Impairment of Cardiorespiratory Reflexes and its Association with Distal Somatic Neuropathy in Diabetic Patients free from Clinical Symptoms of Autonomic Neuropathy

Summary

Signs of autonomic cardiac neuropathy and its association with distal somatic neuropathy were investigated in 36 type 1 and 28 type 2 diabetic patients free from clinical symptoms of autonomic neuropathy. Using bedside tests (deep-breathing, Valsalva manoeuvre and lying-to-standing) definitive cardiac autonomic neuropathy was found in 28 patients (44%), early cardiac autonomic neuropathy was observed in 19 patients (30%) while 17 patients (26%) showed no alterations. The values of motor nerve conduction velocity in peroneal nerves (41.8 ± 0.7 m/s, mean ± SEM) were significantly (p < 0.01) lower in patients with definitive cardiac autonomic neuropathy than those (45.8 ± 1.1 m/s) of patients without any signs of cardiac autonomic neuropathy. These latter values were, however, significantly (p < 0.001) lower than those (53.7 ± 0.7 m/s) of control subjects (n = 50). Signs of early or definitive cardiac autonomic neuropathy were recorded in 31 of 35 diabetic patients with distal somatic neuropathy assessed by measurement of motor nerve conduction velocity in peroneal nerves. It was concluded that abnormal results of noninvasive tests for autonomic neuropathy, i.e. alterations in cardiorespiratory reflexes indicating parasympathetic impairment of cardiac innervation could be often found in diabetic patients without clinical signs of autonomic neuropathy. These alterations could be frequently observed in diabetic patients with distal symmetrical somatic neuropathy.

Key words

Diabetes mellitus - Diabetic polyneuropathy - Nerve conduction velocity - Autonomie neuropathy - Heart rate variability - Cardiorespiratory reflexes - Deep breathing test - Valsalva manoeuvre - Lying-to-standing - Diabetic late complications