Circulation, Vol 86, 1443-1452, Copyright © 1992 by American Heart Association
L Bernardi, L Ricordi, P Lazzari, P Solda, A Calciati, MR Ferrari, I Vandea, G Finardi and P Fratino
BACKGROUND. Diabetic subjects have a high incidence of cardiovascular
accidents, with an altered circadian distribution. Abnormalities in the
circadian rhythm of autonomic tone may be responsible for this altered
temporal onset of cardiovascular disease. METHODS AND RESULTS. To assess
circadian changes of sympathovagal balance in diabetes, we performed
24-hour power spectral analysis of RR interval fluctuations in 54 diabetic
subjects (age, 44 +/- 2 years) with either normal autonomic function or
mild to severe autonomic neuropathy and in 54 age- matched control
subjects. The power in the low-frequency (LF, 0.03-0.15 Hz) and
high-frequency (HF, 0.18-0.40 Hz) bands was considered an index of relative
sympathetic and vagal activity, respectively. Diabetic subjects with
autonomic abnormalities showed a reduction in LF compared with control
subjects (5.95 +/- 0.12 In-msec2 versus 6.73 +/- 0.11, p < 0.001) and an
even greater reduction in LF, particularly during the night and the first
hours after awakening (5.11 +/- 0.18 In-msec2 versus 6.52 +/- 0.14, p <
0.001). Day-night rhythm in sympathovagal balance was reduced or absent in
diabetic subjects compared with control subjects. CONCLUSIONS. Diabetic
subjects with or without signs of autonomic neuropathy have a decreased
vagal activity (and hence a relatively higher sympathetic activity) during
night hours and at the same time of the day, during which a higher
frequency of cardiovascular accidents has been reported. These observations
may provide insight into the increased cardiac risk of diabetic patients,
particularly if autonomic neuropathy is present.
ARTICLES
Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease
Department of Internal Medicine, First Medical Clinics, University of Pavia, Italy.
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