Abstract
This study was designed to assess the effect of patient posture, either sitting or supine, on the results and diagnostic yield of tests of cardiorespiratory reflexes on 25 normal subject controls and 128 patients with diabetes mellitus. The heart rate changes during slow breathing at 6 per minute (ΔR6) and during a Valsalva manoeuvre (highest heart rate during manoeuvre divided by lowest heart rate within 30 s after manoeuvre; Valsalva ratio) were measured from the electrocardiographic signal and tachometry. In control subjects, heart rate changes during slow breathing averaged 25.0 when sitting and 21.3 when supine (p < 0.01); Valsalva ratio averaged 1.90 and 1.83 (p > 0.2) respectively. In diabetic patients, mean values for heart rate changes during slow breathing were 6.1 and 5.1, and mean values for Valsalva ratio were 1.23 and 1.28 in sitting and supine postures respectively. According to our normal limits, heart rate changes during slow breathing was below normal in 109 patients tested when sitting and in 113 tested when supine, and Valsalva ratio was abnormal in 103 and 95 respectively. These results indicate that subject posture is an important variable of cardiorespiratory reflex testing, and should be standardized to allow comparisons of individual results.
Similar content being viewed by others
References
Ewing DJ. Recent advances in the non-invasive investigation of diabetic autonomic neuropathy. In: Bannister R, ed.Autonomic failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1988: 667–689.
McLeod JG. Autonomic dysfunction in peripheral nerve disease.Muscle Nerve 1992;15: 3–13.
Hilsted J. Testing for autonomic neuropathy.Ann Clin Res 1984;16: 128–135.
Dyrberg T, Benn J, Christiansen JS, Hilsted J, Nerup J. Prevalence of diabetic autonomic neuropathy measured by simple bedside tests.Diabetologia 1981;20: 190–194.
Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes.Diabetes Care 1985;8: 491–498.
Kennedy WR, Navarro X, Sakuta M, Mandell H, Knox C, Sutherland DER. Physiological and clinical correlates of cardiorespiratory reflexes in diabetes mellitus.Diabetes Care 1989;12: 399–408.
Low PA, Zimmerman BR, Dyck PJ. Comparison of distal sympathetic with vagal function in diabetic neuropathy.Muscle Nerve 1986;4: 592–596.
Zola B, Khan JK, Juni JE, Vinik AI. Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischemic heart disease.J Clin Endocrinol Metab 1986;63: 208–214.
Canal N, Comi G, Saibene V, Musch B, Pozza G. The relationship between peripheral and autonomic neuropathy in insulin dependent diabetes: a clinical and instrumental evaluation. In: Canal N, Pozza G, eds.Peripheral Neuropathies. Amsterdam: Elsevier, 1978: 247–255.
Pfeifer MA, Weinberg CR, Cook DL, Reenan A, Halter JA, Ensinck JW, Porte D Jr. Autonomic neural dysfunction in recently diagnosed diabetic subjects.Diabetes Care 1984;7: 447–453.
Page MB, Watkins PJ, Cardiorespiratory arrest and diabetic autonomic neuropathy.Lancet 1978;i: 14–16.
Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy.Quart J Med 1980;193: 95–108.
Navarro X, Kennedy WR, Loewenson RB, Sutherland DER. Influence of pancreas transplantation on cardiorespiratory reflexes, nerve conduction, and mortality in diabetes mellitus.Diabetes 1990;39: 802–806.
Eckberg DL. Parasympathetic cardiovascular control in human disease: a critical review of methods and results.Am J Physiol 1980;239: H581-H593.
Benarroch EE, Opfer-Gehrking TL, Low PA. Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man.Muscle Nerve 1991;14: 1165–1172.
Ten Harkel ADJ, Van Lieshout JJ, Van Lieshout EJ, Wieling W. Assessment of cardiovascular reflexes: influence of posture and period of preceding rest.J Appl Physiol 1990;68: 147–153.
O'Brien IA, O'Hare P, Corrall RJM. Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function.Br Heart J 1986;55: 348–354.
Wieling W, Van Brederode JFM, De Rijk LG, Borst C, Dunning AJ. Reflex control of heart rate in normal subjects in relation to age: a database for cardiac vagal neuropathy.Diabetologia 1982;22: 163–166.
Van Dijk JG, Koenderink M, Zwinderman AH, Haan J, Kramer CJS, den Heijer JC. Autonomic nervous system tests depend on resting heart rate and blood pressure.J Auton Nerv System 1991;35: 15–24.
Hellman J, Stacy RW. Variation of respiratory synus arrhythmia with age.J Appl Physiol 1976;41: 734–738.
Ingall TJ, McLeod JG, O'Brien PC. The effect of ageing on autonomic nervous system function.Aust NZ J Med 1990;20: 570–577.
Kalbfleisch JH, Stowe DF, Smith JJ. Evaluation of the heart rate response to the Valsalva maneuver.Am Heart J 1978;95: 707–715.
Vita G, Princi P, Calabro R, Toscano A, Manna L, Messina C. Cardiovascular reflex tests. Assessment of age-adjusted normal range.J Neurol Sci 1986;75: 263–274.
Waddington JL, Macculloch MJ, Sambrooks JE. Resting heart rate variability in man declines with age.Experiments 1979;35: 1197–1198.
Melcher A. Respiratory sinus arrhythmia in man. A study in heart rate regulating mechanisms.Acta Physiol Scand 1976; suppl435: 1–31.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Navarro, X., Kennedy, W.R. Influence of posture on cardiorespiratory reflexes in normal subjects and patients with diabetes mellitus. Clinical Autonomic Research 2, 393–396 (1992). https://doi.org/10.1007/BF01831397
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01831397