Preservation of the Hypoxic Drive to Breathing in Diabetic Autonomic Neuropathy

1982 ◽  
Vol 63 (1) ◽  
pp. 17-22 ◽  
Author(s):  
P. M. A. Calverley ◽  
D. J. Ewing ◽  
I. W. Campbell ◽  
P. K. Wraith ◽  
H. M. Brash ◽  
...  
Keyword(s):  
Heart Rate ◽  
Autonomic Neuropathy ◽  
Heart Rate Response ◽  
Ventilatory Response ◽  
Diabetic Autonomic Neuropathy ◽  
Co2 Production ◽  
Diabetic Patients ◽  
Normal Range ◽  
Peripheral Chemoreceptors ◽  
Carotid Chemoreceptors

1. Unexplained cardiorespiratory arrests have been reported in patients with diabetic autonomic neuropathy and these could be due to denervation of the carotid chemoreceptors. 2. We have studied the ventilatory response to transient hypoxia () during exercise in 22 male diabetic patients, six with symptomatic and cardiovascular evidence to suggest diabetic autonomic neuropathy (DAN+) and 12 without these features (DAN−). 3. There was no difference in the ventilatory response to transient hypoxia between the different groups of diabetic patients ( in DAN+ patients = −0·9 ± 0·2 litre min−1 kPa−1; in DAN− patients = −1·2 ± 0·6 litres min−1 kPa−1) even allowing for differences in the level of exercise achieved (CO2 production in DAN+ patients = 743 ± 103 ml/min; CO2 production in DAN– patients = 800 ± 144 ml/min). These results fell within our normal range for ventilatory response to transient hypoxia at this level of exercise. 4. The heart rate response to transient hypoxia varied within the groups but was significantly (P < 0·05) less in the patients with established diabetic autonomic neuropathy. 5. We conclude that the peripheral chemoreceptors are intact in diabetic autonomic neuropathy and that other mechanisms must be implicated in the unexpected cardiorespiratory arrests seen in these patients.

Heart-Rate Response to Sustained Hand Grip: Comparison of the Effects of Cardiac Autonomic Blockade and Diabetic Autonomic Neuropathy

1979 ◽  
Vol 56 (3) ◽  
pp. 287-291 ◽  
Author(s):  
L. Hume ◽  
D. J. Ewing ◽  
I. W. Campbell ◽  
S. R. Reuben ◽  
B. F. Clarke
Keyword(s):  
Heart Rate ◽  
Autonomic Neuropathy ◽  
Heart Rate Response ◽  
Normal Subjects ◽  
Diabetic Autonomic Neuropathy ◽  
Initial Increase ◽  
Hand Grip ◽  
Before And After ◽  
Autonomic Blockade ◽  
Later Phase

1. The heart-rate response during sustained hand grip was studied in four normal subjects before and after intravenous atropine, propranolol and combined cardiac autonomic blockade with both drugs. The results suggest that the increase in heart rate during the first 30 s is due to parasympathetic withdrawal, whereas the further increase between 30 s and 180 s is probably mediated by a combination of parasympathetic withdrawal and sympathetic stimulation. 2. The increases in heart rate during each minute of sustained hand grip were compared in 26 normal subjects, 37 diabetic subjects without and 24 diabetic subjects with proven autonomic neuropathy. In the diabetic subjects with autonomic neuropathy the increase in heart rate during the first minute was impaired, whereas the increases during the second and third minutes were similar in all three groups. 3. The initial increase in heart rate over the first 30 s of hand grip and the later increase between 30 s and 180 s were compared in nine normal subjects, ten diabetic subjects without and six diabetic subjects with autonomic neuropathy. The increase during the first 30 s was impaired in the diabetic subjects with autonomic neuropathy, whereas the later phase of the response was similar in all three groups. 4. It is concluded that impairment of the heart-rate response to sustained hand grip in diabetic autonomic neuropathy is mainly due to impairment of the early parasympathetic phase, but that the presence of cardiac sympathetic damage can also be detected.

Autonomic mechanisms in the heart rate response to coughing

1987 ◽  
Vol 72 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Claudio CaRdone ◽  
Federico Bellavere ◽  
Marcello Ferri ◽  
Domenico Fedele
Keyword(s):  
Heart Rate ◽  
Autonomic Neuropathy ◽  
Heart Rate Response ◽  
Normal Subjects ◽  
Muscular Contraction ◽  
Diabetic Patients ◽  
Cough Test ◽  
Before And After ◽  
Autonomic Blockade ◽  
Expiratory Muscles

