Sleep in adolescents with or at risk for type 2 diabetes: perspectives from adolescents and parents

OBJECTIVE: Insufficient sleep duration and poor sleep quality are common in adolescence. Poor sleep health can negatively impact cardiometabolic outcomes (e.g., obesity, insulin resistance), but specific psychosocial factors shaping sleep in adolescents with or at risk for type 2 diabetes (T2D) are unknown. METHODS: Twenty-one adolescents with T2D and/or obesity were recruited from a weight management clinic and completed 1 week of at-home actigraph sleep monitoring. Semi-structured qualitative interviews were conducted with adolescents and their parents separately to generate information about adolescents' sleep characteristics, perceived barriers and facilitators of sleep, and parents' roles in sleep health. The data were coded by two coders and analyzed thematically. RESULTS: Actigraphy results revealed an average low sleep duration (6.6 hr/night). Nearly all participants endorsed a preference for late bed and wake times, yet actigraphy showed low social jetlag (average 0.6 hr). Participants acknowledged the connection between sleep and mental health but rarely discussed the relationship between sleep and cardiometabolic health. Technology use and anxiety were commonly reported barriers to sleep health, whereas facilitators included calming behaviors and an established sleep/wake schedule. Parents expressed ambivalence about their involvement in teens' sleep health. They shared desire to instill healthy sleep habits without creating household conflict. CONCLUSIONS: Findings revealed barriers and facilitators to healthy sleep that represent opportunities for intervention, such as educating adolescents on the connection between sleep and cardiometabolic health and supporting parents to establish and enforce sleep rules. Future research should develop and test adolescent-informed interventions for healthy sleep and evaluate related cardiometabolic health outcomes.