| 1. |
- Bengtsson Lindberg, Marie, et al.
(författare)
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Lack of orthostatic symptoms in dementia patients with orthostatic hypotension.
- 2015
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 1619-1560 .- 0959-9851. ; 25:2, s. 87-94
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB). Commonly OH is diagnosed when the patient falls which is a risk factor of premature death. Our objective was to systematically investigate the clinical symptoms associated with measurement of OH in different neurodegenerative dementias and normal controls (NC). Methods: 154 patients [50 DLB, 50 Alzheimer’s disease (AD), 54 AD and vascular components (ADvasc)] were examined with systolic and diastolic blood pressure measurements in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. They were compared with 50 NC. Orthostatic symptoms were registered according to a predefined protocol. Results: Twenty-seven percent of all the investigated individuals reported OH symptoms during the measurement while 43% fulfilled the criteria of OH. Sixty-three percent of orthostatic patients did not have any symptoms during the measurement. The prevalence of any orthostatic symptoms during the measurement differed significantly (p<0.001) between the diagnostic groups with 40% in DLB patients, 37% in ADvasc, 28% in AD and 2% in NC. The most frequent symptom was dizziness 13.7%. Conclusions: Classical orthostatic symptoms are absent in the majority of dementia patients with OH. The orthostatic reaction must therefore be routinely measured in this patient group. This is particularly important for patients with DLB where falls as a result of OH are common.
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| 2. |
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| 3. |
- Fagius, Jan, et al.
(författare)
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Early-onset hereditary isolated non-neurogenic orthostatic hypotension in a Swedish family
- 2023
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Ingår i: Clinical Autonomic Research. - : Springer Berlin/Heidelberg. - 0959-9851 .- 1619-1560. ; 33:4, s. 421-432
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Tidskriftsartikel (refereegranskat)abstract
- Methods One severely affected individual underwent thorough investigation with neurophysiological and blood pressure (BP) measurements, including direct recording of baroreflex-governed sympathetic nerve signalling and induction of BP rise with phenylephrine. Family members underwent parts of the examination. Genetic analysis using exome sequencing was performed.Results Marked postural hypotension with greatly reduced cardiac preload was observed, but without signs of autonomic nervous system dysfunction: sympathetic nerve signalling was normal, as were catecholamine levels, and phenylephrine stimulation revealed a normal increase in BP. The results of the genetic analysis using exome sequencing comprising all known genes associated with the regulation of BP and catecholamine metabolism were normal.Conclusion The combined findings suggest an autosomal dominant form of early-onset orthostatic hypotension with variable clinical expression and without any additional autonomic dysfunction. It is possible that further investigation will reveal an as yet undescribed entity of orthostatic hypotension transmitted as an autosomal dominant trait.
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| 4. |
- Fagius, Jan, et al.
(författare)
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Strong potential for baroreflex-governed sympathetic outflow revealed during nausea
- 2010
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 20:6, s. 371-374
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Tidskriftsartikel (refereegranskat)abstract
- Muscle sympathetic nerve activity (MSNA) was recorded in two patients with amyotrophic lateral sclerosis. As expected, they exhibited a high level of MSNA at rest, with an inverse weak response to different maneuvers normally eliciting strong increase in MSNA. About 30 min after the intake of a glucose solution, they developed nausea with an extreme rise in MSNA and blood pressure. In one patient, a quantified analysis of this reaction could be done: the outflow was close to 200% above the already high resting level and >100% stronger than the response to any of the performed maneuvers. We regard this observation of importance, because it seems to unveil resources utilized only rarely, and strongly overcoming the "ceiling effect" that seemingly is a hindrance for sympathetic activation in subjects with high lever of MSNA at rest. An inhibitory "safety limit" might exist, the trespassing of which would damage the organism and thus occurs only during extraordinary circumstances.
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| 5. |
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| 6. |
- Fedorowski, Artur, et al.
(författare)
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Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?
