Peculiarities of night EEG-monitoring of sleep in children with type 1 diabetes mellitus depending on the glycemia level

BACKGROUND: The patterns of bioelectric activity of the brain in patients with type 1 diabetes mellitus are being actively studied. A recent study of changes in brain bioelectric activity during sleep in children with diabetes mellitus was done without monitoring changes in the level of glycaemia in real time. The current study was conducted with concurrent monitoring of EEG in sleep and glycaemia.

AIM: To study the results of night time EEG monitoring of sleep in children with type 1 diabetes mellitus depending on the level of glycaemia.

METHODS: This study included 20 children (10–17 years of age) with type 1 diabetes. All patients received continuous monitoring of glycaemia and night time EEG of sleep for 9 h.

RESULTS: Absence of pathological changes was more often observed in patients with optimal glycaemic indices (n = 9) compared with patients with hypoglycaemic periods (n = 0) (P = 0.011, Fisher exact test) and hyperglycaemia (n = 3) (P = 0.0011, Fisher exact test). Light paroxysmal disturbances (high-amplitude bilateral flares during theta waves in stages 1–2 of sleep) were more often recorded in patients during periods of hypoglycaemia (n = 3) compared with periods of optimal glycaemia (n = 1) (P = 0.032, Fisher exact test). The hypersynchronous rhythm was also more often detected in patients during periods of hypoglycaemia (n = 3) compared with optimal glycaemia (n = 1) (P = 0.032, Fisher exact test). ECG potentials were more often recorded in hypoglycaemia (n = 4) compared with optimal glycaemia (n = 2) (P = 0.011, Fisher exact test) and hyperglycaemia (n = 3) (P = 0.005, Fisher exact test). The interrelation of brain bioelectric activity and glycaemic indices was seen in patients with hypoglycaemia (positive correlation) and at optimal glycaemia (negative correlation). The highest correlation was seen between ECG potentials (r = +0.61, P < 0.05), hypersynchronous rhythm (r = +0.40; P < 0.05) and hypoglycaemia. Significant differences between the groups were obtained in the beta range (increase in amplitude and beta-rhythm index) by the spectral analysis.

CONCLUSIONS: Disturbance of the bioelectric activity of the brain is seen mainly in the hypoglycaemic state in patients with type 1 diabetes mellitus. This indicates the dysfunction of vegetative regulatory adaptation mechanisms, which can significantly increase the risk of severe hypoglycaemia.

diabetes mellitus, children, bifunctional monitoring, glycemia, electroencephalography

1. Суркова Е.В. Сахарный диабет и центральная нервная система // Терапевтический архив. – 2016. – Т. 88. – №10. – С. 82-86. [Surkova EV. Diabetes mellitus and the central nervous system. Ter Arkh. 2016;88(10):82-86. (In Russ.)] doi: 10.17116/terarkh201688682-86

2. Mazaika PK, Weinzimer SA, Mauras N, et al. Variations in Brain Volume and Growth in Young Children With Type 1 Diabetes. Diabetes. 2016;65(2):476-485. doi: 10.2337/db15-1242

3. Строков И.А., Захаров В.В., Строков К.И. Диабетическая энцефалопатия // Неврология, нейропсихиатрия, психосоматика. – 2012. – Т. 4. – №2S. – С. 30-40. [Strokov IA, Zakharov VV, Strokov KI. Diabetic encephalopathy. Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2S):30-40. (In Russ.)] doi:10.14412/2074-2711-2012-2506

4. Сосина В.Б., Захаров В.В., Строков И.А., Вахнина Н.В. Когнитивные нарушения при сахарном диабете // Неврология, нейропсихиатрия, психосоматика. – 2017. – Т. 9. – №1. – С. 90-95. [Sosina VB, Zakharov VV, Strokov IA, Vakhnina NV. Cognitive impairment in diabetes mellitus. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(1):90-95. (In Russ.)] doi:10.14412/2074-2711-2017-1-90-95

5. Northam EA, Rankins D, Lin A, et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care. 2009;32(3):445-450. doi: 10.2337/dc08-1657

6. Barnea-Goraly N, Raman M, Mazaika P, et al. Alterations in white matter structure in young children with type 1 diabetes. Diabetes Care. 2014;37(2):332-340. doi: 10.2337/dc13-1388

7. Вотякова О.И., Питерская О.Ю., Вотякова Н.А. Влияние на центральную нервную систему у детей с сахарным диабетом острых метаболических нарушений // Вестник новых медицинских технологий (Электронный журнал). – 2013. – Т. 7. – №1. – С. 145-146. [Votyakova OI, Piterskaya OY, Votyakova NA. Effect on the central nervous system in the children with diabetes mellitus acute metabolic disorders. Journal of New Medical Technologies. eJournal. 2013;7(1):145-146. (In Russ.)]

8. Пузикова О.З. Афонин А.А., Попова В.А., Вербицкий Е.В. Особенности ночного сна при сахарном диабете 1 типа у детей и подростков // Международный журнал экспериментального образования. – 2013. – №4-2. – С. 84-91. [Puzikova OZ, Afonin AA, Popova VA, Verbitsky EV. Peculiarities of night’s sleep structure in children and adolescents with type 1 diabetes. International Journal of Experimental Education. 2013;(4-2):84-91. (In Russ.)]

