Spectral Analysis of Heart Rate in Diabetic Autonomic Neuropathy

Freeman, Roy

doi:10.1001/archneur.1991.00530140079020

Cited by 163 publications

(36 citation statements)

References 24 publications

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“…Heart rate variability and baroreflex-mediated heart rate responses are useful to determine integrity and balance of the autonomic nervous system [37][38][39][40]. Changes in autonomic control similar to those observed in the present study have been reported as risk factors for SIDS [41].…”

Section: Functional Impairmentsupporting

confidence: 81%

Endotoxin Effects on Markers of Autonomic Nervous System Function in the Piglet: Implications for SIDS

Voss¹,

Bolton²,

Galland³

et al. 2004

Neonatology

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The hypothesis was tested in 30 newborn piglets that the effects of a low dose of endotoxin (1 µg i.v. bolus; Salmonella abortus equi) would impair autonomic nervous system function. Two tests of autonomic function were performed following external warming (pre-endotoxin) and during endotoxin-generated thermogenesis: (1) analysis of heart rate variability in the time and frequency domains and (2) baroreflex sensitivity measured following intravenous injection of the vasoactive drugs nitroprusside and phenylephrine. Beat-to-beat heart rate variability (SDΔRR) fell by 2.2 ms from 7.0 ms before fever (p < 0.05). Low-frequency spectral power fell by 2.4 ms² from 4.1 ms² before fever (p < 0.05). The sensitivity of the baroreflex to changes in blood pressure induced by the vasoactive drugs decreased during fever by 0.72 ms/mm Hg for the nitroprusside test (p < 0.0005) and by 0.31 ms/mm Hg for the phenylephrine test (p < 0.005). These results indicate that in the piglet the balance of autonomic tone is altered and autonomic responsiveness reduced during the thermogenic phase of a fever. These findings are consistent with known risk factors for sudden infant death syndrome.

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Section: Functional Impairmentsupporting

confidence: 81%

Endotoxin Effects on Markers of Autonomic Nervous System Function in the Piglet: Implications for SIDS

Voss¹,

Bolton²,

Galland³

et al. 2004

Neonatology

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“…8 The frequency components of HRV are of similar diagnostic value as the Ewing battery concerning the presence of cardiovascular autonomic neuropathy. 10 Furthermore, HF spectral indices were found to correlate very strongly with conventional methods.…”

Section: à2mentioning

confidence: 96%

Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects

Wu¹,

Lu²,

Yang³

et al. 2008

Int J Obes

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Background:Little is known about the altered cardiac autonomic function (CAF) across different levels of body mass index (BMI), including underweight, normal weight, overweight and obesity. This study provides a thorough analysis to clarify the CAF change in subjects with underweight, overweight and obesity. Methods: According to the World Health Organization (WHO) Asia-Pacific BMI cutoffs, a total of 1437 participants were classified as underweight (n ¼ 74), normal weight (n ¼ 588), overweight (n ¼ 313), obesity I (n ¼ 390) and obesity II (n ¼ 72). CAF was determined by standard deviation of normal-to-normal (SDNN) intervals or RR intervals, power spectrum in low (LF) and high frequency (HF) (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz), and LF/HF ratio at supine for 5 min, the ratio between the 30th and the 15th RR interval after standing from the supine position (30/15 ratio) and the average heart-rate change while taking six deep breaths in 1 min (HR DB ). Results: There were significant differences in age, gender, socioeconomic status, blood pressure, HOMA insulin resistance index, fasting glucose, cholesterol, triglyceride and high-density lipoprotein (HDL)-C, and the prevalence of hypertension, ischemic/left bundle branch block (LBBB) electrocardiography (EKG) pattern, current smoking and alcohol use among subjects with underweight, normal weight, overweight, obesity I and II. Univariate analysis showed that SDNN, HR DB , HF power and the square root of the LF/HF ratio differed among these five groups. Multivariate analysis showed that obesity I and II were inverse correlates of HR DB and HF power. Overweight, obesity I and II were positively associated with the square root of the LF/HF ratio. No BMI status was related to SDNN, 30/15 ratio or LF power. Underweight was not the independent correlate of any CAF indices. Conclusions: The risk for altered CAF is significant in overweight and obese subjects, independent of cardiovascular risk factors. Underweight is not apparently associated with CAF change.

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“…A study providing a direct compar-ison of PSA and some time-domain techniques for quantifying HRV was completed by Freeman et al (166). In this study, conventional methods to calculate "max-min," standard deviation, E:I ratio, Valsalva ratio, and 30:15 ratio were used, as were those for the low-frequency (0.02-0.15 Hz) and high-frequency (0.15-1.0 Hz) power for the heart rate power spectra of 15 type 1 diabetic patients.…”

Section: Vinik and Associatesmentioning

confidence: 99%

Diabetic Autonomic Neuropathy

et al. 2003

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ABSTRACT-Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of DAN has not been fully appreciated. The reported prevalence of DAN varies widely depending on the cohort studied and the methods of assessment. In randomly selected cohorts of asymptomatic individuals with diabetes, ϳ20% had abnormal cardiovascular autonomic function. DAN frequently coexists with other peripheral neuropathies and other diabetic complications, but DAN may be isolated, frequently preceding the detection of other complications. Major clinical manifestations of DAN include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, "brittle diabetes," and hypoglycemic autonomic failure. DAN may affect many organ systems throughout the body (e.g., gastrointestinal [GI], genitourinary, and cardiovascular). GI disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, and fecal incontinence) are common, and any section of the GI tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. Upper-GI symptoms should lead to consideration of all possible causes, including autonomic dysfunction. Whereas a radiographic gastric emptying study can definitively establish the diagnosis of gastroparesis, a reasonable approach is to exclude autonomic dysfunction and other known causes of these upper-GI symptoms. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea. Diagnostic approaches should rule out autonomic dysfunction and the well-known causes such as neoplasia. Occasionally, anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful. DAN is also associated with genitourinary tract disturbances including bladder and/or sexual dysfunction. Evaluation of bladder dysfunction should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder. Specialized assessment of bladder dysfunction will typically be performed by a urologist. In men, DAN may cause loss of penile erection and/or retrograde ejaculation. A complete workup for erectile dysfunction in men should include history (medical and sexual); psychological evaluation; hormone levels; measurement of nocturnal penile tumescence; tests to assess penile, pelvic, and spinal nerve function; cardiovascular autonomic function tests; and measurement of penile and brachial blood pressure. Neurovascular dysfunction resulting from DAN contributes to a wide spectrum of clinical disorders including erectile dysfunction, loss of skin integrity, and abnormal vascular reflexes. Disruption of microvascular skin blood flow and sudomotor function may be among the earliest manifestations ...

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Spectral Analysis of Heart Rate in Diabetic Autonomic Neuropathy

Cited by 163 publications

References 24 publications

Endotoxin Effects on Markers of Autonomic Nervous System Function in the Piglet: Implications for SIDS

Endotoxin Effects on Markers of Autonomic Nervous System Function in the Piglet: Implications for SIDS

Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects

Diabetic Autonomic Neuropathy

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