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J Appl Physiol 90: 889-896, 2001;
8750-7587/01 $5.00
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Vol. 90, Issue 3, 889-896, March 2001

Cerebrovascular reactivity and hypercapnic respiratory drive in diabetic autonomic neuropathy

Claudio Tantucci1, Paolo Bottini2, Claudio Fiorani3, Marco L. Dottorini2, Fausto Santeusanio2, Leandro Provinciali3, Carlo Augusto Sorbini1, and Giovanni Casucci2

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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