Quantitative Evaluation of Diabetic Autonomic Neuropathy by Using Heart Rate Variations

Determination of the Normal Range for the Diagnosis of Autonomic Neuropathy

Abstract

OIKAWA, N., UMETSU, M., TOYOTA, T. and GOTO, Y. Quantitative Evaluation of Diabetic Autonomic Neuropathy by Using Heart Rate Variations - Determination of the Normal Range for the Diagnosis of Autonomic Neuropathy. Tohoku J. exp. Med., 1985, 145 (3), 233-241 - Heart rate (HR) variations -in supine resting position, during deep breathing and on standing - were measured in 162 healthy subjects and 168 diabetics by use of an instantaneous-HR-change continuous recorder. As indices of HR variations, the standard deviation of the HR at rest (SD of HR), the mean difference between maximal and minimal HR during deep breathing (ΔI-E) and the HR increase on standing (ΔHR) were determined. In healthy subjects, the values for each test declined with age and the log-transformed data fitted the linear regression. The 90% confidence limits were calculated for the normal range and the values below normal range were defined as abnormal. In diabetics, the incidence of abnormal response were 19% in the SD of HR, 38% in the ΔI-E and 22% in the ΔHR. The ΔI-E was the most sensitive index for the autonomic neuropathy. The ΔHR was considered to be able to detect the different mechanisms of neural reflexes because of the poor correlation between the ΔHR and the respiratory HR variations. The present studies suggested that ΔI-E and ΔHR should be measured at the same time to evaluate the autonomic neuropathy.