Preferential impairment of parasympathetic autonomic function in type 2 diabetes

Thorsten K. Rasmussen; Nanna B. Finnerup; Wolfgang Singer; Troels S. Jensen; John Hansen; Astrid J. Terkelsen

doi:10.1016/j.autneu.2022.103026

Preferential impairment of parasympathetic autonomic function in type 2 diabetes

Thorsten K. Rasmussen^*, Nanna B. Finnerup, Wolfgang Singer, Troels S. Jensen, John Hansen, Astrid J. Terkelsen

^*Corresponding author for this work

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Abstract

Objective: Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. Research design and methods: Forty T2D patients (mean age and duration of diabetes ±SD, 65.5 ± 7.3 and 9.5 ± 4.2 years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. Results: Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08–1.18] vs. controls 1.18 [1.11–1.25] (p = 0.01)), and reduced heart rate variability (p < 0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p > 0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8 % ± 8.8 vs. controls 15.8 % ± 7.7 (p < 0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p = 0.04). Conclusions: Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.

Original language	English
Article number	103026
Journal	Autonomic Neuroscience: Basic and Clinical
Volume	243
ISSN	1566-0702
DOIs	https://doi.org/10.1016/j.autneu.2022.103026
Publication status	Published - Dec 2022

Keywords

Autonomic nervous system
Autonomic neuropathy
Autonomic vascular control
Cardiac autonomic regulation
Type 2 diabetes

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10.1016/j.autneu.2022.103026

Preferential impairment of parasympathetic autonomic function in type 2 diabetesFinal published version, 1 MBLicence: CC BY

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@article{c4374754986449d098de2c2967de5d3a,

title = "Preferential impairment of parasympathetic autonomic function in type 2 diabetes",

abstract = "Objective: Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. Research design and methods: Forty T2D patients (mean age and duration of diabetes ±SD, 65.5 ± 7.3 and 9.5 ± 4.2 years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. Results: Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08–1.18] vs. controls 1.18 [1.11–1.25] (p = 0.01)), and reduced heart rate variability (p < 0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p > 0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8 % ± 8.8 vs. controls 15.8 % ± 7.7 (p < 0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p = 0.04). Conclusions: Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.",

keywords = "Autonomic nervous system, Autonomic neuropathy, Autonomic vascular control, Cardiac autonomic regulation, Type 2 diabetes",

author = "Rasmussen, {Thorsten K.} and Finnerup, {Nanna B.} and Wolfgang Singer and Jensen, {Troels S.} and John Hansen and Terkelsen, {Astrid J.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = dec,

doi = "10.1016/j.autneu.2022.103026",

language = "English",

volume = "243",

journal = "Autonomic Neuroscience: Basic and Clinical",

issn = "1566-0702",

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Preferential impairment of parasympathetic autonomic function in type 2 diabetes. / Rasmussen, Thorsten K.; Finnerup, Nanna B.; Singer, Wolfgang et al.
In: Autonomic Neuroscience: Basic and Clinical, Vol. 243, 103026, 12.2022.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Preferential impairment of parasympathetic autonomic function in type 2 diabetes

AU - Rasmussen, Thorsten K.

AU - Finnerup, Nanna B.

AU - Singer, Wolfgang

AU - Jensen, Troels S.

AU - Hansen, John

AU - Terkelsen, Astrid J.

PY - 2022/12

Y1 - 2022/12

N2 - Objective: Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. Research design and methods: Forty T2D patients (mean age and duration of diabetes ±SD, 65.5 ± 7.3 and 9.5 ± 4.2 years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. Results: Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08–1.18] vs. controls 1.18 [1.11–1.25] (p = 0.01)), and reduced heart rate variability (p < 0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p > 0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8 % ± 8.8 vs. controls 15.8 % ± 7.7 (p < 0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p = 0.04). Conclusions: Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.

AB - Objective: Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. Research design and methods: Forty T2D patients (mean age and duration of diabetes ±SD, 65.5 ± 7.3 and 9.5 ± 4.2 years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. Results: Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08–1.18] vs. controls 1.18 [1.11–1.25] (p = 0.01)), and reduced heart rate variability (p < 0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p > 0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8 % ± 8.8 vs. controls 15.8 % ± 7.7 (p < 0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p = 0.04). Conclusions: Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.

KW - Autonomic nervous system

KW - Autonomic neuropathy

KW - Autonomic vascular control

KW - Cardiac autonomic regulation

KW - Type 2 diabetes

U2 - 10.1016/j.autneu.2022.103026

DO - 10.1016/j.autneu.2022.103026

M3 - Journal article

C2 - 36137485

AN - SCOPUS:85138137574

SN - 1566-0702

VL - 243

JO - Autonomic Neuroscience: Basic and Clinical

JF - Autonomic Neuroscience: Basic and Clinical

M1 - 103026

ER -

Preferential impairment of parasympathetic autonomic function in type 2 diabetes

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Keywords

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