; 36: 1148-1155
        • Dong L
        • Martinez AJ
        • Buysse DJ
        • Harvey AG.
        A composite measure of sleep health predicts concurrent mental and physical health outcomes in adolescents prone to eveningness.
        Sleep Health. 2019; 5: 166-174
        • Watson NF
        • Badr MS
        • Belenky G
        • et al.
        Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion.
        J Clin Sleep Med. 2015; 11: 931-952
        • Buysse DJ
        • Reynolds 3rd, CF
        • Monk TH
        • Berman SR
        • Kupfer DJ.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28 (doi:0165-1781(89)90047-4): 193-213
        • Fitzmaurice GM
        • Laird NM
        • Ware JH.
        Applied Longitudinal Analysis. 998. John Wiley & Sons, 2012
        • Little RJ
        • Rubin DB.
        Statistical Analysis With Missing Data. 793. John Wiley & Sons, 2019
        • Engle-Friedman M
        • Mathew GM
        • Martinova A
        • Armstrong F
        • Konstantinov V.
        The role of sleep deprivation and fatigue in the perception of task difficulty and use of heuristics.
        Sleep Sci. 2018; 11: 74-84
        • Oris L
        • Luyckx K
        • Rassart J
        • et al.
        Change and stability in depressive symptoms in young adults with type 1 diabetes.
        Diabetes Res Clin Pract. 2016; 111: 93-96
        • Bowen AE
        • Staggs S
        • Kaar J
        • Nokoff N
        • Simon SL.
        Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males.
        Sleep Health. 2021; 7: 445-450
        • Huang YL
        • Liu RY
        • Wang QS
        • Van Someren EJ
        • Xu H
        • Zhou JN.
        Age-associated difference in circadian sleep-wake and rest-activity rhythms.
        Physiol Behav. 2002; 76: 597-603
        • Wittmann M
        • Dinich J
        • Merrow M
        • Roenneberg T.
        Social jetlag: misalignment of biological and social time.
        Chronobiol Int. 2006; 23: 497-509
        • Larcher S
        • Gauchez AS
        • Lablanche S
        • Pepin JL
        • Benhamou PY
        • Borel AL.
        Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag.
        Eur J Endocrinol. 2016; 175: 411-419
        • Kyle SD
        • Aquino MR
        • Miller CB
        • et al.
        Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: a systematic examination of CBT-I trial content.
        Sleep Med Rev. 2015; 23: 83-88
        • Chiang JJ
        • Kim JJ
        • Almeida DM
        • et al.
        Sleep efficiency modulates associations between family stress and adolescent depressive symptoms and negative affect.
        J Adolesc Health. 2017; 61: 501-507
      1. Baum KT, Desai A, Field J, Miller LE, Rausch J, Beebe DW. Sleep restriction worsens mood and emotion regulation in adolescents. J Child Psychol Psychiatry. 2014;55(2):180–190. doi:

        • Cote KA
        • Milner CE
        • Smith BA
        • et al.
        CNS arousal and neurobehavioral performance in a short-term sleep restriction paradigm.
        J Sleep Res. 2009; 18: 291-303
        • Glozier N
        • Martiniuk A
        • Patton G
        • et al.
        Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study.
        Sleep. 2010; 33: 1139-1145
        • Lauderdale DS
        • Knutson KL
        • Yan LL
        • Liu K
        • Rathouz PJ.
        Sleep duration: how well do self-reports reflect objective measures? The CARDIA Sleep Study.
        Epidemiology. 2008; 19: 838
        • Johnson DA
        • Jackson CL
        • Williams NJ
        • Alcántara C.
        Are sleep patterns influenced by race/ethnicity—a marker of relative advantage or disadvantage? Evidence to date.
        Nat Sci Sleep. 2019; 11: 79
        • Quiñones AR
        • Newsom JT
        • Elman MR
        • et al.
        Racial and ethnic differences in multimorbidity changes over time.
        Med Care. 2021; 59: 402-409
        • Volkow ND
        • Tomasi D
        • Wang GJ
        • et al.
        Evidence that sleep deprivation downregulates dopamine D2R in ventral striatum in the human brain.
        J Neurosci. 2012; 32: 6711-6717