Obesity is not a confounding factor for performing autonomic function tests in individuals with diabetes mellitus

Cardiovascular autonomic neuropathy is a serious complication of diabetes mellitus. Previous studies have revealed conflicting results with regard to the role of obesity and its effect on the performance of tests (e.g. RR-variation during deep breathing) for the determination of the presence of cardiovascular autonomic dysfunction. The objective of this study was to determine if obesity affects the performance and the reproducibility of autonomic function tests.

This cross-sectional study included 159 diabetic individuals. Autonomic function tests included: RR-variation during deep breathing and the Valsalva ratio. These tests were assessed using the ANS2000 ECG Monitor and Respiration Pacer. RR-variation was measured by vector analysis (i.e. mean circular resultant, MCR). Reproducibility of the autonomic function tests was assessed by determining the coefficient of variation (CV) on repeat testing.

Using cut-off points to describe normal weight (body mass index (b.m.i.) < or = 25 kg/m(2)), overweight (b.m.i. 25.01-30 kg/m(2)), obese (b.m.i. 30.01-40 kg/m(2)), and morbidly obese (b.m.i. > or = 40.1 kg/m(2)), no difference was found for the MCR, Valsalva ratio, CV of the MCR, or CV of the Valsalva ratio among the various weight levels for individuals with type 1 or type 2 diabetes.

The results of this study indicate that obesity is not a confounding factor in the performance of autonomic function tests. Likewise, the reproducibility of autonomic function testing is not affected by obesity. Assessment of autonomic function is important for obese and non-obese individuals given that reduced RR-variation is associated with exercise intolerance, intraoperative cardiovascular lability and increased risk of mortality.