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Updated: Jun 29, 2026
Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
Dispersion of the P wave as a test for cardiac autonomic function in diabetic children
Ebru Y Imamoglu1, Funda Oztunc, Ayse G Eroglu
1Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. ebruli013@hotmail.com
Insights
Diabetic children show increased P wave dispersion, indicating early cardiac electrical changes before autonomic dysfunction is detectable. This finding highlights potential early heart health risks in type 1 diabetes.
Area of Science:
- Cardiology
- Diabetology
- Physiology
Background:
- Type 1 diabetes can lead to cardiac complications.
- Early detection of cardiac involvement is crucial in diabetic children.
- Autonomic dysfunction is a known complication of diabetes.
Purpose of the Study:
- To compare P wave dispersion between children with type 1 diabetes and healthy controls.
- To investigate the relationship between P wave dispersion and cardiac autonomic dysfunction in diabetic children.
Main Methods:
- 49 children with type 1 diabetes and 32 healthy controls were enrolled.
- P wave duration and dispersion were measured using 12-lead electrocardiograms.
- Cardiac autonomic function was assessed via Valsalva ratio, resting heart rate, and orthostatic hypotension.
Main Results:
- Diabetic children exhibited significantly increased P wave dispersion compared to controls.
- P wave dispersion remained stable before and after the Valsalva maneuver in diabetics, unlike controls.
- No significant differences in Valsalva ratio, resting heart rate, or orthostatic hypotension were observed between groups.
Conclusions:
- Increased P wave dispersion in diabetic children suggests early cardiac electrophysiological heterogeneity.
- This electrophysiological change precedes detectable parasympathetic and sympathetic dysfunction.
- P wave dispersion may serve as an early marker for cardiac involvement in type 1 diabetes.
Objective:
We aimed, in this study, to compare dispersion of the p wave in patients with type 1 diabetes to nondiabetic control subjects, and to investigate the relationship between the dispersion of the p wave and cardiac autonomic dysfunction in diabetic children.
Methods:
We enrolled 49 patients with type 1 diabetes, and 32 age- and sex-matched healthy subjects, measuring the Valsalva ratio, resting heart rate, and orthostatic hypotension in all. The duration of the p wave was measured manually on a high-resolution computer screen. Dispersion, defined as the difference between maximum and minimum durations of the p waves, was also measured in the 12-lead electrocardiogram before and after the Valsalva maneuver.
Results:
The mean age of the patients and their controls were 14.2 +/- 4.8 years, and 12.7 +/- 4.5 years, respectively. The mean duration of diabetes had been 6.2 +/- 4.6 years. Maximal and minimal values for the duration of the p wave were significantly decreased in the diabetic children, with the dispersion itself significantly increased. Values for the dispersion in the diabetic subjects were similar before and after the Valsalva maneuver, whereas dispersion was found significantly increased after this maneuver in the controls. The differences in the Valsalva ratio, resting heart rate, and orthostatic hypotension between the groups, on the other hand, were not found to be statistically significant.
Conclusion:
The noted increase in the dispersion of the p wave in diabetic children reveals the onset of cardiac electrophysiological heterogeneity before it is possible to detect parasympathetic and sympathetic dysfunction with other tests.
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