Sleep, Coping, and Executive Functioning in Youth With Type 1 Diabetes

A mixed methods approach will be used to characterize sleep and explore the associations between sleep disturbances and executive function, coping, glycemic control, adherence, and adjustment in adolescents with type 1 diabetes. To understand these relationships, the investigators will collect quantitative data, including self-report and parent-report questionnaires and a test of cognitive functioning after consent and screening. Clinical data related to diabetes will be collected from the medical chart and CGM, and overnight sleep data will be collected during the subsequent week. The investigators will also collect qualitative data, using semi-structured interviews.

Aim 1. Describe the objective and subjective characteristics of sleep (duration, continuity, bed time/rise times); sleep quality and sleep habits among adolescents with type 1 diabetes.

After completing the initial recruitment procedures and questionnaires, adolescents will wear the Respironics Minimitter Actiwatch AW64, a wrist-worn accelerometer, continuously for 1 week, removing them only for bathing, and depress the event marker at "lights out" and "lights on" times to demarcate time in bed. Sleep diaries will be completed daily in the mornings and evenings to track daytime sleep-related behaviors (e.g., caffeine use, exercise) and nocturnal sleep characteristics (e.g., bedtime, wakings). The research assistants will call adolescents the day after enrollment to address any problems and elicit understanding. At the end of the week, they will call adolescents as a reminder to complete the data collection and return the watch and diary in a prepaid mailer.

Data Analysis. Actigraph data will be scored with Actiware v. 5 software. Diary forms have been prepared in scannable format to reduce the need for research staff entering data manually. Forms will be examined for improperly filled items and missing data, scanned and committed to an MS Access database. Descriptive statistics will be used to summarize each of the primary sleep variables (diary and actigraph) (% wake after sleep onset, time in bed, sleep efficiency, sleep latency, duration) over the 1-week interval. Descriptive statistics will also be used to characterize the total and component scores of the Children's Sleep Questionnaire.

The expected outcome of this aim is a more detailed characterization of sleep patterns in adolescents with T1D to identify the key variables to be measured in a large scale study.