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Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy

¹ Dept of Internal Medicine and Endocrine-Metabolic Sciences, University of Perugia, Perugia, and ² Respiratory Medicine, University of Brescia, Brescia, Italy

CORRESPONDENCE: C. Tantucci, I Medicina, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. Fax: 39 30396011. E-mail: tantucci@med.unibs.it

Keywords: autonomic neuropathy, control of breathing, diabetes, sleep apnoea

Received: August 5, 2002
Accepted May 28, 2003

This work was supported by a grant from Ministry of Education, University and Research (MIUR) of Italy.

To assess the occurrence and nature of sleep-disordered breathing (SDB) in 26 adult, nonobese diabetics (18 with autonomic neuropathy (DAN+) (age 45 (41–50) yrs; body mass index (BMI) 24.1 (22–26) kg·m^–2) and eight without autonomic neuropathy (DAN–) (age 45 (35–55) yrs; BMI 24.8 (23–26) kg·m^–2)) overnight full sleep studies and measurements of central and peripheral carbon dioxide (CO₂) chemosensitivity were performed.

DAN+ were divided in two subgroups, according to the presence (DAN+PH+; n=10) or absence (DAN+PH–; n=8) of postural hypotension. Ten normal subjects were studied as controls (age 42 (36–48) yrs; BMI 24.4 (23–25) kg·m^–2).

In contrast to DAN– and controls, who did not show SDB, five DAN+ (four DAN+PH– and one DAN+PH+) had an apnoea/hypopnoea index 10 and four DAN+ (two DAN+PH– and two DAN+PH+) had an apnoea index 5. All the events were obstructive, occurring mainly during rapid eye movement (REM) sleep. Ten DAN+ exhibited a mean lowest oxygen saturation <90% during REM sleep. No periodic breathing or central sleep apnoeas were found in DAN+PH+, although they had an enhanced central chemoresponsiveness to CO₂. Both DAN+ subgroups showed a marked reduction in peripheral CO₂ chemosensitivity.

In conclusion, adult nonobese diabetics with autonomic neuropathy, independent of the severity of their dysautonomy, have obstructive sleep apnoea/hypopnoea with a frequency >30%. A decrease in peripheral carbon dioxide chemosensitivity prevents adult nonobese diabetics with autonomic neuropathy and postural hypotension from experiencing posthyperventilatory central sleep apnoea, despite an increased hypercapnic central drive.

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