Department of Pediatrics, Region Kalmar County, Kalmar, Sweden.
Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
Ann Noninvasive Electrocardiol. 2020 Sep;25(5):e12760. doi: 10.1111/anec.12760. Epub 2020 Apr 30.
Autonomic neuropathy (AN) commonly arises as a long-term complication in diabetes mellitus and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram recordings. Psychosocial stress also affects HRV and could be one of several confounders for cardiac AN. The present work investigated the impact of psychosocial stress on HRV in individuals with type 1 diabetes mellitus (T1DM) and assessed the use of salivary cortisol as a biomarker for psychosocial stress in this context.
A total of 167 individuals 6-60 years old (113 with T1DM and 54 healthy controls) underwent 24-hr ECG recordings with HRV analysis. Salivary cortisol was sampled thrice during the registration day. Perceived psychosocial stress along with other factors of possible importance for the interpretation of HRV was documented in a diary.
Heart rate variability (high-frequency power during sleep) was reduced (p < .05) with older age, longer diabetes duration, higher mean glucose levels, physical inactivity, and perceived psychosocial stress. Salivary cortisol levels in the evening were increased (p < .05) in women in ovulation phase, in individuals with preceding hypoglycemia or with hyperglycemia. The amplitude of salivary cortisol was reduced (p < .05) with the presence of perceived psychosocial stress, but only in adult healthy controls, not in individuals with diabetes.
Psychosocial stress might be a confounder for reduced HRV when diagnosing cardiac AN in T1DM. Salivary cortisol is, however, not a useful biomarker for psychosocial stress in diabetes since the physiological stress of both hypoglycemia and hyperglycemia seems to overrule the effect of psychosocial stress on cortisol.
自主神经病变（AN）通常是糖尿病的一种长期并发症，可以通过心电图记录计算的心率变异性（HRV）来诊断。心理社会应激也会影响 HRV，并且可能是心脏 AN 的几个混杂因素之一。本研究调查了心理社会应激对 1 型糖尿病（T1DM）患者 HRV 的影响，并评估了唾液皮质醇作为该背景下心理社会应激生物标志物的用途。
共有 167 名年龄在 6-60 岁的个体（113 名患有 T1DM，54 名健康对照）接受了 24 小时心电图记录和 HRV 分析。在登记日期间三次采集唾液皮质醇样本。在日记中记录了感知到的心理社会应激以及其他可能对 HRV 解释很重要的因素。
心率变异性（睡眠期间的高频功率）随着年龄的增长、糖尿病病程的延长、平均血糖水平的升高、身体活动的减少和感知到的心理社会应激而降低（p<0.05）。在女性排卵期间、发生低血糖或高血糖之前，傍晚的唾液皮质醇水平升高（p<0.05）。在感知到心理社会应激时，唾液皮质醇的幅度降低（p<0.05），但仅在成年健康对照中，而不是在糖尿病患者中。
在诊断 T1DM 中的心脏 AN 时，心理社会应激可能是 HRV 降低的混杂因素。然而，唾液皮质醇并不是糖尿病患者心理社会应激的有用生物标志物，因为低血糖和高血糖的生理应激似乎超过了心理社会应激对皮质醇的影响。