- 2017
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 27:3, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The contribution of diastolic blood pressure measurement to the diagnosis of classical orthostatic hypotension is not known. We aimed to explore the prevalence of isolated systolic and diastolic orthostatic hypotension components in patients with syncope and orthostatic intolerance. Methods: A total of 1520 patients aged >15 years with suspected syncope and/or symptoms of orthostatic intolerance were investigated in a tertiary center using tilt-table testing and continuous non-invasive blood pressure monitoring. Classical orthostatic hypotension was defined as a decline in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg at 3 min of tilt test. The prevalence of upright systolic blood pressure <90 mmHg and its overlap with isolated diastolic orthostatic hypotension was also assessed. Results: One hundred eighty-six patients (12.2%) met current diagnostic criteria for classical orthostatic hypotension. Of these, 176 patients (94.6%) met the systolic criterion and 102 patients (54.8%) met the diastolic criterion. Ninety-two patients (49.5%) met both systolic and diastolic criteria, whereas ten patients (5.4%) met the diastolic criterion alone. Of these, three had systolic blood pressure <90 mmHg during tilt test and were diagnosed with orthostatic hypotension on the grounds of low standing blood pressure. Based on patient history and ancillary test results, causes of orthostatic intolerance and syncope other than orthostatic hypotension were present in the remaining seven patients. Conclusions: An abnormal orthostatic fall in diastolic blood pressure without an abnormal fall in systolic blood pressure is rare among patients with syncope and orthostatic intolerance. Approximately 95% of patients with classical orthostatic hypotension can be identified by systolic criterion alone.
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| 7. |
- Finucane, Ciarán, et al.
(författare)
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A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring
- 2019
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 29:4, s. 427-441
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Forskningsöversikt (refereegranskat)abstract
- Purpose: The average adult stands approximately 50–60 times per day. Cardiovascular responses evoked during the first 3 min of active standing provide a simple means to clinically assess short-term neural and cardiovascular function across the lifespan. Clinically, this response is used to identify the haemodynamic correlates of patient symptoms and attributable causes of (pre-)syncope, and to detect autonomic dysfunction, variants of orthostatic hypotension, postural orthostatic tachycardia syndrome and orthostatic hypertension. Methods: This paper provides a set of experience/expertise-based recommendations detailing current state-of-the-art measurement and analysis approaches for the active stand test, focusing on beat-to-beat BP technologies. This information is targeted at those interested in performing and interpreting the active stand test to current international standards. Results: This paper presents a practical step-by-step guide on (1) how to perform active stand measurements using beat-to-beat continuous blood pressure measurement technologies, (2) how to conduct an analysis of the active stand response and (3) how to identify the spectrum of abnormal blood pressure and heart rate responses which are of clinical interest. Conclusion: Impairments in neurocardiovascular control are an attributable cause of falls and syncope across the lifespan. The simple active stand test provides the clinician with a powerful tool for assessing individuals at risk of such common disorders. However, its simplicity belies the complexity of its interpretation. Care must therefore be taken in administering and interpreting the test in order to maximise its clinical benefit and minimise its misinterpretation.
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| 8. |
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| 9. |
- Johansson, Madeleine, et al.
(författare)
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Orthostatic blood pressure adaptations, aortic stiffness, and central hemodynamics in the general population: insights from the Malmö Offspring Study (MOS)
- 2023
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 1619-1560 .- 0959-9851. ; 33:1, s. 29-40
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Tidskriftsartikel (refereegranskat)abstract
- PurposeArterial stiffness is independently associated with orthostatic hypotension in older individuals. The relationship between orthostatic blood pressure adaptation and aortic stiffness has not been thoroughly examined in a younger population. We investigated the relationship between orthostatic blood pressure adaptations, central aortic hemodynamics, and aortic stiffness in a cohort of predominantly younger and middle-aged adults.MethodsWe analyzed an observational, population-based study of 5259 individuals living in Malmö, Sweden. We related aortic stiffness and central hemodynamics assessed by carotid–femoral pulse wave velocity and pulse wave analysis at the arteria radialis using Sphygmocor to orthostatic blood pressure adaptation after 3 min standing.ResultsThe mean age of the population was 41.9 ± 14.5 years, and 52.1% were women. We observed the highest aortic stiffness and central aortic blood pressure measurements in the lowest and highest quartiles of orthostatic systolic blood pressure differences (p < 0.001). Aortic stiffness and central aortic blood pressure gradually decreased across increasing quartiles of orthostatic diastolic blood pressure difference (p < 0.001). After full adjustment, orthostatic diastolic blood pressure remained significantly associated with aortic stiffness (p = 0.001) and central aortic blood pressure (p < 0.001), whereas orthostatic systolic blood pressure was significantly associated only with central aortic systolic blood pressure (p = 0.009). No significant associations were found between subclinical orthostatic hypotension, aortic stiffness, and central hemodynamics.ConclusionsOur findings demonstrate that altered blood pressure responses to orthostatic challenges, both blood pressure reductions and blood pressure increases, are independently and inversely associated with markers of aortic stiffness (vascular aging) in a predominantly young to middle-aged population.
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| 10. |
- Jordan, J, et al.
(författare)
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Consensus statement on the definition of orthostatic hypertension endorsed by the American Autonomic Society and the Japanese Society of Hypertension
- 2023
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 1619-1560. ; 33:1, s. 69-73
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Tidskriftsartikel (refereegranskat)abstract
- We propose a consensus definition of “an exaggerated orthostatic pressor response” in subjects in whom systolic blood pressure increases ≥ 20 mmHg when going from supine to standing posture. This definition can be extended for seated to standing measurements. We reserve the term “orthostatic hypertension” for when this pressor response leads to an upright systolic blood pressure ≥ 140 mmHg. We believe this consensus definition will help in the study of the pathophysiology, clinical impact, and potential treatment of these entities, and identification of patients who are at greater cardiovascular risk.
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| 11. |
- Karlsson-Groth, Anna, et al.
(författare)
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Treatment of compensatory hyperhidrosis after sympathectomy with botulinum toxin and anticholinergics
- 2015
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 25:3, s. 161-167
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Tidskriftsartikel (refereegranskat)abstract
- Compensatory hyperhidrosis (CH) is the most common adverse complication of sympathectomy. It often has a major negative impact on life quality. No efficient treatment of CH is available. We report nine cases of CH after sympathectomy, which were treated with botulinum toxin A/B (BTX) and anticholinergics. The patients responded to a dermatology life quality index (DLQI) questionnaire before injections with BTX and 3 weeks after treatment. At the follow-up visit, the participants also ranked the effect of the treatment on a five-grade scale. Three patients had residual sweating after BTX treatment, and received additional anticholinergics at the follow-up visit. Those subjects eventually had a third evaluation with the DLQI. The DLQI score was, on average, 16.4 before treatment and decreased to 4.8 after BTX injections. Eight out of nine patients were satisfied with the treatment. The average DLQI score decreased to 2.2 when the patients with residual sweating (n = 3) received additional anticholinergics. Adverse events from BTX were mild and temporary, but dry mouth was substantial in one patient using anticholinergics. A combination of BTX A/B and anticholinergics alleviated the hyperhidrosis with minor side-effects. We consider this treatment safe, effective, and well tolerated.
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| 12. |
- Macefield, Vaughan G, et al.
(författare)
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Firing properties of sudomotor neurones in hyperhidrosis and thermal sweating.
- 2008
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 0959-9851. ; 18:6, s. 325-30
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Idiopathic palmar-plantar hyperhidrosis is characterized by excessive sweating of the palms and feet, and is commonly treated by transthoracic regional sympathicotomy. As the condition is believed to be due to a high sudomotor drive, we wanted to assess the firing properties of individual sudomotor neurones in this state of sympathoexcitation, extending our recent work on other pathologies associated with high sympathetic nerve activity. METHODS: Single-unit recordings were made from eight sudomotor neurones supplying the fingers via tungsten microelectrodes inserted percutaneously into the median nerve at the wrist or upper arm. RESULTS: Typical of sudomotor, muscle vasoconstrictor and cutaneous vasoconstrictor neurones recorded in healthy individuals in states of high sympathetic drive, all units had low firing probabilities (active in only 30.0 +/- 6.7 (SE) % of cardiac intervals) and primarily fired only once per heart beat. The percentage of cardiac intervals in which the neurones generated 1, 2, 3 or 4 spikes was 60.4 +/- 6.3, 22.9 +/- 3.9, 9.7 +/- 2.1 and 3.4 +/- 1.3%, respectively. For comparison, these values were 77.6 +/- 7.7, 15.0 +/- 4.1, 4.6 +/- 2.3 and 1.8 +/- 1.3% for eight sudomotor neurones innervating the hairy skin of the foot during thermally-induced sweating in normal subjects. INTERPRETATION: We conclude that the firing properties of spontaneously active sudomotor neurones in subjects with hyperhidrosis are similar to those of sudomotor neurones active during thermal sweating, reflecting an increase in central sympathetic drive to the sweat glands in hyperhidrosis.
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| 13. |
- Memarian, Ensieh, et al.
(författare)
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Associations between physical activity and autonomic function during deep breathing test : the Swedish CArdioPulmonary bioImage Study (SCAPIS).
- 2023
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Ingår i: Clinical Autonomic Research. - : Springer. - 0959-9851 .- 1619-1560. ; 33:4, s. 411-420
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The deep breathing test (DBT) is a sensitive test of cardiovagal function. The aim of this study was to explore associations between physical activity and sedentary time, measured by accelerometer, and autonomic function, using DBT.METHODS: In the Swedish Cardio-Pulmonary bioImage Study, men and women aged 50-64 were randomly invited from the general population. A total of 4325 subjects who underwent DBT and assessment of physical activity and sedentary time by accelerometery were included. ECG files from 1-min DBT were used to calculate measures of respiratory sinus arrhythmia [RSA; expiration-inspiration (E-I) difference and E/I ratio], heart rate variability [HRV; root mean square of successive differences (RMSSD), standard deviation of heart rates and mean circular resultant]. Low RSA and HRV was defined as the lowest 10% in the population.RESULTS: For accelerometer-assessed physical activity, there were significant associations between high percentage of sedentary time and low E/I (p < 0.01), and low RMSSD (p < 0.01) in an age- and sex-adjusted model, and between percentage of sedentary time and low RMSSD (p = 0.04) in a risk factor-adjusted model. Low RMSSD was less common in those with a high percentage of moderate to vigorous physical activity (p = 0.04, after risk-factor adjustment). These associations became non-significant when further adjusting for heart rate.CONCLUSION: We report associations between degree of physical activity and indices of autonomic dysfunction in a large population. The relationships were no longer significant after adjustments for heart rate, indicating that the relationship between physical activity and cardiovagal function partly is accounted for by reduced heart rate.
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| 14. |
- Obici, Laura, et al.
(författare)
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Diagnosis and treatment of gastrointestinal dysfunction in hereditary TTR amyloidosis
- 2019
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Ingår i: Clinical Autonomic Research. - : Springer. - 0959-9851 .- 1619-1560. ; 29, s. 55-63
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Forskningsöversikt (refereegranskat)abstract
- Purpose: To review the management of gastrointestinal symptoms in patients with hereditary transthyretin amyloidosis, discussing diagnostic evaluations, assessment of disease progression and therapeutic strategies that could be implemented in routine practice.Methods: Literature review. Key search terms included "gastrointestinal symptoms", "autonomic neuropathy", "hereditary transthyretin amyloidosis" and "familial amyloid polyneuropathy".Results: Gastrointestinal disturbances are a common and serious manifestation of hereditary transthyretin amyloidosis, with significant effects on patients' quality of life and demonstrating a strong association with mortality. Gastrointestinal involvement is more often subclinical in the early stages of the disease, although in some patients gastric and/or bowel abnormalities may be the inaugural symptoms. In both cases, under-recognition, delayed investigation and suboptimal treatment frequently occur. A clear understanding of the mechanisms underlying gastrointestinal dysfunction in hereditary transthyretin amyloidosis is still lacking, but similar to diabetic enteropathy, multiple pathophysiological alterations seem to play a role.Conclusions: Early detection and treatment of gastrointestinal disturbances is key to the successful treatment of this devastating disease. Gastroenterologists play a valuable role in both the diagnosis and the timely management of gastrointestinal symptoms in hereditary transthyretin amyloidosis and should, therefore, be part of a multidisciplinary and comprehensive approach to this disorder.
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| 15. |
- Passant, Ulla, et al.
(författare)
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Cortical blood flow during head-up postural change in subjects with orthostatic hypotension
- 1993
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. ; 3:5, s. 311-8
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Tidskriftsartikel (refereegranskat)abstract
- Regional cerebral blood flow was measured with the 133-Xenon inhalation method in seven healthy subjects with orthostatic hypotension not due to autonomic failure (i.e. non-neurogenic clinical disorder). Measurements were performed during supine rest and during head-up tilt (70 degrees). All subjects had a consistent drop in systolic blood pressure and the typical symptomatology of orthostatic hypotension. The results showed lower mean hemispheric blood flow during head-up tilt than during supine rest. In addition, a consistent and significant redistribution of the regional flow values was seen, with a reduction in frontal and an increase in postcentral areas. The frontal flow decrease during tilt was more marked than in subjects without orthostatic hypotension and was not related to variations in the level of PCO2 or to respiration. In contrast to the clinical symptoms of orthostatic hypotension (dizziness, nausea, visual disturbances, and in some cases syncope), the cortical blood flow reduction was, however, relatively moderate.
