Decreased epinephrine responses to hypoglycemia during sleep
Decreased epinephrine responses to hypoglycemia during sleep
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DOI：
10.1056/nejm199806043382303
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发表时间：
1998-06-04
影响因子：
158.5
通讯作者：
Tamborlane, WV
中科院分区：
文献类型：
--
作者：
Jones, TW;Porter, P;Tamborlane, WV
背景在I型糖尿病患者中，低血糖通常发生在睡眠期间，并且通常无症状。这就提出了一个问题，睡眠是否与降低反调节激素反应lowglycemic.Methods我们研究了反调节激素反应胰岛素诱导的低血糖症在8例青少年I型糖尿病患者和6个年龄匹配的正常人，当他们在白天清醒，晚上睡觉，晚上醒来。在每项研究中，血浆葡萄糖浓度稳定在约100 mg/dl（5.6 mmol/L）60分钟，然后降至50 mg/dl（2.8 mmol/L），并在该浓度下维持40分钟。在每项研究期间，经常测量血浆游离胰岛素、肾上腺素、去甲肾上腺素、皮质醇和生长激素。结果两组患者的血糖和游离胰岛素浓度在所有研究中均相似。在研究期间，当受试者睡着时，在低血糖阶段没有人被唤醒，但在研究的最后30分钟内，当受试者醒来时，糖尿病患者和正常受试者都有低血糖症状。在糖尿病患者中，低血糖时血浆肾上腺素反应在睡眠时减弱（平均[+/-SE]血浆肾上腺素峰值浓度，70+/-14 pg/ml [382+/-76 pmol/L];与基线比较P=0.3），与他们白天或晚上醒着的时候相比，（238+/-39 pg/ml [1299+/-213 pmol/L]，与基线比较P=0.004，296+/-60 pg/ml [1616+/-327 pmol/L]，P=0.004）。患者的血浆去甲肾上腺素反应在睡眠期间也减少，而他们的血浆皮质醇浓度没有增加，他们的血浆生长激素浓度略有增加。结论睡眠损害糖尿病患者和正常人对低血糖的反调节激素反应。(C)1998年，马萨诸塞州医学会。
Background In patients with type I diabetes mellitus, hypoglycemia occurs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregulatory-hormone responses to hypoglycemia.Methods We studied the counterregulatory-hormone responses to insulin-induced hypoglycemia in eight adolescent patients with type I diabetes and six age-matched normal subjects when they were awake during the day, asleep at night, and awake at night. In each study, the plasma glucose concentration was stabilized for 60 minutes at approximately 100 mg per deciliter (5.6 mmol per liter) and then reduced to 50 mg per deciliter (2.8 mmol per liter) and maintained at that concentration for 40 minutes. Plasma free insulin, epinephrine, norepinephrine, cortisol, and growth hormone were measured frequently during each study. Sleep was monitored by polysomnography.Results The plasma glucose and free insulin concentrations were similar in both groups during all studies. During the studies when the subjects were asleep, no one was awakened during the hypoglycemic phase, but during the final 30 minutes of the studies when the subjects were awake both the patients with diabetes and the normal subjects had symptoms of hypoglycemia. In the patients with diabetes, plasma epinephrine responses to hypoglycemia were blunted when they were asleep (mean [+/-SE] peak plasma epinephrine concentration, 70+/-14 pg per milliliter [382+/-76 pmol per liter]; P=0.3 for the comparison with base line), as compared with when they were awake during the day or night (238+/-39 pg per milliliter [1299+/-213 pmol per liter], P=0.004 for the comparison with base line, and 296+/-60 pg per milliliter [1616+/-327 pmol per liter], P=0.004, respectively). The patients' plasma norepinephrine responses were also reduced during sleep, whereas their plasma cortisol concentrations did not increase and their plasma growth hormone concentrations increased, slightly. The patterns of counterregulatory-hormone responses in the normal subjects were similar.Conclusions Sleep impairs counterregulatory-hormone responses to hypoglycemia in patients with diabetes and normal subject. (C) 1998, Massachusetts Medical Society.