Sleep apnoea in children with diabetes mellitus : effect of glycaemic control

• Published in: Diabetologia Vol. 43; no. 6; pp. 696 - 702
• Main Authors: VILLA, M. P, MULTARI, G, MONTESANO, M, PAGANI, J, CERVONI, M, MIDULLA, F, CERONE, E, RONCHETTI, R
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-06-2000; Springer Nature B.V
• Subjects: Associated diseases and complications; Biological and medical sciences; Blood Glucose - metabolism; Child; Child, Preschool; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - blood; Diabetic Neuropathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Glycated Hemoglobin A - analysis; Humans; Male; Medical sciences; Polysomnography; Reference Values; Respiratory Mechanics; Sleep Apnea Syndromes - epidemiology; Endocrinopathy; Human; Immunopathology; Sleep apnea syndrome; Diseases of the autonomic nervous system; Insulin dependent diabetes; Autoimmune disease; Complication; Child; Glycemia
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s001250051365

Patients with diabetes mellitus commonly have cardiovascular autonomic dysfunction and an abnormal ventilatory pattern during sleep. Few data are available on these changes in childhood diabetes. We investigated whether young diabetic children with or without diabetic neuropathy have ventilatory dysfunction during sleep and if so, whether these autonomic changes are related to the duration of diabetes and glycaemic control.
We studied 25 children with insulin-dependent diabetes mellitus (19 boys, mean age 7.72 +/- 1.99 years). All patients were insulin-dependent at diagnosis; blood samples for HbA1c assay were collected on the morning before testing and at 3-month intervals during the preceding year. Patients and control subjects (20 age-matched healthy children, 15 boys) underwent overnight polysomnography.
More diabetic patients than control subjects had sleep apnoeas (p = 0.006); apnoeas in patients also lasted longer (p = 0.07). Patients with poorly controlled diabetes had more apnoeas than patients with well-controlled diabetes and than healthy control subjects (p < 0.0001). Respiratory events during sleep correlated significantly with glycaemic control (r = 0.360; p = 0.09) and with the duration of diabetes (r = 0.430; p = 0.04).
We conclude that respiratory control is compromised very early in children with diabetes. These anomalies are closely related to the duration of diabetes and to glycaemic control. In young children with diabetes, screening of ventilatory control using recording techniques that are simpler than polysomnography could provide an early indication that an adverse cardiopulmonary reaction has begun.