Abnormal Response to Valsalva Maneuver in Diabetics: Relation to Autonomic Neuropathy

Diabetes ◽  
1967 ◽  
Vol 16 (7) ◽  
pp. 462-465 ◽  
Author(s):  
P. W. Nathanielsz ◽  
E. J. Ross
Keyword(s):  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Abnormal Response

scholarly journals Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
M. Matta ◽  
A. Pavy-Le Traon ◽  
S. Perez-Lloret ◽  
C. Laporte ◽  
I. Berdugo ◽  
...  
Keyword(s):  
Autonomic Neuropathy ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Valsalva Maneuver ◽  
Cardiovascular Autonomic Neuropathy ◽  
Bivariate Analysis ◽  
Diabetic Patients ◽  
Laboratory Assessment ◽  
Low Bmi ◽  
Type 1 Diabetic Patients

Aim. The prevalence of cardiovascular autonomic neuropathy (CAN) in diabetes mellitus is well documented. However, the rate and predictors of both the development and progression of CAN have been less studied. Hereby, we assessed the rate and the major risk factors for CAN initiation and progression in a cohort of type 1 diabetic patients followed over a three-year period. Methods. 175 type 1 diabetic patients (mean age: 50 ± 11 years; female/male: 76/99) with positive bedside screening for CAN were included and underwent 2 standardized autonomic testings using 4 standardized tests (deep breathing, Valsalva maneuver, 30/15 ratio, and changes in blood pressure during standing), separated by 3 ± 1 years. CAN staging was achieved according to the Toronto Consensus Panel on Diabetic Autonomic Neuropathy into 4 categories: absent, possible, confirmed, or severe CAN. Results. Out of the 175 patients included, 31.4% were free of CAN, 34.2% had possible CAN, 24.6% had confirmed CAN, and 9.7% exhibited severe CAN at the first assessment. Among the 103 patients with nonsevere CAN at inclusion, forty-one (39.8%) had an increase of at least one category when reassessed and 62 (60.2%) remained stable. A bivariate analysis indicated that only BMI and exposure to selective serotonin reuptake inhibitors (SSRIs) were significantly different in both groups. A multivariate analysis indicated that lower BMI (OR: 0.15, CI 95%: 0.05–0.48, p=0.003) and SSRI exposure (OR: 4.18, CI 95%: 1.03–16.97, p=0.04) were the sole predictors of CAN deterioration. In the 55 patients negative for CAN at the first laboratory assessment, 12 became positive at the second assessment. Conclusion. No clear predictive factor for CAN onset was identified. However, once present, CAN progression was related to low BMI and SSRI exposure.

Abnormal Response to Exercise in Middle-aged NIDDM Patients with and without Autonomic Neuropathy

1996 ◽  
Vol 13 (3) ◽  
pp. 259-265 ◽  
Author(s):  
M. Radice ◽  
A. Rocca ◽  
E. Bedon ◽  
N. Musacchio ◽  
A. Morabito ◽  
...  
Keyword(s):  
Autonomic Neuropathy ◽  
Middle Aged ◽  
Abnormal Response ◽  
Response To Exercise ◽  
Niddm Patients

scholarly journals Time in Range, as a Novel Metric of Glycemic Control, Is Reversely Associated with Presence of Diabetic Cardiovascular Autonomic Neuropathy Independent of HbA1c in Chinese Type 2 Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Qingyu Guo ◽  
Pu Zang ◽  
Shaoying Xu ◽  
Wenjing Song ◽  
Zhen Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Logistic Regression ◽  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Glycemic Variability ◽  
Cardiovascular Autonomic Neuropathy ◽  
Rate Variation ◽  
Time In Range ◽  
The Relationship

Objective. The objective of this study is to investigate the relationship between time in range (TIR), a new metric of continuous glucose monitoring (CGM) and cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes mellitus (T2DM). Methods. A total of 349 individuals with T2DM were enrolled in this study. Evaluating by the standard cardiac autonomic reflex tests (CARTs), there were 228 diabetic individuals without cardiovascular autonomic neuropathy (without confirmed CAN) including absent CAN (n=83 cases) and early CAN (n=145 cases) and 121 diabetic individuals complicated with cardiovascular autonomic neuropathy (CAN) including definite CAN (n=109 cases) and severe CAN (n=12 cases). All patients underwent 3-day CGM. TIR is defined as the time percent during a 24-hour period when the glucose is in the range of 3.9-10 mmol/L. The Spearman analysis was used to analyze the correlation between TIR and CART parameters, total CAN score. The logistic regression was applied to analyze the relationship between TIR and CAN by adjusting for the age, duration of diabetes, sex, lipid situation, serum creatinine, body mass index, blood pressure, HbA1c (%), and other glycemic variability (GV) metrics. Results. The total presence of CAN was 34.67% (definite CAN 31.23% and severe CAN 3.44%). Patients with more severe CAN had lower TIR (P<0.001). With increasing quartiles of TIR, the presence of CAN by severity declined (P<0.05). TIR is inversely correlated with total score of CAN (P<0.001) and positively associated with heart rate variation during the lying to standing, Valsalva maneuver, and deep breathing (P<0.05). The logistic regression found a robust association between TIR and CAN independent of HbA1c and GV metrics. Conclusion. TIR is associated with the presence of CAN independent of HbA1c and GV metrics in Chinese type 2 diabetes.

Cardiovascular Autonomic Reflex Tests and 7 Heart Rate Variability Indices for Early Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Individuals

2021 ◽  
Vol 17 ◽  
Author(s):  
Yeelen Ballesteros Atala ◽  
Mozânia Reis De Matos ◽  
Denise Engelbrecht Zantut-Wittmann ◽  
Alejandro Rosell Castillo ◽  
Daniele P Santos-Bezerra ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Cross Sectional Study ◽  
Cardiovascular Autonomic Neuropathy ◽  
Cross Sectional ◽  
Autonomic Reflex

Background: Cardiovascular autonomic neuropathy (CAN) is a common complication of type 2 Diabetes mellitus (T2D), and prevalence varies according to the methodology used. CAN should be diagnosed in the subclinical stage when an intensive treatment of T2D could avoid the progression to irreversible phases. Objective: Determine the prevalence of early involvement (EI) of CAN in T2D individuals comparing two methodologies. Methods: This was a cross-sectional study that included 183 T2D individuals who were monitored in a Tertiary centre. The diagnosis of CAN was based on the results of four cardiovascular autonomic reflex tests (CARTs: expiration-inspiration index, Valsalva maneuver, orthostatic test, and changes in blood pressure after standing) and of seven heart rate variability (7HRV) indices (CARTs plus the spectral analysis). The findings were validated in an independent cohort comprised of 562 T2D individuals followed in a Primary care setting. Results: With the use of 7HRV, 30.6% and 77.8% of individuals in the Tertiary and in the Primary centers, respectively, were classified as without CAN; 25.1% and 15.3% as EI and 44.3% and 6.9% as definitive CAN, respectively. The use of CARTs decreased the proportion of individuals without CAN in both centers (7.1% and 47%) and increased the frequency of EI (30.6% and 36.6%) and definitive CAN (62.3% and 16.4%), respectively. The concordance between both evaluated methodologies was weak. Conclusion: Higher proportions of T2D individuals were diagnosed with EI and with definitive CAN with the use of CARTs.

scholarly journals Autonomic Neuropathy in Healthy Elderly Person

2014 ◽  
Vol 8 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Taslima Islam ◽  
Noorzahan Begum ◽  
Sultana Ferdousi
Keyword(s):  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Elderly Person ◽  
Autonomic Nerve ◽  
Elderly Subjects ◽  
Nerve Function ◽  
Cross Sectional ◽  
Autonomic Nerve Function ◽  
Healthy Elderly ◽  
Apparently Healthy

