Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease

Pasquale Esposito, Roberto Mereu, Giacomo De Barbieri, Teresa Rampino, Alessandro Di Toro, Per-Henrik Groop, Antonio Dal Canton, Luciano Bernardi

Research output: Contribution to journalArticlepeer-review


AIMS: Cardiovascular autonomic dysfunction, evaluated as baroreflex sensitivity (BRS), could be acutely corrected by slow breathing or oxygen administration in patients with type 1 diabetes, thus suggesting a functional component of the disorder. We tested this hypothesis in patients with the type 2 diabetes with or without renal impairment.

METHODS: Twenty-six patients with type 2 diabetes (aged 61.0 ± 0.8 years, mean ± SEM; duration of diabetes 10.5 ± 2 years, BMI 29.9 ± 0.7 kg/m(2), GFR 68.1 ± 5.6 ml/min) and 24 healthy controls (aged 58.5 ± 1.0 years) were studied. BRS was obtained from recordings of RR interval and systolic blood pressure fluctuations during spontaneous and during slow, deep (6 breaths/min) controlled breathing in conditions of normoxia or hyperoxia (5 l/min oxygen).

RESULTS: During spontaneous breathing, diabetic patients had lower RR interval and lower BRS compared with the control subjects (7.1 ± 1.2 vs. 12.6 ± 2.0 ms/mmHg, p < 0.025). Deep breathing and oxygen administration significantly increased arterial saturation, reduced RR interval and increased BRS in both groups (to 9.6 ± 1.8 and 15.4 ± 2.4 ms/mmHg, respectively, p < 0.05, hyperoxia vs. normoxia). Twelve diabetic patients affected by chronic diabetic kidney disease (DKD) presented a significant improvement in the BRS during slow breathing and hyperoxia (p < 0.025 vs. spontaneous breathing during normoxia).

CONCLUSIONS: Autonomic dysfunction present in patients with type 2 diabetes can be partially reversed by slow breathing, suggesting a functional role of hypoxia, also in patients with DKD. Interventions known to relieve tissue hypoxia and improve autonomic function, like physical activity, may be useful in the prevention and management of complications in patients with diabetes.

Original languageEnglish
Pages (from-to)217-26
Number of pages10
JournalActa Diabetologica
Issue number2
Publication statusPublished - Apr 2016


  • Adolescent
  • Adult
  • Aged
  • Autonomic Nervous System Diseases
  • Baroreflex
  • Blood Pressure
  • Breathing Exercises
  • Cardiovascular Diseases
  • Diabetes Mellitus, Type 2
  • Diabetic Nephropathies
  • Female
  • Humans
  • Hyperoxia
  • Hypoxia
  • Male
  • Middle Aged
  • Oxygen
  • Oxygen Consumption
  • Respiration
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't


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