Impaired autonomic function in type 2 diabetic patients during upper gastrointestinal endoscopy.
BACKGROUND
Cardiac autonomic neuropathy, representing decreased parasympathetic nerve activity and predominance of sympathetic tone, is often encountered in diabetic patients, and leads to an increased risk of cardiovascular events including arrhythmia. To evaluate the potential cardiovascular risk of diabetics in performing esophagogastroduodenoscopy (EGD), we compared the autonomic function and cardiovascular parameters during EGD between diabetic and nondiabetic patients.


METHODS
The autonomic nervous responses in 86 consecutive outpatients (42 type 2 diabetics and 44 nondiabetics) were determined by power spectral analysis (PSA) of heart-rate variations on an electrocardiogram. PSA data were based on two peaks in the low-frequency (LF) and high-frequency (HF) ranges. HF power and the ratio of LF power/HF power represented parasympathetic and sympathetic nerve activities, respectively.


RESULTS
Diabetic patients showed significantly lower DeltaHF power and significantly higher DeltaLF power/HF power than nondiabetics, suggesting enhanced predominance of sympathetic activity and marked suppression of parasympathetic function. Significant correlations were found between these autonomic parameters and the diabetic duration. A slightly higher incidence of ventricular premature contractures was observed in diabetics during EGD. However, no significant difference was found in pulse or blood pressure increments during EGD between the two groups.


CONCLUSIONS
This is the first study demonstrating an imbalance of autonomic function in diabetics during EGD, which may be linked to a slightly higher risk of arrhythmia.
Mori
Akihiro
A
Department of Gastroenterology, Inuyama Chuo Hospital, 6 Futagozuka, Goromaru, Inuyama, 484-8511, Japan.
Maruyama
Takako
T
Ohashi
Noritsugu
N
Shibuya
Takashi
T
Sakai
Katsuhisa
K
Tatebe
Hideharu
H
Inoue
Hiroshi
H
Kato
Toshiharu
T
Okuno
Masataka
M
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D017776:Autonomic Pathways / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors