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Standing to Lying Heart Rate Variation. A New Simple Test in the Diagnosis of Diabetic Autonomic Neuropathy

We have examined the immediate heart‐rate response to standing to lying (S‐L) in 83 male insulin‐dependent diabetic subjects aged 40 ± 11 years (mean ± S.D.) who underwent five other cardiovascular autonomic tests. Using a specially devised scoring system, the patients were divided into 3 groups: (1) 54 subjects without autonomic neuropathy; (2) 17 ‘borderlines’; (3) 12 with autonomic neuropathy. The results were compared with those of 50 sex and age matched controls. We evaluated: S‐L1 = ratio between R‐R mean before lying and R‐R minimum over the first 5 beats after lying; S‐L2 = ratio between R‐R maximum between the 20th to 25th beat and R‐R minimum over the first 5 beats after lying. In controls S‐L1 was 1.23 ± 0.098 (mean ± S.D.), S‐L2 1.56 ± 0.2. In diabetic subjects without autonomic neuropathy S‐L1 was 1.18 ± 0.096 (p<0.01), S‐L2 1.50 ± 0.23. In the autonomic group S‐L1 was 1.03 ± 0.01 (p<0.001), S‐L2 1.16 ± 0.086 (p<0.001). We propose that the lowest normal and highest abnormal limits of S‐L1 are 1.10 and 1.07, respectively, and that normal and highest abnormal limits of S‐L2 are 1.23 and 1.14, respectively. We suggest the use of S‐L1 as a pure parasympathetic test and S‐L2 as a mixed but predominantly sympathetic test in the diagnosis of autonomic neuropathy.