More severe forms of cardiovascular autonomic neuropathy increase the incidence of nocturnal ventricular arrhythmias in adults with type 2 diabetes, according to findings presented in the Journal of Diabetes.
“There are multiple reasons for the occurrence of fatal arrhythmias during sleep,” Yan Bi, of the department of endocrinology at Drum Tower Hospital, Nanjing University Medical School in Nanjing, China, and colleagues wrote. “One factor is autonomic neuropathy, which may result in ion channel disorder and cardiac electrophysiological disorder.”
Bi and colleagues measured CV autonomic neuropathy (CAN) severity in 219 adults with type 2 diabetes who were recruited between January 2017 and May 2018 at Drum Tower Hospital.
Four measures were combined to establish the degree of CAN severity: blood pressure variability after standing, heart rate variability during deep breathing, heart rate variability during the Valsalva maneuver, and heart rate variability going from lying down to standing. Based on the results of these tests, participants were categorized as without CAN (n = 43; mean age, 45.4 years; 27.9% women) or having early (n = 87; mean age, 56.5 year; 29.9% women), definite (n = 69; mean age, 57.8 years; 36.2% women) or advanced (n = 20; mean age, 59.5 years; 40% women) forms of the condition. Once CAN status was established, participants were monitored for 24 hours with arrhythmia events recorded.
Participants with the most severe form of CAN, which the researchers called advanced CAN, had the highest rate of ventricular arrhythmia at night (60%) compared with the rates in early (29.9%) and definite (36.2%) stages as well as those with no CAN (18.6%; P for trend = .034). In addition, the researchers observed an independent association between increasing CAN severity and nocturnal ventricular arrhythmias (OR = 1.765; 9% CI, 1.184-2.632).
“Arrhythmias, especially ventricular arrhythmias, are an important cause of morbidity and sudden death in almost all forms of heart disease,” the researchers wrote. “Our findings suggest that early detection of CAN and monitoring of nocturnal arrhythmias may help predict the incidence of adverse cardiovascular events and mortality during sleep in patients with [type 2 diabetes].” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.