Diabetic carotid atherosclerosis is a prevalent vascular disease in individuals with diabetes mellitus, imposing a significant global burden. A lesser-known risk factor for the development of diabetes and its associated atherosclerosis is sleep disturbance. Obstructive Sleep Apnea Syndrome has been confirmed by many studies to affect atherosclerosis, but the mechanism of other nonobstructive sleep disorders such as the number of awakenings on atherosclerosis is still unclear. This study aims to investigate the relationship between sleep patterns and carotid atherosclerosis in diabetic patients.Experiments were designed, and Huawei Band 9 bracelets were utilized to monitor the sleep patterns of patients. Specific sleep indicators such as number of nighttime awakenings, time taken to fall asleep, waking time, duration of deep sleep, duration of shallow sleep, rapid eye movement (REM) duration, and sleep breathing quality were recorded. Carotid artery ultrasound was performed to assess the severity of carotid atherosclerosis in all patients, followed by statistical analysis to examine the correlation between sleep parameters and carotid atherosclerosis grades in diabetic individuals.Spearman correlation analysis revealed that age, duration of hypertension, number of nighttime awakenings, proportion of shallow sleep, average duration of shallow sleep per night, hypertension severity, years of smoking, and duration of diabetes were identified as risk factors for diabetic carotid atherosclerosis. Ordinal logistic regression analysis showed that diabetic carotid atherosclerosis was more severe in patients with a sleep score of less than 76 compared to those with a score greater than or equal to 76 (OR = 2.497, 95%CI 1.034-6.032). Patients with a shallow sleep duration of greater than or equal to 5.4 h had a higher grade of diabetic carotid atherosclerosis than those with a duration of less than 5.4 h (OR = 6.475, 95%CI 1.573-26.656), and patients with more than 4 awakenings had more severe diabetic carotid atherosclerosis than those with less than 4 awakenings at night (OR = 2.933, 95%CI 1.035-8.314). The degree of carotid atherosclerosis in diabetic patients over 60 years old is higher than that in diabetic patients under or equal to 60 years old (odds ratio = 4.019, 95% confidence interval: 0.496-2.285). (P < 0.05, Table 3, Fig. 4). The results of the multivariate ordinal logistic model showed that compared to patients with a shallow sleep duration of less than 5.4 h, patients with a duration of greater than or equal to 5.4 h had higher grades of diabetic carotid atherosclerosis (OR = 4.50, 95% CI 1.010-20.045) (P < 0.05).Prolonged periods of shallow sleep are associated with diabetic carotid atherosclerosis.ChiCTR2300069928.© 2025. The Author(s).