Autonomic Nervous System Assessment
The autonomic nervous system (ANS) is an extensive neural network whose main role is to regulate the body's internal environment and functions by controlling homeostasis, hemodynamics, blood pressure, heart rate, blood glucose levels, sweating, and visceral functions such as digestion, bladder, and sexual organs.
Therefore, the role of the autonomic nervous system is important in several medical disciplines, such as internal medicine, cardiology, neurology, gastroenterology, urology, and endocrinology.
ANS dysfunction could be related to reduced autonomic nervous system activity, imbalance between sympathetic and parasympathetic systems, or damage of the ANS nerves (autonomic neuropathy is a failure of response to challenges resulting in an abnormal performance of the regulation and/or homeostasis of one or more involuntary body functions).
Autonomic neuropathy can be a complication of a number of diseases and conditions, but it can also occur due to the side effects of medications. Diabetics are at a high risk for developing autonomic neuropathy, also referred to as Diabetic Autonomic Neuropathy (DAN). DAN is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality, and its association with multiple symptoms and impairments, the significance of DAN has not been fully appreciated. The reported prevalence of DAN varies widely depending on the cohort studied and the methods of assessment. In randomly selected cohorts of asymptomatic individuals with diabetes, approximately 20% had abnormal cardiovascular autonomic function. DAN frequently coexists with other peripheral neuropathies and diabetic complications, but DAN may be isolated and frequently precedes the detection of other complications.
Major clinical manifestations of DAN include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, "brittle diabetes," and hypoglycemic autonomic failure. Hypoglycemia is the limiting factor in the glycemic management of diabetes.
Autonomic testing (including sudomotor testing) is recommended for all patients with type 2 diabetes at the time of the diagnosis, and 5 years after diagnosis in individual with type 1 diabetes ( Boulton et al., 2005;Tesfaye et al., 2010;Spallone et al., 2011; Bernardi et al.,2011.)
Individuals with diabetes and autonomic neuropathy have a significantly higher mortality rate, and different guidelines for anesthesia, surgery and medical therapies to affect outcomes have been established (Boulton, et al., 2005; Spallone, et al., 2011a; Vinik & Ziegler, 2007).
ANS is Treatable
AHA 2011
ANS - Diabetic Neuropathies ADA
ANS - Effect of CAN on mortality
Clinical Endocrinology
Recognizing Autonomic neuropathy
Rx Therapy for Autonomic Nervous System