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| 16. |
- Passant, Ulla, et al.
(författare)
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Orthostatic hypotension in organic dementia: relationship between blood pressure, cortical blood flow and symptoms
- 1996
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. ; 6:1, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- Regional cerebral blood flow was measured in 35 patients with organic dementia (Alzheimer's disease, n = 13, vascular dementia, n = 17, frontotemporal dementia, n = 5) and orthostatic hypotension. Measurements were performed during supine rest and during head-up tilt (60 degrees). Despite marked blood pressure falls, few patients had symptoms of orthostatic hypotension. All three dementia groups had a decrease in regional cerebral blood flow in the frontal lobes during head-up tilt, but no change in mean hemispheric flow. All patients had a consistent drop in their systolic blood pressure upon head-up tilt, with a wide variation over time. The findings suggest that orthostatic hypotension needs to be considered, and actively sought for, in organic dementia as many patients may lack the typical symptoms of orthostatic hypotension, despite a marked fall in blood pressure.
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| 17. |
- Peinado, A. B., et al.
(författare)
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Neural control of blood pressure in women: differences according to age
- 2017
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 27:3, s. 157-165
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The blood pressure "error signal'' represents the difference between an individual's mean diastolic blood pressure and the diastolic blood pressure at which 50% of cardiac cycles are associated with a muscle sympathetic nerve activity burst (the "T50''). In this study we evaluated whether T50 and the error signal related to the extent of change in blood pressure during autonomic blockade in young and older women, to study potential differences in sympathetic neural mechanisms regulating blood pressure before and after menopause. Methods We measured muscle sympathetic nerve activity and blood pressure in 12 premenopausal (25 +/- 1 years) and 12 postmenopausal women (61 +/- 2 years) before and during complete autonomic blockade with trimethaphan camsylate. Results At baseline, young women had a negative error signal (-8 +/- 1 versus 2 +/- 1 mmHg, p < 0.001; respectively) and lower muscle sympathetic nerve activity (15 +/- 1 versus 33 +/- 3 bursts/min, p < 0.001; respectively) than older women. The change in diastolic blood pressure after autonomic blockade was associated with baseline T50 in older women (r = -0.725, p = 0.008) but not in young women (r = -0.337, p = 0.29). Women with the most negative error signal had the lowest muscle sympathetic nerve activity in both groups (young: r = 0.886, p < 0.001; older: r = 0.870, p < 0.001). Conclusions Our results suggest that there are differences in baroreflex control of muscle sympathetic nerve activity between young and older women, using the T50 and error signal analysis. This approach provides further information on autonomic control of blood pressure in women.
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| 18. |
- Ruzieh, Mohammed, et al.
(författare)
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Risks of adverse events in patients with orthostatic intolerance undergoing surgery with general anesthesia
- 2021
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 1619-1560. ; 31:2, s. 231-237
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Orthostatic intolerance (OI) is a group of disorders characterized by symptoms that occur upon standing and resolve with recumbence. Although well established but not widely recognized, these diagnoses may create uncertainty for clinicians dealing with a patient affected by OI and requiring a surgical procedure.OBJECTIVES: To determine the rate of intra- and postoperative major adverse events in patients with OI undergoing surgery with general anesthesia.METHODS: The study was a retrospective study of patients with orthostatic intolerance who underwent surgery requiring general anesthesia from 1 January 2000 to 31 December 2018.RESULTS: A total 171 patients with OI underwent 190 surgeries. In patients with POTS and orthostatic-induced VVS, there were no major significant adverse events. There was one episode of AVNRT in a patient with POTS and one episode of bradycardia secondary to vasovagal reflex in a patient with orthostatic-induced VVS. Moreover, there were 13 (6.8%) episodes of postoperative hypotension. However, the majority of these episodes were related to bleeding, volume depletion or sepsis. All cases of hypotension responded well to appropriate therapy. In patients with OH, the rate of postoperative major adverse cardiac events was 4.7%, and the 30-day mortality rate was 6.1%. This is not significantly different from the calculated risk for patients without OH. There were no myocardial infarctions or deaths at 30 days in patients with POTS or orthostatic-induced VVS.CONCLUSION: Patients with OI may not experience higher rates of perioperative complications compared with patients without OI syndromes.
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| 19. |
- Sverrisdóttir, Yrsa Bergmann, 1960, et al.
