title: A novel association between nondipping and painful diabetic polyneuropathy.
abstract: OBJECTIVE
  We hypothesized the meaningful coexistence of neuropathic pain and nondipping in painful diabetic polyneuropathy (PDPN).
  
  
  METHODS
  In 113 patients with PDPN, with painless diabetic polyneuropathy (DPN(+)) and without DPN (DPN(-)), neuropathic pain, sleep, risk for obstructive sleep apnea (OSA), autonomic function, and blood pressure (BP) circadian pattern were assessed using the Douleur Neuropathique en 4 Questions (DN4), the Medical Outcomes Study Sleep Scale, the Berlin Questionnaire, cardiovascular reflex tests, and ambulatory BP monitoring.
  
  
  RESULTS
  Patients with PDPN showed higher nighttime systolic BP (130.4 ± 15.6 mmHg) than both DPN(-) (119.9 ± 10.6 mmHg; P < 0.0001) and DPN(+) patients (124.2 ± 12.3 mmHg; P < 0.05), and lower day-night difference (∆) in systolic BP (5.5 ± 6.5 vs. 8.6 ± 7.7%; P < 0.05) and diastolic BP than DPN(-) patients. In a stepwise regression analysis, orthostatic hypotension, high risk for OSA, and PDPN (DN4 interview) were independent determinants of ∆ in systolic BP (r = 0.46; P = 0.0001), ∆ in diastolic BP, and nighttime systolic BP.
  
  
  CONCLUSIONS
  PDPN is associated with higher nocturnal systolic BP and impaired BP circadian pattern independent of pain-related comorbidities, suggesting a condition of high cardiovascular risk.
authors: Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
authors: Cinzia
authors: C
authors: D'Amato
authors: Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
authors: Roberto
authors: R
authors: Morganti
authors: Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
authors: Federica
authors: F
authors: Di Gennaro
authors: Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
authors: Carla
authors: C
authors: Greco
authors: Neurology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
authors: Girolama A
authors: GA
authors: Marfia
authors: Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy vispa@mclink.it.
authors: Vincenza
authors: V
authors: Spallone
mesh_terms: D001794:Blood Pressure; D001795:Blood Pressure Determination; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000150:complications / Q000503:physiopathology*; D017286:Polysomnography; D012044:Regression Analysis; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology*