Respiratory influence on heart rate in diabetes mellitus

To find a simple and accurate test of autonomic nervous dysfunction in diabetes mellitus, 41 insulin-dependent diabetics and 25 controls were investigated. The diabetics, none of whom had symptoms of autonomic dysfunction, were tested for retinopathy and sensory neuropathy. Each subject also perform...

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Bibliographic Details
Published in:BMJ 1979-04, Vol.1 (6168), p.924-925
Main Authors: Sundkvist, G, Almér, L O, Lilja, B
Format: Article
Language:English
Subjects:
Abnormal reflexes
Adult
Autonomic Nervous System - physiopathology
Diabetes
Diabetes complications
Diabetes mellitus
Diabetic neuropathies
Diabetic Neuropathies - complications
Diabetic Neuropathies - diagnosis
Diabetic Neuropathies - physiopathology
Diabetic Retinopathy - complications
Electrocardiography
Female
Heart Rate
Humans
Inspiration
Male
Postoperative Complications - prevention & control
Ratios
Reflex, Abnormal - complications
Respiration
Risk
Sensory disorders
Type 1 diabetes mellitus
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Summary:To find a simple and accurate test of autonomic nervous dysfunction in diabetes mellitus, 41 insulin-dependent diabetics and 25 controls were investigated. The diabetics, none of whom had symptoms of autonomic dysfunction, were tested for retinopathy and sensory neuropathy. Each subject also performed maximal deep-breathing procedures while undergoing electrocardiographic recording: in normal subjects the intervals are shortened during inspiration and prolonged during expiration, and a difference in the heart rate between inspiration and expiration of 10% or less seems to indicate autonomic dysfunction. This difference was calculated as an E:I ratio of the mean of the longest R-R interval during maximal expiration to the mean of the shortest during maximal inspiration. Ten of the 18 patients found to have sensory neuropathy had abnormal E:I ratios, and among those with absent ankle reflexes the proportion was even higher (9 out of 11). The E:I ratio also seemed to be as accurate as traditional tests for autonomic dysfunction and easier to perform. Diabetics with autonomic dysfunction have an increased risk of acute cardiorespiratory death during and after surgery, and maximal deep breathing and calculation of the E:I ratio may be a useful test to perform on diabetics at risk.
ISSN:0007-1447
0959-8138
1468-5833
DOI:10.1136/bmj.1.6168.924