Background: Cardiac autonomic nerve function can be affected in older age. Objective: To find out the degree of autonomic neuropathy by autonomic nerve function scoring system in apparently healthy elderly subjects. Methods: This cross sectional study was conducted in the Department of Physiology, BSMMU, Dhaka between July 2005 and June 2006.For study group, 30 elderly subjects age ranged from 51-60 years were enrolled in one group whereas another 30 elderly subjects age between 61-70 years were enrolled in another group. For comparison sex and BMI matched thirty apparently healthy adults with age from 21-30 years were studied as control. Autonomic nerve function status of all the subjects were examined by five simple non-invasive cardiovascular reflex tests Valsalva maneuver deep breathing test, orthostatic test handgrip test, and sudden standing. Autonomic nerve function (ANF) scoring was done to find out the degree of autonomic neuropathy. Results: 23.34% of subjects of 61-70 years group showed autonomic nerve dysfunctions and 20% had early involvement and 3.34% of them had definite involvement of Autonomic neuropathy. But this percentage was relatively less (10%) in 51-60 years who had early involvement and none had found definite involvement whereas autonomic nerve function was normal in 21-30 years age group.. Conclusion: From this study, it can be concluded that aging process substantially impaired cardiovascular autonomic nerve function. DOI: http://dx.doi.org/10.3329/jbsp.v8i2.18658 Bangladesh Soc Physiol. 2013, December; 8(2): 77-83

scholarly journals Diabetic Retinopathy Is Strongly Predictive of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chih-Cheng Huang ◽  
Jong-Jer Lee ◽  
Tsu-Kung Lin ◽  
Nai-Wen Tsai ◽  
Chi-Ren Huang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Risk Factor ◽  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cardiovascular Autonomic Neuropathy ◽  
Deep Breathing

A well-established, comprehensive, and simple test battery was used here to re-evaluate risk factors for cardiovascular autonomic neuropathy (CAN) in type 2 diabetes. One hundred and seventy-four patients with type 2 diabetes were evaluated through the methods of deep breathing and Valsalva maneuver for correlation with factors that might influence the presence and severity of CAN. The Composite Autonomic Scoring Scale (CASS) was used to grade the severity of autonomic impairment, and CAN was defined as a CASS score ≥2. Results showed that nephropathy, duration of diabetes, blood pressure, uric acid, and the presence of retinopathy and metabolic syndrome significantly correlated with the CASS score. Age may not be a risk factor for diabetic CAN. However, the effects of diabetes on CAN are more prominent in younger patients than in older ones. Diabetic retinopathy is the most significant risk factor predictive of the presence of CAN in patients with type 2 diabetes.

Abnormal Response to the Valsalva Maneuver in Patients on Chronic Hemodialysis

Nephron ◽  
1972 ◽  
Vol 9 (4) ◽  
pp. 251-256 ◽  
Author(s):  
G. Soriano ◽  
R.P. Eisinger
Keyword(s):  
Valsalva Maneuver ◽  
Chronic Hemodialysis ◽  
Abnormal Response

scholarly journals A study of cardiovascular reflexes in diabetic autonomic neuropathy patients at a tertiary care hospital

2017 ◽  
Vol 4 (6) ◽  
pp. 1676
Author(s):  
Dasharatham Ponna ◽  
E. Ashok Kumar ◽  
Arun Kumar Ponna
Keyword(s):  
Autonomic Neuropathy ◽  
Postural Hypotension ◽  
Tertiary Care Hospital ◽  
Average Duration ◽  
Tertiary Care ◽  
Diabetic Autonomic Neuropathy ◽  
Cardiovascular Reflexes ◽  
Care Hospital ◽  
Duration Of Diabetes ◽  
Abnormal Response

Background: Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes mellitus which is generally neglected by the treating doctor as well as patient. The objective of the study was to study cardiovascular reflexes in diabetic autonomic neuropathy at a tertiary care hospital.Methods: Present hospital based cross sectional study was conducted at Osmania Medical College and General Hospital which is a tertiary care hospital for a period of two years among 80 known cases of diabetes. Institutional Ethics Committee permission was obtained, and informed consent was taken.Results: In the present study, maximum i.e. 60% were males. Postural hypotension was noted in the long-standing diabetics. The average duration of diabetes showing postural hypotension was 13.5 years. The highest recorded postural hypotension was 50 mmHg. 30% showed the autonomic damage. 45% showed normal variation. 25% showed border line variation. 30% had abnormal response (A Valsalva ratio of 1.10 and less is abnormal). 35% showed abnormal response (If the ratio is 1.00 or less, vagal damage is probably present).Conclusions: The average duration of diabetes showing postural hypotension was 13.5 years. The highest recorded postural hypotension was 50 mmHg. 25% of the patients had blood pressure fall of 30 mmHg and more. In 55% of the cases, the fall was between 10-20 mmHg. 30% showed the autonomic damage. 30% had abnormal Valsalva ratio. 

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