Effect of hypoxia on heart rate variability and baroreflex sensitivity during hypoglycemia in type 1 diabetes mellitus

Jacqueline K. Limberg, Simmi Dube, Myrthe Kuijpers, Kathryn E. Farni, Ananda Basu, Robert A. Rizza, Timothy B Curry, Rita Basu, Michael Joseph Joyner

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Patients with type 1 diabetes mellitus exhibit impairments in autonomic and cardiovascular control which are worsened with acute hypoglycemia––thus increasing the risk of adverse cardiovascular events. Hypoxia, as seen with the common comorbidity of sleep apnea, may lead to further autonomic dysfunction and an increased risk of ventricular arrhythmias. Therefore, we hypothesized that heart rate variability (HRV) and baroreflex sensitivity (BRS) would be reduced during hypoglycemia in adults with type 1 diabetes, with a further decline when combined with hypoxia. Methods: Subjects with type 1 diabetes (n = 13; HbA1c = 7.5 ± 0.3 %, duration of diabetes = 17 ± 5 yrs) completed two 180 min hyperinsulinemic (2 mU/kg TBW/min), hypoglycemic (~3.3 µmol/mL) clamps separated by a minimum of 1 week and randomized to normoxia (S<inf>p</inf>O<inf>2</inf> ~98 %) or hypoxia (S<inf>p</inf>O<inf>2</inf> ~85 %). Heart rate (electrocardiogram) and blood pressure (finger photoplethysmography) were analyzed at baseline and during the hypoglycemic clamp for measures of HRV and spontaneous cardiac BRS (sCBRS). Results: Hypoglycemia resulted in significant reductions in HRV and sCBRS when compared with baseline levels (main effect of hypoglycemia: p < 0.05). HRV and sCBRS were further impaired during hypoxia (main effect of hypoxia: p < 0.05). Conclusions: Acute hypoxia worsens hypoglycemia-mediated impairments in autonomic and cardiovascular control in patients with type 1 diabetes and may increase the risk of cardiovascular mortality. These results highlight the potential cumulative dangers of hypoglycemia and hypoxia in this vulnerable population.

Original languageEnglish (US)
Pages (from-to)243-250
Number of pages8
JournalClinical Autonomic Research
Volume25
Issue number4
DOIs
StatePublished - Aug 22 2015

Fingerprint

Baroreflex
Type 1 Diabetes Mellitus
Hypoglycemia
Heart Rate
Hypoglycemic Agents
Photoplethysmography
Sleep Apnea Syndromes
Vulnerable Populations
Hypoxia
Fingers
Comorbidity
Cardiac Arrhythmias
Electrocardiography
Blood Pressure
Mortality

Keywords

  • Baroreflex sensitivity
  • Heart rate variability
  • Hypoglycemia
  • Hypoxia
  • Type 1 diabetes mellitus

ASJC Scopus subject areas

  • Clinical Neurology
  • Endocrine and Autonomic Systems

Cite this

Effect of hypoxia on heart rate variability and baroreflex sensitivity during hypoglycemia in type 1 diabetes mellitus. / Limberg, Jacqueline K.; Dube, Simmi; Kuijpers, Myrthe; Farni, Kathryn E.; Basu, Ananda; Rizza, Robert A.; Curry, Timothy B; Basu, Rita; Joyner, Michael Joseph.

In: Clinical Autonomic Research, Vol. 25, No. 4, 22.08.2015, p. 243-250.

Research output: Contribution to journalArticle

Limberg, Jacqueline K. ; Dube, Simmi ; Kuijpers, Myrthe ; Farni, Kathryn E. ; Basu, Ananda ; Rizza, Robert A. ; Curry, Timothy B ; Basu, Rita ; Joyner, Michael Joseph. / Effect of hypoxia on heart rate variability and baroreflex sensitivity during hypoglycemia in type 1 diabetes mellitus. In: Clinical Autonomic Research. 2015 ; Vol. 25, No. 4. pp. 243-250.
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AU - Limberg, Jacqueline K.

AU - Dube, Simmi

AU - Kuijpers, Myrthe

AU - Farni, Kathryn E.

AU - Basu, Ananda

AU - Rizza, Robert A.

AU - Curry, Timothy B

AU - Basu, Rita

AU - Joyner, Michael Joseph

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AB - Purpose: Patients with type 1 diabetes mellitus exhibit impairments in autonomic and cardiovascular control which are worsened with acute hypoglycemia––thus increasing the risk of adverse cardiovascular events. Hypoxia, as seen with the common comorbidity of sleep apnea, may lead to further autonomic dysfunction and an increased risk of ventricular arrhythmias. Therefore, we hypothesized that heart rate variability (HRV) and baroreflex sensitivity (BRS) would be reduced during hypoglycemia in adults with type 1 diabetes, with a further decline when combined with hypoxia. Methods: Subjects with type 1 diabetes (n = 13; HbA1c = 7.5 ± 0.3 %, duration of diabetes = 17 ± 5 yrs) completed two 180 min hyperinsulinemic (2 mU/kg TBW/min), hypoglycemic (~3.3 µmol/mL) clamps separated by a minimum of 1 week and randomized to normoxia (SpO2 ~98 %) or hypoxia (SpO2 ~85 %). Heart rate (electrocardiogram) and blood pressure (finger photoplethysmography) were analyzed at baseline and during the hypoglycemic clamp for measures of HRV and spontaneous cardiac BRS (sCBRS). Results: Hypoglycemia resulted in significant reductions in HRV and sCBRS when compared with baseline levels (main effect of hypoglycemia: p < 0.05). HRV and sCBRS were further impaired during hypoxia (main effect of hypoxia: p < 0.05). Conclusions: Acute hypoxia worsens hypoglycemia-mediated impairments in autonomic and cardiovascular control in patients with type 1 diabetes and may increase the risk of cardiovascular mortality. These results highlight the potential cumulative dangers of hypoglycemia and hypoxia in this vulnerable population.

KW - Baroreflex sensitivity

KW - Heart rate variability

KW - Hypoglycemia

KW - Hypoxia

KW - Type 1 diabetes mellitus

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