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Clinica di 1 Semeiotica e Metodologia Medica and 3 Neurologia e Neuroriabilitazione, University of Ancona, 60020 Ancona; and 2 Dipartimento di Medicina Interna e Scienze Endocrino-Metaboliche, University of Perugia, 06100 Perugia, Italy
Because abnormalities in
cerebrovascular reactivity (CVR) in subjects with long-term diabetes
could partly be ascribed to autonomic neuropathy and related to central
chemosensitivity, CVR and the respiratory drive output during
progressive hypercapnia were studied in 15 diabetic patients without
(DAN
) and 30 with autonomic neuropathy (DAN+), of whom 15 had
postural hypotension (PH) (DAN+PH+) and 15 did not (DAN+PH), and in
15 control (C) subjects. During CO2 rebreathing,
changes in occlusion pressure and minute ventilation were assessed, and
seven subjects in each group had simultaneous measurements of the
middle cerebral artery mean blood velocity (MCAV) by transcranial
Doppler. The respiratory output to CO2 was greater in
DAN+PH+ than in DAN+PH and DAN (P < 0.01), whereas
a reduced chemosensitivity was found in DAN+PH (P < 0.05 vs. C). MCAV increased linearly with the end-tidal
PCO2 (PETCO2) in
DAN+PH but less than in C and DAN (P < 0.01). In contrast, DAN+PH+ showed an exponential increment in MCAV with PETCO2 mainly >55 Torr. Thus CVR
was lower in DAN+ than in C at PETCO2 <55
Torr (P < 0.01), whereas it was greater in DAN+PH+ than in DAN+PH (P < 0.01) and DAN
(P < 0.05) at PETCO2 >55
Torr. CVR and occlusion pressure during hypercapnia were correlated only in DAN+ (r = 0.91, P < 0.001). We
conclude that, in diabetic patients with autonomic neuropathy, CVR to
CO2 is reduced or increased according to the severity of
dysautonomy and intensity of stimulus and appears to modulate the
hypercapnic respiratory drive.
diabetes; control of breathing
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