The Relative Prevalence and Severity of Autonomic Nervous System Dysfunction

The Relative Prevalence and Severity of Autonomic Nervous System Dysfunction in Diabetic Patients Undergoing Retinal Surgery

The purpose of this study is to measure the prevalence and severity of cardiac autonomic neuropathy (CAN), diabetic autonomic neuropathy (DAN) which in non-diabetics is termed advanced nervous system (ANS) dysfunction, and autonomic dysfunction as well as the overall sympathovagal balance (SB) in the CEFH population of diabetic patients versus non-diabetic patients undergoing elective vitreoretinal surgery.

The purpose of this study is to measure the prevalence and severity of cardiac autonomic neuropathy (CAN), diabetic autonomic neuropathy (DAN) which in non-diabetics is termed advanced nervous system (ANS) dysfunction, and autonomic dysfunction as well as the overall sympathovagal balance (SB) in the CEFH population of diabetic patients versus non-diabetic patients undergoing elective vitreoretinal surgery.

Inclusion Criteria:

• Type I and Type II Diabetic patients 19 or older who are scheduled for elective surgery to improve vision impaired by diabetic retinopathy
• Patients scheduled during the same time period without diabetes for retinal surgery will serve as an age and gender matched reference group to undergo the non-invasive ANS testing on the day of surgery

Exclusion Criteria:

• Inability to stand will only do baseline, deep breathing and Valsalva portions (A-D) of the testing as described in section 8.1
• Patients with syncope on standing will only do portions A-D of the test
• Inability to cooperate with deep breathing and Valsalva
• Tracheoscopy or otherwise not able to perform a Valsalva
• Not desiring to participate after informed consent
• Known history of idiopathic dysautonomia
• Pulmonary difficulties associated with hyperventilation, including acute URI
• Pacemaker dependent
• Persistently high intraocular pressure despite treatment
• Atrial fibrillation
• Ventricular arrhythmias greater than 10 beats per minute
• Taking MAO inhibitors