Reyes-Lagos José Javier, Guzmán-Ramos Kioko, Lomelí Joel, Pliego-Carrillo Adriana Cristina, Peña-Castillo Miguel Ángel, López-Sánchez Pedro, Trujillo-Condes Virgilio Eduardo, Garay-Jiménez Laura Ivoone, Echeverría Juan Carlos, Villegas-Zarco María Fernanda, Santiago-Fuentes Laura Mercedes
Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca de Lerdo, Toluca, Mexico.
Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Lerma, Lerma, Mexico.
Front Physiol. 2025 Apr 25;16:1584922. doi: 10.3389/fphys.2025.1584922. eCollection 2025.
The Pulse-Respiration Quotient (PRQ) is considered a powerful tool for assessing dynamic interactions between cardiac and respiratory rhythms. Type 2 diabetes mellitus (T2DM) disrupts autonomic control, potentially compromising the complexity and adaptability of cardiorespiratory dynamics. In this cross-sectional, exploratory study, we investigated whether T2DM alters cardiorespiratory dynamics by analyzing short-term PRQ signals using conventional linear indices and Recurrence Quantification Analysis (RQA).
Thirty-eight participants (20 T2DM and 18 controls) completed four standardized tasks-supine rest, orthostatic challenge, paced breathing, and the Valsalva maneuver-while electrocardiographic and respiratory signals were continuously recorded. From these signals, R-to-R peak interval (RRI) and breath-to-breath (BB) time series were derived, allowing us to compute the PRQ time series as the ratio of instantaneous heart rate to instantaneous breathing rate. Linear indices of PRQ and RQA metrics were then calculated for the PRQ signals, enabling comparisons between groups (T2DM vs. control) and across tasks. Additionally, entropy-based mutual information (MI) between RRI and BB was assessed as a quantitative measure of cardiorespiratory coupling.
T2DM participants exhibited higher recurrence rates and prolonged recurrence time of the first type in the PRQ series, especially during paced breathing, suggesting a more rigid and less adaptive control mechanism. Although linear PRQ indices showed changes in some stage-dependent responses, they were less adept than RQA metrics at discerning subtle differences between groups. Furthermore, the complementary cardiorespiratory coupling assessment by MI revealed distinct compensatory patterns in T2DM during paced respiration and Valsalva.
These findings indicate potential dysautonomia or partial autonomic dysregulation in individuals with T2DM, as reflected by altered cardiorespiratory dynamics and reduced adaptability.
脉搏 - 呼吸商（PRQ）被认为是评估心脏和呼吸节律之间动态相互作用的有力工具。2型糖尿病（T2DM）会破坏自主神经控制，可能会损害心肺动力学的复杂性和适应性。在这项横断面探索性研究中，我们通过使用传统线性指标和递归量化分析（RQA）分析短期PRQ信号，研究了T2DM是否会改变心肺动力学。
38名参与者（20名T2DM患者和18名对照者）完成了四项标准化任务——仰卧休息、直立位应激试验、定频呼吸和瓦尔萨尔瓦动作，同时持续记录心电图和呼吸信号。从这些信号中得出R - R峰间期（RRI）和逐次呼吸（BB）时间序列，从而使我们能够计算PRQ时间序列，即瞬时心率与瞬时呼吸率之比。然后计算PRQ信号的PRQ线性指标和RQA指标，以便在组间（T2DM组与对照组）和不同任务之间进行比较。此外，评估RRI和BB之间基于熵的互信息（MI），作为心肺耦合的定量测量指标。
T2DM参与者在PRQ序列中表现出更高的复发率和第一类复发时间延长，尤其是在定频呼吸期间，这表明其控制机制更僵化且适应性更差。尽管线性PRQ指标在某些阶段依赖性反应中显示出变化，但在区分组间细微差异方面，它们不如RQA指标灵敏。此外，通过MI进行的补充心肺耦合评估揭示了T2DM患者在定频呼吸和瓦尔萨尔瓦动作期间有明显的代偿模式。
这些发现表明，T2DM患者存在潜在的自主神经功能障碍或部分自主神经调节异常，表现为心肺动力学改变和适应性降低。
