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Objective: Autonomic symptoms may occur frequently in diabetic and other neuropathies. There is a need to develop a simple instrument to measure autonomic symptoms in subjects with neuropathy and to test the validity of the instrument.
Methods: The Survey of Autonomic Symptoms (SAS) consists of 11 items in women and 12 in men. Each item is rated by an impact score ranging from 1 (least severe) to 5 (most severe). The SAS was tested in observational studies and compared to a previously validated autonomic scale, the Autonomic Symptom Profile (ASP), and to a series of autonomic tests.
Results: The SAS was tested in 30 healthy controls and 62 subjects with neuropathy and impaired glucose tolerance or newly diagnosed diabetes. An increased SAS score was associated with the previously validated ASP (rank order correlation = 0.68; p < 0.0001) and with quantitative measures of autonomic function: a reduced quantitative sudomotor axon reflex test sweat volume (0.31; p < 0.05) and an abnormal 30:15 ratio (0.53; p < 0.01). The SAS shows a high sensitivity and specificity (area under the receiver operating characteristic curve 0.828) that compares favorably with the ASP. The SAS scale domains had a good internal consistency and reliability (Cronbach α = 0.76). The SAS symptom score was increased in neuropathy (95% confidence interval [CI] 2.99–4.14) compared to control (95% CI 0.58–1.69; p < 0.0001) subjects.
Conclusions: The SAS is a new, valid, easily administered instrument to measure autonomic symptoms in early diabetic neuropathy and would be of value in assessing neuropathic autonomic symptoms in clinical trials and epidemiologic studies.
Footnotes
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Study funding: Supported in part by U01AR057967-01 (L.Z.); 1K23 NS056009-01A1 (A.C.P.); NIH NS40458, DK064814, and the ADA (G.S.); NIH NS40458, NS36778, NIH NS38849, NIH U01 RR025764 (J.R.S.); NIH RR024888, NS40458, NS42056, U01AR057967-01, JDRF, Office of Research Development (Medical Research Service and Rehabilitation Service), Department of Veterans Affairs, ADA (A.A. and J.W.R.); NIH 068182, DK076160, AG020591, ADA and JDRF (E.L.F.); AG08808 and AG 109675; Office of Research and Development, Medical Service and Rehabilitation Research and Development Service of the Department of Veterans Affairs; and the Dorothy and Herman Miller Fund for Mobility Research in Older Adults (N.B.A.). The Maryland database was supported by the PROMIS grant (U01AR057967-01).
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- ASP
- Autonomic Symptom Profile
- AUC
- area under the curve
- CAN
- cardiac autonomic neuropathy
- CASS
- Composite Autonomic Scoring Scale
- CI
- confidence interval
- COMPASS
- Composite Autonomic Symptom Scale
- E:I
- expiration:inspiration ratio
- HRR
- heart rate range
- IENFD
- intraepidermal nerve fiber density
- IFG
- impaired fasting glucose
- IGR
- impaired glucose regulation
- IGT
- impaired glucose tolerance
- NCS
- nerve conduction studies
- OR
- odds ratio
- QSART
- quantitative sudomotor axon reflex test
- QST
- quantitative sensory testing
- ROC
- receiver operating characteristic
- SAS
- Survey of Autonomic Symptoms
- SSR
- sympathetic skin response
- TIS
- total symptom impact score
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Supplemental data at www.neurology.org
- Received April 22, 2010.
- Accepted December 8, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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