Integrated cardiovascular/respiratory control in type 1 diabetes evidences functional imbalance: Possible role of hypoxia

Autor: Pietro Fratino, Cesare Porta, Carmine Gazzaruso, Andrea Rinaldi, R. Paltro, Pasquale Decata, L. Bianchi, P. Protti, Luciano Bernardi
Přispěvatelé: Department of Medical and Clinical Genetics, Medicum
Rok vydání: 2016
Předmět:
Adult
Male
Diabetic neuropathy
AUTONOMIC NEUROPATHY
Chemoreflex
030209 endocrinology & metabolism
030204 cardiovascular system & hematology
Baroreflex
03 medical and health sciences
MELLITUS
Electrocardiography
0302 clinical medicine
Diabetes mellitus
OBSTRUCTIVE SLEEP-APNEA
medicine
Heart rate variability
Autonomic nervous system
Humans
OXIDATIVE STRESS
Hypoxia
business.industry
VENTILATORY RESPONSES
Blood Pressure Determination
ASSOCIATION
Hypoxia (medical)
SPONTANEOUS BAROREFLEX SENSITIVITY
medicine.disease
OXYGEN-SATURATION
CHRONIC HEART-FAILURE
Chemoreceptor Cells
3. Good health
LUNG-FUNCTION
Type 1 diabetes
Diabetes Mellitus
Type 1
Anesthesia
3121 General medicine
internal medicine and other clinical medicine
Reflex
Respiratory Mechanics
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Hypercapnia
circulatory and respiratory physiology
Zdroj: International journal of cardiology. 244
ISSN: 1874-1754
Popis: Background: Cardiovascular (baroreflex) and respiratory (chemoreflex) control mechanisms were studied separately in diabetes, but their reciprocal interaction (well known for diseases like heart failure) had never been comprehensively assessed. We hypothesized that prevalent autonomic neuropathy would depress both reflexes, whereas prevalent autonomic imbalance through sympathetic activation would depress the baroreflex but enhance the chemoreflexes. Methods: In 46 type-1 diabetic subjects (7.0 +/- 0.9 year duration) and 103 age-matched controls we measured the baroreflex (average of 7 methods), and the chemoreflexes, (hypercapnic: ventilation/carbon dioxide slope during hyperoxic progressive hypercapnia; hypoxic: ventilation/oxygen saturation slope during normocapnic progressive hypoxia). Autonomic dysfunction was evaluated by cardiovascular reflex tests. Results: Resting oxygen saturation and baroreflex sensitivity were reduced in the diabetic group, whereas the hypercapnic chemoreflex was significantly increased in the entire diabetic group. Despite lower oxygen saturation the hypoxic chemoreflex showed a trend toward a depression in the diabetic group. Conclusion: Cardio-respiratory control imbalance is a common finding in early type 1 diabetes. A reduced sensitivity to hypoxia seems a primary factor leading to reflex sympathetic activation (enhanced hypercapnic chemoreflex and baroreflex depression), hence suggesting a functional origin of cardio-respiratory control imbalance in initial diabetes. (C) 2017 Elsevier B.V. All rights reserved.
Databáze: OpenAIRE
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