Respiratory Modulation of Muscle Sympathetic Nerve Activity in Type 2 Diabetes Mellitus
Authors: Plunkett Michael , Holwerda Seth , Young Benjamin , Fadel Paul , Fisher James 
Published: May 2024

Dysfunctional sympathetic neural regulation is present in patients with type 2 diabetes (T2D) with augmented muscle sympathetic nerve activity (MSNA) responses to handgrip exercise, cold pressor testing, and augmented sympathetic-blood pressure transduction identified. MSNA is modulated by respiration such that it is inhibited at higher lung volumes and increased at lower lung volumes. Herein we aimed to determine whether T2D affects the respiratory modulation of MSNA. Resting MSNA (microneurography) and respiration pattern (strain-gauge pneumobelt) were measured simultaneously in 20 patients with T2D (age 49.1±7.4 years, body mass index [BMI] 31.9±4.1 kg∙m−2, mean ± SD) and 13 age- and BMI-matched, healthy controls (46.3±9.4 years; 32.1±4.6 kg∙m−2). MSNA was stratified by the phase of respiration. Further comparisons were made between low lung volume (defined as 60-100% expiration + 0-60% inspiration) and high lung volume states (60-100% inspiration + 0-60% expiration). Resting MSNA burst frequency, burst incidence and total activity were similar between T2D and controls (p=0.953, p=0.624, and p=0.884, respectively). Both groups exhibited peak MSNA in late expiration to early inspiration, whilst inhibition of MSNA occurred during late inspiration to early expiration (respiratory phase p<0.001 for burst frequency, incidence and total activity), though no group x respiratory phase interaction was observed (p>0.05 for all MSNA measures). When MSNA responses were compared between lung volume states, percent reduction of MSNA burst incidence from low lung volume to high lung volume was less in T2D than controls (26.1±33.9 vs 50.1±25.6%, p=0.025). Furthermore, in T2D, there was a shift in the distribution of MSNA bursts with a greater proportion of bursts occurring at high lung volumes (i.e., burst count during high lung volume divided by total burst count) compared to controls (43.8±10.5 vs. 37.8±12.5% respectively, group x volume interaction p=0.04). Notably, the normal pattern of respiratory modulation of MSNA was absent in 5 T2D patients (non-modulators), whilst this did not occur in any control participants. Non-modulators had higher systolic blood pressure compared to modulators (138.7±16.6 vs. 123.2±10.6 mmHg respectively, p=0.024), with no differences in age, BMI, HbA1c, duration of T2D, or overall MSNA parameters (all p<0.05). These results suggest that whilst respiratory modulation of MSNA occurs in T2D, its effect appears blunted compared to healthy controls. Notably, the usual pattern of respiratory-sympathetic coupling is absent in some T2D patients, which may be associated with higher resting systolic blood pressure. MP is supported by the Greenlane Research and Educational Fund (21/01/4153). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.