1. To differentiate between the possible reflex and mechanical components in the heart rate response to cough, eight healthy subjects performed a standardized cough test before and after pharmacological autonomic blockade; to test the clinical usefulness of the cough manoeuvre two groups of diabetic patients (without and with autonomic neuropathy) were compared with a group of age-matched normal subjects. 2. Because of the use of abdominal and expiratory muscles during cough, the cardioacceleratory response was compared with that induced by an intense contraction of the arm muscles (handgrip). 3. The cardioacceleratory response was completely abolished by atropine while propranolol failed to affect it. The diabetic patients with autonomic neuropathy showed a response similar to that after cholinergic blockade. The response was similar to that induced by muscular contraction for 4 s, after which it differed showing a continued cardioacceleration. The patterns of recovery were not different. 4. The cough-induced cardioacceleration is essentially reflex in nature and under cholinergic control; initially the mechanism may be partially related to the intense contraction of abdominal and expiratory muscles; later, the arterial hypotension related to the cough may contribute to the more sustained shortening of the R–R interval. 5. The cough test may be useful for the evaluation of cardiac parasympathetic integrity.

scholarly journals Cardiovascular Autonomic Neuropathyin Chronic Kidney Diseases

2010 ◽  
Vol 49 (178) ◽  
Author(s):  
L Thapa ◽  
P Karki ◽  
SK Sharma ◽  
BK Bajaj
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Heart Rate ◽  
Kidney Disease ◽  
Autonomic Neuropathy ◽  
Autonomic Function ◽  
Heart Rate Response ◽  
Kidney Diseases ◽  
Diabetic Patients ◽  
Age And Sex

INTRODUCTION: This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients. METHODS: Autonomic function using five standard tests was examined in 20 diabetic patients with CKD, 20 age and sex matched diabetic patients without CKD and 20 age and sex matched controls. Analysis of difference between the autonomic function was done in the three groups using Chi-square test or Fischer's test. RESULTS: Total 20 (100%) diabetic CKD patients were found to have autonomic neuropathy. Of these, 2 (10%) patients had early parasympathetic damage, 8 (40%) patients had definite parasympathetic damage, and 10 (50%) patients had combined damage. Heart rate response to standing was statistically significant (p = 0.014) among diabetic CKD patients when compared with diabetic patients without CKD. Combined form of autonomicdysfunction was more frequent in advanced stages of diabetic CKD. Three (42.85%) patients in stage 3 CKD, 4 (66.66%) patients in stage 4 CKD and 5 (71.42%) patients in stage 5 CKD, had combined autonomic failure. CONCLUSIONS: Autonomic neuropathy is common in native Nepalese diabetic CKD patients. Heart rate response to standing is significantly abnormal in diabetic CKD patients in comparison with diabetes mellitus patient without CKD. Severity of autonomic dysfunction increases with severity of CKD..  KEYWORDS: cardiovascualr autonomic neuropathy, chronic kidney disease, diabetes mellitus.

scholarly journals An analysis of spectrum components and CCV of heart rate variability on diabetic autonomic neuropathy

1995 ◽  
Vol 115 (3) ◽  
pp. 460-465
Author(s):  
Toshihiro Nishimura ◽  
Souzaburou Yoshihara ◽  
Kazuyuki Nagatsuka ◽  
Takeshi Inoue ◽  
Masao Saito ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Autonomic Neuropathy ◽  
Diabetic Autonomic Neuropathy

Increased bronchial reactivity to histamine in diabetic autonomic neuropathy

1987 ◽  
Vol 73 (4) ◽  
pp. 401-405 ◽  
Author(s):  
George B. Rhind ◽  
Grahame A. Gould ◽  
David J. Ewing ◽  
Basil F. Clarke ◽  
Neil J. Douglas
Keyword(s):  
Autonomic Neuropathy ◽  
Maximum Concentration ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Diabetic Autonomic Neuropathy ◽  
The Other ◽  
Autonomic Nerves ◽  
Diabetic Patients ◽  
Maximal Flow ◽  
Bronchial Reactivity

1. Twelve male diabetic patients inhaled nebulized histamine in doubling concentrations from 0.03 mg/ml to 32 mg/ml until they reached the maximum concentration or until their forced expiratory volume in 1 s (FEV1.0) fell by at least 20%. Six had evidence of severe autonomic neuropathy (DAN), while the other six did not. 2. More of the DAN group decreased their FEV1.0 on histamine inhalation by at least 20% (P < 0.02) and more of them decreased their maximal flow at 50% vital capacity by at least 20% than those in the group without DAN (P < 0.05). 3. The fall in FEV1.0 and in maximal flow at 50% of vital capacity was greater (P < 0.05) in the DAN group than in the group without DAN. 4. This suggests that diabetic patients with autonomic neuropathy have increased bronchial reactivity to histamine. This could either be due to differential damage of the respiratory autonomic nerves or, alternatively, to denervation hypersensitivity.

Sign in / Sign up

Export Citation Format

Share Document