(författare)
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Sympathetic nerve activity in stress-induced cardiomyopathy.
- 2012
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 1619-1560. ; 22:6, s. 259-64
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate directly recorded efferent sympathetic nerve traffic in patients with stress-induced cardiomyopathy (SIC).
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| 20. |
- Tanaka, H., et al.
(författare)
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Evidence of decreased sympathetic function in children with psychosomatic symptoms
- 2002
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 12:6, s. 477-482
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Tidskriftsartikel (refereegranskat)abstract
- We investigated cardiovascular autonomic function using power spectral analysis of heart rate variation and beat-to-beat finger arterial pressure at rest and while standing and correlated these findings with self-reported psychosomatic and psychosocial symptoms in 122 schoolchildren. Children with three or more psychosomatic and psychosocial symptoms (somatizers) were found to have significantly lower blood pressure than children without symptoms. Somatizers had the more decreased spectral power of the low frequency (LF) band of arterial pressure and RR intervals in the supine position. The high frequency (HF) power did not differ between the two groups. Somatizers showed a more marked reduction in systolic arterial pressure at the onset of standing than did subjects without symptoms but somatizers showed an identical response in systolic arterial pressure when compared to subjects without symptoms during the later stage of standing. The increases in the LF band of arterial pressure and LF/HF of RR intervals during standing were higher in somatizers. These results suggest that somatizers have decreased sympathetic modulation. We conclude that psychosomatic and psychosocial symptoms in children might be associated with low blood pressure and decreased sympathetic modulation.
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| 21. |
- Tanha, Tina, et al.
(författare)
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Correlation between physical activity, aerobic fitness and body fat against autonomic function profile in children
- 2016
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 1619-1560 .- 0959-9851. ; 26:3, s. 197-203
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate correlations between physical activity, VO2PEAK and body fat versus autonomic function in children.METHODS: Children (n = 98) between 10 and 12 years underwent a maximal exercise test (VO2PEAK) and dual-energy X-ray absorptiometry measured body fat. General physical activity, moderate to vigorous physical activity and vigorous physical activity were assessed by accelerometers. Deep breath test with E/I-ratio calculation and a head-up tilt test were performed. The sum of z-scores represented an index score for autonomic function profile and included E/I-ratio plus difference in blood pressure and heart rate between supine and tilted position. Correlation analyses were performed between physical activity parameters, body fat and VO2PEAK versus autonomic function profile.RESULTS: No significant correlations were found between autonomic function profile and physical activity or body fat (p > 0.05). VO2PEAK was correlated with autonomic function profile in boys (r = 0.30, p < 0.05), but not in girls (r = 0.04, NS). One girl and eight boys terminated head-up tilt test prematurely due to intolerance. Minutes of vigorous physical activity per day was lower in these boys compared with those (n = 48) who completed the head-up tilt test (5.1 ± 3.3 vs. 10.4 ± 6.6, p < 0.05).CONCLUSION: Physical activity or body fat was not associated with autonomic function profile. VO2PEAK correlated to autonomic function profile in boys.
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| 22. |
- Thijs, RD, et al.
(författare)
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How to unblur the vasovagal evidence?
- 2023
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 1619-1560. ; 33:1, s. 5-7
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 23. |
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| 24. |
- Wallin, Gunnar B, 1936
(författare)
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Regulation of sympathetic nerve traffic to skeletal muscle in resting humans.
- 2006
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - : Springer Science and Business Media LLC. - 0959-9851. ; 16:4, s. 262-9
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Forskningsöversikt (refereegranskat)abstract
- An overview is given of microneurographic studies of resting vasoconstrictor traffic in human muscle nerves (muscle sympathetic nerve activity = MSNA). In multiunit recordings, the activity consists of synchronized bursts of vasoconstrictor impulses, the outflow of which is under potent arterial baroreflex control. In agreement with this, the bursts always display cardiac rhythmicity and occur during temporary reductions of blood pressure. Burst occurrence shows a close inverse correlation to variations of diastolic blood pressure whereas the correlation to the strength of the bursts is weak or absent, suggesting that the mechanisms controlling the two parameters are not identical. These dynamic characteristics are similar in all subjects despite large, reproducible, interindividual differences in number of bursts. Such interindividual differences probably have a genetic origin, and since discharge frequencies in single vasoconstrictor fibers are similar in subjects with few and many bursts, the differences in multiunit activity are likely to be due to a higher number of active fibers in subjects with many bursts. The interindividual differences in multiunit activity are not associated with differences in resting blood pressure levels. Recent studies have revealed (a) an inverse relationship between resting levels of cardiac output and MSNA and (b) evidence of reduced vascular responsiveness to noradrenaline in subject with many sympathetic bursts at rest. These findings suggest that the vasoconstriction induced by the sympathetic impulses is balanced or reduced by these factors, which thereby contribute to the poor relationship between the mean number of sympathetic bursts and the blood pressure level.
