Loss of Breathing Modulation of Heart Rate Variability in Patients with Recent and Long Standing Diabetes Mellitus Type II.
Healthy subjects under rhythmic breathing have heart interbeat intervals with a respiratory band in the frequency domain that can be an index of vagal activity. Diabetes Mellitus Type II (DM) affects the autonomic nervous system of patients, thus it can be expected changes on the vagal activity. Here, the influence of DM on the breathing modulation of the heart rate is evaluated by analyzing in the frequency domain heart interbeat interval (IBI) records obtained from 30 recently diagnosed, 15 long standing DM patients, and 30 control subjects during standardized clinical tests of controlled breathing at 0.1 Hz, supine rest and standing upright. Fourier spectral analysis of IBI records quantifies heart rate variability in different regions: low-frequencies (LF, 0.04-0.15 Hz), high-frequencies (HF, 0.15-0.4 Hz), and a controlled breathing peak (RP, centered around 0.1 Hz). Two new parameters are introduced: the frequency radius rf (square root of the sum of LF and HF squared) and β (power of RP divided by the sum of LF and HF). As diabetes evolves, the controlled breathing peak loses power and shifts to smaller frequencies, indicating that heart rate modulation is slower in diabetic patients than in controls. In contrast to the traditional parameters LF, HF and LF/HF, which do not show significant differences between the three populations in neither of the clinical tests, the new parameters rf and β, distinguish between control and diabetic subjects in the case of controlled breathing. Sympathetic activity that is driven by the baroreceptor reflex associated with the 0.1 Hz breathing modulations is affected in DM patients. Diabetes produces not only a rigid heartbeat with less autonomic induced variability (rf diminishes), but also alters the coupling between breathing and heart rate (reduced β), due to a progressive decline of vagal and sympathetic activity.
Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México.|Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.
Ana Leonor
http://orcid.org/0000-0002-0296-7966
AL
Rivera
Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.|Laboratorio de Neurofisiología, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
Bruno
B
Estañol
Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México.|Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.
Ruben
R
Fossion
Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.
Juan C
JC
Toledo-Roy
Laboratorio de Neurofisiología, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
José A
JA
Callejas-Rojas
Laboratorio de Neurofisiología, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
José A
JA
Gien-López
Laboratorio de Neurofisiología, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.|Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
Guillermo R
GR
Delgado-García
Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México.|Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.|Colegio Nacional, México City, México.
Alejandro
A
Frank
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012018:Reflex / Q000502:physiology; D012119:Respiration; D055815:Young Adult