Erectile dysfunction as a sentinel symptom of cardiovascular autonomic neuropathy in heavy drinkers

Abstract

Because autonomic neuropathy (AN) is not routinely assessed in chronic alcoholism, its features and relationship with other disease parameters remain undefined. The very existence of true alcohol-related autonomic dysfunction, in the absence of alcoholic hepatopathy, is even controversial. We aimed this study at evaluating the frequency and pattern of AN in a population of heavy drinkers without liver dysfunction. We also investigated the putative risk factors for AN as well as its relationship to peripheral neuropathy (PN). Autonomic function was evaluated in 70 detoxified alcoholics and 70 well-matched controls by heart-rate response to deep breathing, heart-rate response to standing from lying position, and blood pressure response to standing up. PN was assessed by electroneurography (ENG). Detailed information about sensorimotor and autonomic symptoms, nutritional status, and parameters reflecting alcohol intake were recorded. No patients showed signs of caloric/protein malnutrition. PN was found in 74% and AN (abnormal test results in two of three tests performed) in 26%; abnormalities in at least one autonomic test were found in 62%. All patients with PN were symptomatic, mainly due to sensory disturbances. In line with this, ENG abnormalities were more evident at sural nerves. AN was symptomatic in 10 of 18 patients, and its sole clinical expression was impotence: indeed, the pattern of autonomic involvement was mainly parasympathetic. AN did not correlate with PN, nor with any parameter reflecting the amount of alcohol intake; only performances on heart-rate response to standing from lying position were related to the duration of abuse. The lack of correlation between PN and AN may suggest a different pathophysiology for these two complications. Unlike PN, AN is often asymptomatic. Among symptomatic patients (55%), erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.

Alcohol-induced autonomic dysfunction: a systematic review

“…Gastrointestinal autonomic dysfunction did not usually occur in the presence of alcohol-related peripheral neuropathy but, as discussed earlier in the present review, autonomic dysfunction affecting the gastrointestinal system is challenging to explore [33,36]. Only two studies found no co-occurrence between peripheral neuropathy and autonomic dysfunction [22,44].…”

“…There were no significant differences between the mean ages of patients chronically abusing alcohol who did and did not demonstrate autonomic dysfunction in these studies. Three studies found no relationship; however, one study conducted by Ravaglia et al identified a significant negative correlation with increasing age and heart rate response to deep breathing, but did not appear to have adjusted for duration of alcohol abuse or TLDE [22]. This study also considered other parameters of cardiovascular, gastrointestinal autonomic dysfunction and impotence.…”

“…Nonetheless, there is a significant body of research available, which supports a high rate of autonomic dysfunction amongst alcohol abusers with cardiovascular reflex measures of neuropathy producing rates ranging between 16% and 73% [12,21]. This range is clearly quite wide and explained by the heterogeneity between studies, and it is worth noting that the most methodologically sound study with amongst the largest studied populations established that 26% of the study population (patients satisfying DSM IV criteria for alcohol dependence) have abnormal cardiovascular reflexes, defined as two or more abnormal parameters [22]. Interestingly, with respect to the cardiovascular system, parasympathetic impairment occurs with greater frequency than sympathetic, which is Table 2 [8,10,[22][23][24][25][26].…”

Alcohol-induced autonomic dysfunction: a systematic review

“…Gastrointestinal autonomic dysfunction did not usually occur in the presence of alcohol-related peripheral neuropathy but, as discussed earlier in the present review, autonomic dysfunction affecting the gastrointestinal system is challenging to explore [33,36]. Only two studies found no co-occurrence between peripheral neuropathy and autonomic dysfunction [22,44].…”

“…There were no significant differences between the mean ages of patients chronically abusing alcohol who did and did not demonstrate autonomic dysfunction in these studies. Three studies found no relationship; however, one study conducted by Ravaglia et al identified a significant negative correlation with increasing age and heart rate response to deep breathing, but did not appear to have adjusted for duration of alcohol abuse or TLDE [22]. This study also considered other parameters of cardiovascular, gastrointestinal autonomic dysfunction and impotence.…”

“…Nonetheless, there is a significant body of research available, which supports a high rate of autonomic dysfunction amongst alcohol abusers with cardiovascular reflex measures of neuropathy producing rates ranging between 16% and 73% [12,21]. This range is clearly quite wide and explained by the heterogeneity between studies, and it is worth noting that the most methodologically sound study with amongst the largest studied populations established that 26% of the study population (patients satisfying DSM IV criteria for alcohol dependence) have abnormal cardiovascular reflexes, defined as two or more abnormal parameters [22]. Interestingly, with respect to the cardiovascular system, parasympathetic impairment occurs with greater frequency than sympathetic, which is Table 2 [8,10,[22][23][24][25][26].…”

Alcohol-related peripheral neuropathy: a systematic review and meta-analysis

“…As seen in Fig. 3, 17 of the studies gave prevalence data in populations diagnosed peripheral neuropathy using NCS, giving a pooled prevalence of 46.3% (CI 35.7–57.3%; n = 1596) [2, 5, 6, 12, 14, 23, 35, 37–39, 41–47]. Just one study focussed on the prevalence of small fibre neuropathy, in which amongst 98 patients, 45 patients had large fibre peripheral neuropathy and 37 patients (37.8%) had small fibre neuropathy [5].…”

“…Alcohol-related peripheral neuropathy has a slow, progressive onset over months to years [3, 4, 51, 52], almost always affects the lower limbs more than the upper limbs and begins distally [2–4, 14, 19, 20, 26, 27, 30, 35, 37–41, 47, 51, 53–59]. Generally, patients present with primarily sensory features, including paraesthesia, numbness and impaired vibration sensation [2, 3, 6, 14, 15, 19, 20, 26, 27, 30, 32, 33, 35, 37–41, 51, 53–56, 60, 61]. Reduced proprioception has been reported in a smaller number of cases [39, 40].…”

Alcohol-induced autonomic dysfunction: a systematic review

“…Gastrointestinal autonomic dysfunction did not usually occur in the presence of alcohol-related peripheral neuropathy but, as discussed earlier in the present review, autonomic dysfunction affecting the gastrointestinal system is challenging to explore [33,36]. Only two studies found no co-occurrence between peripheral neuropathy and autonomic dysfunction [22,44].…”

“…There were no significant differences between the mean ages of patients chronically abusing alcohol who did and did not demonstrate autonomic dysfunction in these studies. Three studies found no relationship; however, one study conducted by Ravaglia et al identified a significant negative correlation with increasing age and heart rate response to deep breathing, but did not appear to have adjusted for duration of alcohol abuse or TLDE [22]. This study also considered other parameters of cardiovascular, gastrointestinal autonomic dysfunction and impotence.…”

“…Nonetheless, there is a significant body of research available, which supports a high rate of autonomic dysfunction amongst alcohol abusers with cardiovascular reflex measures of neuropathy producing rates ranging between 16% and 73% [12,21]. This range is clearly quite wide and explained by the heterogeneity between studies, and it is worth noting that the most methodologically sound study with amongst the largest studied populations established that 26% of the study population (patients satisfying DSM IV criteria for alcohol dependence) have abnormal cardiovascular reflexes, defined as two or more abnormal parameters [22]. Interestingly, with respect to the cardiovascular system, parasympathetic impairment occurs with greater frequency than sympathetic, which is Table 2 [8,10,[22][23][24][25][26].…”

Alcohol-related peripheral neuropathy: a systematic review and meta-analysis

“…As seen in Fig. 3, 17 of the studies gave prevalence data in populations diagnosed peripheral neuropathy using NCS, giving a pooled prevalence of 46.3% (CI 35.7–57.3%; n = 1596) [2, 5, 6, 12, 14, 23, 35, 37–39, 41–47]. Just one study focussed on the prevalence of small fibre neuropathy, in which amongst 98 patients, 45 patients had large fibre peripheral neuropathy and 37 patients (37.8%) had small fibre neuropathy [5].…”

“…Alcohol-related peripheral neuropathy has a slow, progressive onset over months to years [3, 4, 51, 52], almost always affects the lower limbs more than the upper limbs and begins distally [2–4, 14, 19, 20, 26, 27, 30, 35, 37–41, 47, 51, 53–59]. Generally, patients present with primarily sensory features, including paraesthesia, numbness and impaired vibration sensation [2, 3, 6, 14, 15, 19, 20, 26, 27, 30, 32, 33, 35, 37–41, 51, 53–56, 60, 61]. Reduced proprioception has been reported in a smaller number of cases [39, 40].…”

Alcohol-induced autonomic dysfunction: a systematic review

“…Gastrointestinal autonomic dysfunction did not usually occur in the presence of alcohol-related peripheral neuropathy but, as discussed earlier in the present review, autonomic dysfunction affecting the gastrointestinal system is challenging to explore [33,36]. Only two studies found no co-occurrence between peripheral neuropathy and autonomic dysfunction [22,44].…”

“…There were no significant differences between the mean ages of patients chronically abusing alcohol who did and did not demonstrate autonomic dysfunction in these studies. Three studies found no relationship; however, one study conducted by Ravaglia et al identified a significant negative correlation with increasing age and heart rate response to deep breathing, but did not appear to have adjusted for duration of alcohol abuse or TLDE [22]. This study also considered other parameters of cardiovascular, gastrointestinal autonomic dysfunction and impotence.…”

“…Nonetheless, there is a significant body of research available, which supports a high rate of autonomic dysfunction amongst alcohol abusers with cardiovascular reflex measures of neuropathy producing rates ranging between 16% and 73% [12,21]. This range is clearly quite wide and explained by the heterogeneity between studies, and it is worth noting that the most methodologically sound study with amongst the largest studied populations established that 26% of the study population (patients satisfying DSM IV criteria for alcohol dependence) have abnormal cardiovascular reflexes, defined as two or more abnormal parameters [22]. Interestingly, with respect to the cardiovascular system, parasympathetic impairment occurs with greater frequency than sympathetic, which is Table 2 [8,10,[22][23][24][25][26].…”

Alcohol-related peripheral neuropathy: a systematic review and meta-analysis

“…As seen in Fig. 3, 17 of the studies gave prevalence data in populations diagnosed peripheral neuropathy using NCS, giving a pooled prevalence of 46.3% (CI 35.7–57.3%; n = 1596) [2, 5, 6, 12, 14, 23, 35, 37–39, 41–47]. Just one study focussed on the prevalence of small fibre neuropathy, in which amongst 98 patients, 45 patients had large fibre peripheral neuropathy and 37 patients (37.8%) had small fibre neuropathy [5].…”

“…Alcohol-related peripheral neuropathy has a slow, progressive onset over months to years [3, 4, 51, 52], almost always affects the lower limbs more than the upper limbs and begins distally [2–4, 14, 19, 20, 26, 27, 30, 35, 37–41, 47, 51, 53–59]. Generally, patients present with primarily sensory features, including paraesthesia, numbness and impaired vibration sensation [2, 3, 6, 14, 15, 19, 20, 26, 27, 30, 32, 33, 35, 37–41, 51, 53–56, 60, 61]. Reduced proprioception has been reported in a smaller number of cases [39, 40].…”