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| 25. |
- Warkentin, Siegbert, et al.
(författare)
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Redistribution of blood flow in the cerebral cortex of normal subjects during head-up postural change
- 1992
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. ; 2:2, s. 119-24
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Tidskriftsartikel (refereegranskat)abstract
- Regional cerebral blood flow was measured in 21 normotensive subjects during supine rest and during head-up tilt to 70 degrees. The results showed significant and consistent regional cerebral blood flow changes in the frontal areas with lower relative flow distribution values (percentage of mean flow) during head-up tilt than during supine rest. The lower frontal flow distribution values during tilt were not related to habituation, to repeated measurements, or to the estimated level of arterial CO2 which was derived from expired end-tidal CO2 levels. None of the subjects had orthostatic hypotension and there was no significant difference in mean hemispheric blood flow between lying down and standing up. There was no significant gender difference in regional cerebral blood flow, although female subjects tended to have higher mean hemispheric flow than males in both postures. It remains to be established whether the flow decreases in the frontal cortex are caused by cerebral functional factors or by haemodynamic mechanisms.
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| 26. |
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| 27. |
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| 28. |
- De Kanter, M., et al.
(författare)
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A prospective study of orthostatic blood pressure in diabetic patients
- 1998
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Ingår i: Clinical Autonomic Research. - 0959-9851. ; 8:4, s. 189-193
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Tidskriftsartikel (refereegranskat)abstract
- To clarify whether orthostatic blood pressure is affected by the type of diabetes, cardiac autonomic neuropathy, and the duration of diabetes, orthostatic blood pressure (passive 90°tilt) was evaluated in 102 patients with insulin dependent diabetes mellitus (IDDM), 51 patients with non-insulin dependent diabetes mellitus (NIDDM), and in 238 control subjects in a first study followed up after 8 to 17 years. The heart rate reaction during deep breathing (E/I ratio) and to tilt (acceleration and brake indices) assessed cardiac autonomic function. In the first study, the lowest systolic blood pressure (LSBP) and the lowest diastolic blood pressure (LDBP) after tilt were significantly lower in IDDM patients compared with NIDDM patients (p < 0.001 for LSBP and p < 0.05 for LDBP) and controls (p < 0.001). LDBP was, however, also significantly lower (p < 0.05) in NIDDM patients than in controls. Hence, although most severe in IDDM, LDBP was disturbed in both types of diabetes. In IDDM, a low E/I ratio was associated with disturbed orthostatic blood pressure. At follow-up examinations, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients. In conclusion, LSBP and LDBP were impaired in IDDM patients compared with NIDDM and control subjects; however, LDBP was also impaired in NIDDM patients compared with controls. When the duration of diabetes increased, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients.
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| 29. |
- Gao, Sinsia, 1966, et al.
