Open AccessAssessing heart rate variability in type 1 diabetes mellitus—Psychosocial stress a possible confounder
Author(s) -
Kristiansen Eva,
Wanby Pär,
Åkesson Karin,
Blomstrand Peter,
Brudin Lars,
Thegerström Johanna
Publication year - 2020
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12760
Subject(s) - medicine , psychosocial , heart rate variability , diabetes mellitus , confounding , hypoglycemia , heart rate , type 1 diabetes , endocrinology , biomarker , circadian rhythm , psychiatry , blood pressure , biochemistry , chemistry
Background 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. Methods 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. Results 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. Conclusion 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.