9. Дорошкевич И.П., Мохорт Т.В. Оценка влияния гликемии на показатели сна при сахарном диабете 1-го типа: результаты одномоментного когортного исследования // Международный эндокринологический журнал. – 2014. – №7. – С. 23-27. [Doroshkevich IP, Mohort TV. Assessment of glycemia impact on the parametrs of sleep in type1 diabetes mellitus: the results of cross-sectional control trial. International journal of endocrinology. 2014;(7):23-27. (In Russ.)]

10. Luders HO, Noachtar S. Atlas and classification of electroencephalography. 1st ed. Saunders; 2000.

11. Мухин К.Ю., Петрухин А.С., Глухова Л.Ю. Эпилепсия: атлас электроклинической диагностики. – М.: Альварес Паблишинг; 2004. [Mukhin KY, Petruhin AS, Glukhova LY. Epilepsiya: atlas elektroklinicheskoy diagnostiki. Moscow: Alvares Publishing; 2004. (In Russ.)]

12. Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под ред. Дедова И.И., Шестаковой М.В., Майорова А.Ю. – 8-й выпуск // Сахарный диабет. – 2017. – Т. 20. – №1S. – C. 1-121. [Dedov II, Shestakova MV, Mayorov AY, et al. Dedov II, Shestakova MV, Mayorov AY, editors. Standards of specialized diabetes care. 8th edition. Diabetes mellitus. 2017;20(1S):1-121. (In Russ.)] doi: 10.14341/DM20171S8

13. Макаров Л.М., Комолятова В.Н., Куприянова О.О., и др. Национальные российские рекомендации по применению методики холтеровского мониторирования в клинической практике // Российский Кардиологический Журнал. – 2013. – Т. 19. – №2. – С. 6-71. [Makarov LM, Komolyatova VN, Kupriyanova OO, et al. National Russian guidelines on application of the methods of Holter monitoring in clinical practice. Russian journal of cardiology. 2014;19(2):6-71. (In Russ.)]

14. Зенков Л.Р., Ронкин М.А. Функциональная диагностика нервных болезней. Руководство для врачей. – М.: МЕДпресс-информ; 2013. [Zenkov LR, Ronkin MA. Funktsional&apos;naya diagnostika nervnykh bolezney. Rukovodstvo dlya vrachey. Мoscow: MEDpress-inform; 2013. (In Russ.)]

15. Verrotti A, Loiacono G, Mohn A, Chiarelli F. New insights in diabetic autonomic neuropathy in children and adolescents. Eur J Endocrinol. 2009;161(6):811-818. doi: 10.1530/EJE-09-0710

16. Черний Т.В. Нейрофизиологическая трактовка ЭЭГ-феноменологии в оценке функциональных нарушений при тяжелых повреждениях головного мозга // Журнал неврологии им. Б.М. Маньковского. – 2014. – Т. 2. – №3. – С. 81-91. [Chernii TV. Neurophysiological explanation of EEG-phenomenon in the estimation of functional disorders due to severe brain injury. The journal of neuroscience of B.M. Mankovskyi. 2014;2(3):81-91. (In Russ.)]

17. Larsen A, Hojlund K, Poulsen MK, et al. Hypoglycemia-associated electroencephalogram and electrocardiogram changes appear simultaneously. J Diabetes Sci Technol. 2013;7(1):93-99. doi: 10.1177/193229681300700111

18. Манушарова Р.А. Инсулинома // Лечащий врач. – 2004. – №10. – С. 76-79. [Manusharova RA. Insulinoma. Practitioner. 2004;(10):76-79. (In Russ.)]

19. Лаптев Д.Н. Связь гипогликемии и вариабельности гликемии с автономной дисфункцией у детей и подростков с сахарным диабетом 1 типа // Сахарный диабет. – 2014. – Т. 17. – №4. – С. 87-92. [Laptev DN. Relationship of hypoglycemia and glucose variability with autonomic dysfunction in children and adolescents with type 1 diabetes. Diabetes Mellitus. 2014;17(4):87-92. (In Russ.)] doi:10.14341/DM2014487-92

20. Ковальзон В.М. Основы сомнологии. Физиология и нейрохимия цикла «бодрствование-сон». – М.: Бином. Лаборатория знаний; 2017. [Kovalzon VM. Osnovy somnologii. Fiziologiya i neyrokhimiya tsikla "bodrstvovanie-son". Moscow: Binom. Laboratoriya znaniy; 2017. (In Russ.)]

21. Craig ME, Jefferies C, Dabelea D, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2014;15 Suppl 20:4-17. doi: 10.1111/pedi.12186

22. Рабаданова А.И. Возрастные особенности электрической активности и кровообращения головного мозга у людей с различным типом вегетативной регуляции // Современные проблемы науки и образования. – 2015. – № 2-2. [Rabadanova AI. Age features of electrical activity and cerebral circulation in people with different types of vegetative regulation. Modern problems of science and education. 2015;(2-2). (In Russ.)]

23. Сенаторова А.С., Караченцев Ю.И., Кравчун Н.А., и др. Сахарный диабет: от ребенка до взрослого. – Харьков: ХНМУ; 2009. [Senatorova AS, Karachentsev YI, Kravchun NA, et al. Saharnyy diabet: ot rebenka do vzroslogo. Kharkov: KhNMU; 2009. (In Russ.)]