Porter P A, Byrne G, Stick S, Jones T W
Department of Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia.
Arch Dis Child. 1996 Aug;75(2):120-3. doi: 10.1136/adc.75.2.120.
To determine the effect of nocturnal hypoglycaemia on sleep architecture in adolescents with insulin dependent diabetes mellitus (IDDM).
20 adolescents with IDDM (mean age 12.8 years, mean glycated haemoglobin (HbA1c) 8.9%) were studied on one night. Plasma glucose was measured every 30 minutes and cortisol and growth hormone levels every 60 minutes. Sleep was recorded using standard polysomnographic montages, and sleep architecture was analysed for total sleep time, stages 1-4, rapid eye movement, fragmentation, and arousals.
Six subjects (30%) became hypoglycaemic (five subjects < 2.5 mmol/l), with one being symptomatic. There were no differences in age, HbA1c, duration of diabetes, or insulin regimen between hypoglycaemic and non-hypoglycaemic subjects. Hypoglycaemia was not predicted by glucose measurements before bed. There was no detectable rise in plasma cortisol or growth hormone concentrations during hypoglycaemia. Sleep architecture was not disturbed by nocturnal hypoglycaemia with no differences found in sleep stages, fragmentation, or arousals.
Nocturnal hypoglycaemia is a common and usually asymptomatic complication of treatment in adolescents with IDDM. Moderate hypoglycaemia has not been shown to affect sleep architecture adversely. These findings are consistent with, and may explain, the observation that severe hypoglycaemia, with consequent seizure activity, is more common at night than during the day. Counterregulatory hormone responses to nocturnal hypoglycaemia may be less marked than with similar degrees of diurnal hypoglycaemia.
确定夜间低血糖对胰岛素依赖型糖尿病（IDDM）青少年睡眠结构的影响。
对20名IDDM青少年（平均年龄12.8岁，平均糖化血红蛋白（HbA1c）8.9%）进行了一晚的研究。每30分钟测量一次血糖，每60分钟测量一次皮质醇和生长激素水平。使用标准多导睡眠图记录睡眠情况，并分析睡眠结构的总睡眠时间、1-4期、快速眼动期、片段化和觉醒情况。
6名受试者（30%）出现低血糖（5名受试者血糖<2.5 mmol/l），其中1名有症状。低血糖组和非低血糖组在年龄、HbA1c、糖尿病病程或胰岛素治疗方案方面无差异。睡前血糖测量无法预测低血糖情况。低血糖期间血浆皮质醇或生长激素浓度未检测到升高。夜间低血糖未干扰睡眠结构，睡眠阶段、片段化或觉醒方面未发现差异。
夜间低血糖是IDDM青少年治疗中常见且通常无症状的并发症。尚未证明中度低血糖会对睡眠结构产生不利影响。这些发现与夜间严重低血糖伴发癫痫活动比白天更常见的观察结果一致，且可能解释该现象。夜间低血糖时的反调节激素反应可能不如白天类似程度的低血糖明显。
