{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T23:17:58Z","timestamp":1785712678685,"version":"3.56.0"},"reference-count":43,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2008,7,1]],"date-time":"2008-07-01T00:00:00Z","timestamp":1214870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Diabetes Sci Technol"],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cardiovascular autonomic neuropathy (CAN) is a disorder of progressive autonomic dysfunction (AD) associated with diabetes and other chronic diseases. Orthostatic hypotension (OH) is one of the most incapacitating symptoms of CAN and AD. AD in OH can include sympathetic withdrawal (SW). To detect and diagnose SW, parasympathetic and sympathetic changes must be clearly differentiated from each other. This is accomplished by means of the novel autonomic nervous system (ANS) method based on the simultaneous spectral analyses of respiratory activity (RA) and heart rate variability (HRV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We performed autonomic profiling of 184 (142 females) consecutive, arrhythmia-free patients with type 2 diabetes using the ANX-3.0 autonomic monitoring system. The patient cohort included 86 (64 female) patients for whom an a\n                      <jats:sub>1<\/jats:sub>\n                      -agonist was the only drug changed and increased from one test to the next; 37 (33 female) for whom the a\n                      <jats:sub>1<\/jats:sub>\n                      -agonist was discontinued; and 61 (45 female) who were on an a\n                      <jats:sub>1<\/jats:sub>\n                      -agonist, but for whom no drug changes were made. The tests averaged 3.1 \u00b1 1.4 months apart; midodrine (ProAmatine) was the a\n                      <jats:sub>1<\/jats:sub>\n                      -agonist prescribed. Of the group, 99 patients also had hypertension and 47 also had cardiovascular disease. No patient had supine hypertension.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Changes in parameters from the HRV (without respiration) and ANS methods were compared with changes in heart rate and blood pressure (BP) as measured from one test (test N) to the next (test N + 1). SW with a BP drop of less than the clinical definition may be a trend that can be an early indicator of orthostasis. In this study, patients were treated with low-dose, short-term \u03b1\n                      <jats:sub>1<\/jats:sub>\n                      -agonist (vasopressor) therapy, which tended to correct the abnormal trend of SW with a drop in BP. Included in the findings was a systolic BP trend in response to vasopressor therapy of an (expected) initial increase in BP followed by an eventual decrease in systolic BP as SW was reversed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The ANS method enables quantitative assessment of CAN by independently and simultaneously quantifying the two branches of the ANS, sympathetic and parasympathetic. The ANS method modifies standard spectral analysis of HRV (without RA analysis) by incorporating spectral analysis of RA. The ANS method appears to model the normal and abnormal responses to upright posture and changes in vasopressor therapy with greater fidelity than the HRV method. Independent, simultaneous assessment of progressive parasympathetic and sympathetic dysfunction, autonomic imbalance, and responses of the two ANS branches to therapy seems to enable early detection and early intervention. Orthostasis, by way of example, illustrates that frequent, sensitive assessments of both ANS branches can improve the negative outcomes associated with CAN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/193229680800200416","type":"journal-article","created":{"date-parts":[[2014,1,10]],"date-time":"2014-01-10T10:35:51Z","timestamp":1389350151000},"page":"645-657","source":"Crossref","is-referenced-by-count":48,"title":["Autonomie Mechanisms and Therapeutic Implications of Postural Diabetic Cardiovascular Abnormalities"],"prefix":"10.1177","volume":"2","author":[{"given":"Rohit R.","family":"Arora","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Chicago Medical School, North Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Bulgarelli","sequence":"additional","affiliation":[{"name":"Integrative Cardiology, The Cardiovascular Group, Riddle Memorial Hospital, Media, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samanwoy","family":"Ghosh-Dastidar","sequence":"additional","affiliation":[{"name":"ANSAR Medical Technologies, Inc., Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Colombo","sequence":"additional","affiliation":[{"name":"ANSAR Medical Technologies, Inc., Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2008,7,1]]},"reference":[{"key":"bibr1-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-817720"},{"key":"bibr2-193229680800200416","unstructured":"Vinik AI, Aysin B, Colombo J. Dynamic enhanced frequency domain analysis indicates a significant decline in autonomic function before age 50. Diabetes Technology Conference; 2005 Nov 10\u201312; San Francisco, CA."},{"key":"bibr3-193229680800200416","unstructured":"Vinik AI, Aysin B, Colombo J. Differentiation of autonomic dysfunction by enhanced frequency domain analysis reveals additional stages in the progression of autonomic decline in diabetics. Diabetes Technology Conference; 2005 Nov 10\u201312; San Francisco, CA."},{"key":"bibr4-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2005.09.027"},{"key":"bibr5-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-817720"},{"key":"bibr6-193229680800200416","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.4.956"},{"issue":"13","key":"bibr7-193229680800200416","first-page":"1132","volume":"100","author":"Joint Editorial Statement by the American Diabetes Association; the National Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation International; the National Institute of Diabetes and Digestive and Kidney Diseases; and the American Heart Association","year":"1999","journal-title":"Circulation."},{"key":"bibr8-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.100.10.1134"},{"key":"bibr9-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-817727"},{"key":"bibr10-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-0754"},{"key":"bibr11-193229680800200416","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.634949"},{"key":"bibr12-193229680800200416","unstructured":"Aysin B, Aysin E, Colombo J, Vinik A. 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