(författare)
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Reproducibility of methods for assessing baroreflex sensitivity and temporal QT variability in end-stage renal disease and healthy subjects
- 2005
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Ingår i: Clin Auton Res. - 0959-9851. ; 15:1, s. 21-8
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Tidskriftsartikel (refereegranskat)abstract
- Spontaneous baroreflex sensitivity (BRS), the reflex heart rate modulation in response to blood pressure changes (predominantly an index of cardiac vagal activity) and temporal QT variability (an index of myocardial repolarization) have been demonstrated to convey important prognostic information. The information about reproducibility of BRS and temporal QT variability is limited and there is lack of information regarding patients with cardiovascular diseases. We investigated reproducibility of spontaneous BRS using the sequence technique and temporal QT variability index (QTVI) in terms of intra-, interexaminer and within-subject variability in end-stage renal disease patients (ESRD, n=17, age 55+/-14 years) and healthy subjects (HS, n=29, age 32+/-12 years, P<0.01). ECG and blood pressure (Portapres) were recorded on two separate days and BRS and QTVI were evaluated by two independent examiners. The mean heart rate was similar in ESRD patients in comparison to healthy controls, whereas the mean arterial pressure was 13 % higher in ESRD patients (P<0.01). Spontaneous BRS was 62% lower (P<0.01) and QTVI was 41% higher in ESRD patients (P<0.01) compared to healthy subjects, respectively. Coefficient of variation (CV) of within-subject reproducibility of BRS and QTVI measurements was moderate (BRS: 33 % for ESRD, 27% for HS; QTVI: 40% for ESRD, 18% for HS). The 95% limit of within-subject reproducibility of BRS measurements was 3.8 ms/mm Hg for ESRD patients and 8.1 ms/mm Hg for healthy subjects; whereas the 95% limit of reproducibility of within-subject reproducibility of QTVI measurements was 0.73 for ESRD patients and 0.55 for healthy subjects. Concordance correlation coefficients of within-subject variability of BRS and QTVI were between 0.74 and 0.83 in both groups. CV of intra- and inter-examiner reproducibility of BRS and QTVI measurements in both groups ranged between 1 and 11%. In conclusion, the intra- and inter-examiner reproducibility/agreement of BRS and QTVI were high, whereas the within-subject reproducibility of these two methods was moderate, in both ESRD patients and healthy subjects. Thus, small differences in BRS and QTVI in longitudinal/interventional studies should be interpreted with caution.
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| 30. |
- Heyman, Isak, et al.
(författare)
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Exploring the prevalence of undetected bradyarrhythmia in dementia with Lewy bodies
- 2023
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Ingår i: Clinical autonomic research : official journal of the Clinical Autonomic Research Society. - 1619-1560. ; 33:4, s. 433-442
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore the prevalence of undetected bradyarrhythmia in a cohort of people with dementia with Lewy bodies.METHODS: Thirty participants diagnosed with dementia with Lewy bodies were enrolled from three memory clinics in southern Sweden between May 2021 and November 2022. None had a history of high-grade atrioventricular block or sick sinus syndrome. Each participant underwent orthostatic testing, cardiac [ 123I]metaiodobenzylguanidine scintigraphy and 24-h ambulatory electrocardiographic monitoring. Concluding bradyarrhythmia diagnosis was obtained until the end of December 2022. RESULTS: Thirteen participants (46.4%) had bradycardia at rest during orthostatic testing and four had an average heart rate < 60 beats per minute during ambulatory electrocardiographic monitoring. Three participants (10.7%) received a diagnosis of sick sinus syndrome, of whom two received pacemaker implants to manage associated symptoms. None received a diagnosis of second- or third-degree atrioventricular block.CONCLUSION: This report showed a high prevalence of sick sinus syndrome in a clinical cohort of people with dementia with Lewy bodies. Further research on the causes and consequences of sick sinus syndrome in dementia with Lewy bodies is thus warranted.
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| 31. |
- Lind, H, et al.
(författare)
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Selective attenuation of neuropeptide-Y-mediated contractile responses in blood vessels from patients with diabetes mellitus
- 1995
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Ingår i: Clinical Autonomic Research. - 1619-1560. ; 5:4, s. 191-197
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Tidskriftsartikel (refereegranskat)abstract
- Vascular smooth muscle contractile responses to neuropeptide Y, alpha,beta-methyleneATP and noradrenaline were studied in circular segments of isolated vessels with intact endothelium in vitro from 12 patients with diabetes mellitus type 2 (NIDDM) and 12 control subjects. The dilatory effect of acetylcholine was used to test the function of the endothelium. Subcutaneous arteries and veins (diameter 0.1-1.1 mm) were obtained during surgery. There was no difference in contractile responses to noradrenaline or alpha,beta-methyleneATP between diabetic and control vessels. The contractile response to neuropeptide Y, however, was markedly reduced in the diabetic group. The maximal contractile effect (46.0 +/- 14.0%, p < 0.05) but not the sensitivity to neuropeptide Y was significantly less in diabetic veins compared to control (107.5 +/- 19.6%). Thus, the attenuation of neuropeptide Y responses was present in humans as previously observed in alloxan-induced diabetes mellitus in rabbits. There was no difference in the dilator effect of acetylcholine between the diabetic and the control group in any of the vessel types, indicating that the difference in vascular reactivity to neuropeptide Y was not endothelium-dependent. In conclusion, the present study has shown that the postjunctional effects of neuropeptide Y, a co-transmitter of the peripheral sympathetic nervous system, is selectively attenuated in diabetes mellitus.
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| 32. |
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