A Novel Association Between Nondipping and Painful Diabetic Polyneuropathy

作者：D'Amato Cinzia; Morganti Roberto; Di Gennaro Federica; Greco Carla; Marfia Girolama A; Spallone Vincenza^*

来源：Diabetes Care, 2014, 37(9): 2640-2642.

DOI：10.2337/dc14-0528

OBJECTIVE
We hypothesized the meaningful coexistence of neuropathic pain and nondipping in painful diabetic polyneuropathy (PDPN).
RESEARCH DESIGN AND METHODS
In 113 patients with PDPN, with painless diabetic polyneuropathy (DPN+) and without DPN (DPN-), neuropathic pain, sleep, risk for obstructive sleep apnea (OSA), autonomic function, and blood pressure (BP) circadian pattern were assessed using the Douleur Neuropathique en 4 Questions (DN4), the Medical Outcomes Study Sleep Scale, the Berlin Questionnaire, cardiovascular reflex tests, and ambulatory BP monitoring.
RESULTS
Patients with PDPN showed higher nighttime systolic BP (130.4 +/- 15.6 mmHg) than both DPN2 (119.9 +/- 10.6mmHg; P < 0.0001) and DPN+ patients (124.2 +/- 12.3 mmHg; P < 0.05), and lower day-night difference (Delta) in systolic BP (5.5 +/- 6.5 vs. 8.6 +/- 7.7%; P < 0.05) and diastolic BP than DPN2 patients. In a stepwise regression analysis, orthostatic hypotension, high risk for OSA, and PDPN (DN4 interview) were independent determinants of Delta in systolic BP (r = 0.46; P = 0.0001), Delta in diastolic BP, and nighttime systolic BP.
CONCLUSIONS
PDPN is associated with higher nocturnal systolic BP and impaired BP circadian pattern independent of pain-related comorbidities, suggesting a condition of high cardiovascular risk.

• 出版日期2014-9