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1.
Niger J Clin Pract ; 23(10): 1437-1442, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047703

RESUMO

Background: Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. Objectives: This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. Methods: A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. Results: The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). Conclusion: CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.


Assuntos
Doenças do Sistema Nervoso Autônomo/epidemiologia , Sistema Nervoso Autônomo/fisiopatologia , Epilepsia/fisiopatologia , Coração/fisiopatologia , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Doenças do Sistema Nervoso Autônomo/etiologia , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Feminino , Força da Mão/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Postura/fisiologia , Gravidez , Fatores de Risco , Convulsões , Centros de Atenção Terciária , Adulto Jovem
3.
Expert Rev Cardiovasc Ther ; 18(11): 749-759, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32885689

RESUMO

BACKGROUND: Imbalance in autonomic modulation can occur after a cardiac event, which can lead to deleterious consequences. Exercise has proven to be a therapy which affects this modulation and can be assessed through heart rate variability (HRV). AREAS COVERED: The objective of this systematic review was to investigate the effects of physical exercise on heart rate variability in individuals with coronary artery disease (CAD). The PubMed, PEDro, Scielo, Lilacs and Cochrane databases were systematically searched, for articles which performed supervised exercises in phase II of cardiac rehabilitation in patients with CAD. EXPERT OPINION: Given the differences between studies on interventions and population characteristics, it is difficult to justify similarities or divergences in terms of results. In addition to the variation in sample size, intervention duration, carrying out an additional program at home, and patients with different clinical presentations, it can be inferred that responses to exercise may vary for certain types/clinical profile of individuals with CAD. Thus, it is necessary to carry out more studies with greater methodological rigor, greater standardization of the variables studied and the evaluation forms, in order to increase the veracity of the results and the consequent clinical relevance and therapeutic application.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Terapia por Exercício , Reabilitação Cardíaca/métodos , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Humanos
4.
Neurology ; 95(21): e2854-e2865, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-32938788

RESUMO

OBJECTIVES: To assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in Parkinson disease (PD), we retrospectively studied 173 patients with PD and 173 age- and sex-matched controls with orthostatic intolerance, who underwent cardiovascular autonomic function testing under continuous noninvasive blood pressure (BP) monitoring. METHODS: We screened for tOH (systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg resolving within the first minute upon standing) and classic OH (cOH, sustained systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg within 3 minutes upon standing). In patients with PD, we reviewed the medical records of the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance. RESULTS: tOH occurred in 24% of patients with PD and 21% of controls, cOH in 19% of patients with PD and in none of the controls, independently of any clinical-demographic or PD-specific characteristic. Forty percent of patients with PD had a history of falls, in 29% of cases due to syncope. Patients with PD with history of orthostatic intolerance and syncope had a more severe systolic BP fall and lower diastolic BP rise upon standing, most pronounced in the first 30-60 seconds. CONCLUSIONS: tOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD. Continuous noninvasive BP monitoring upon standing may help identify a modifiable risk factor for syncope-related falls in parkinsonian patients.


Assuntos
Acidentes por Quedas/prevenção & controle , Hipotensão Ortostática/complicações , Doença de Parkinson/complicações , Síncope/complicações , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Determinação da Pressão Arterial/métodos , Feminino , Humanos , Hipotensão/complicações , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Intolerância Ortostática/complicações , Fatores de Risco
5.
Hipertens. riesgo vasc ; 37(3): 108-114, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193519

RESUMO

INTRODUCCIÓN Y OBJETIVOS: Las alteraciones del sistema nervioso autónomo fueron propuestas como precursoras en la génesis y perpetuación de la aterosclerosis hace ya mucho tiempo. Nuestro objetivo fue determinar si existe asociación entre la presencia de aterosclerosis carotídea y la función autonómica evaluada mediante la variabilidad de la frecuencia cardíaca. MÉTODOS: A través de un estudio prospectivo de casos y controles investigamos la variabilidad de la frecuencia cardíaca en 5 min y la presencia de aterosclerosis carotídea mediante ultrasonografía en 54 pacientes que dividimos en 2 grupos según la presencia (+) o ausencia (−) de placas ateroscleróticas en carótidas (ATE). Se analizó la variabilidad de frecuencia cardíaca en dominio de frecuencia en el espectro de alta frecuencia, baja frecuencia, cociente alta/baja frecuencia y potencia espectral total. RESULTADOS: Sobre una población de 54 individuos sin enfermedad cardiovascular establecida evaluados en forma consecutiva, se detectaron 26 individuos (48%) portadores de ATE+. Se observó una reducción en la variabilidad de la frecuencia cardíaca en el grupo ATE+ representada por el espectro de baja frecuencia (LF) (p < 0,0001). La actividad parasimpática específicamente representada por el componente espectral de alta frecuencia también resultó menor en el grupo ATE+en análisis univariado (p < 0,0001) al igual que la potencia espectral total (p < 0,0001), un índice de regulación autonómica integral. No se encontraron diferencias significativas cuando se analizó el balance autonómico de baja y alta frecuencia (LF/HF) (p = 0,1598). En un modelo de regresión logística solo la presión arterial sistólica y el poder espectral total resultaron predictores independientes de ATE+. CONCLUSIÓN: Verificamos una disminución en la variabilidad de la frecuencia cardíaca en sujetos con aterosclerosis carotídea, que se estableció tanto a través de sus componentes espectrales como de la potencia espectral total, no así a través de la valoración del balance autonómico. La potencia espectral total, en principio, sería un método correcto de evaluación autonómica en este grupo de pacientes


INTRODUCTION AND OBJECTIVES: Alterations of the sympathetic and parasympathetic nervous system have been proposed as precursors of the genesis and perpetuation of atherosclerosis for a long time. The objective of this study is to determine if there is an association between the presence of carotid atherosclerosis and the reduction in heart rate variability. METHODS: Using a prospective case-control design, the heart rate variability and the presence of carotid atherosclerosis was investigated in 54 patients, divided into 2 groups according to the presence or absence of carotid atherosclerosis. An analysis was made of the heart rate variability variables of the frequency (spectral) domain in high frequency band, low frequency band, parasympathetic autonomic balance, and the total spectral band. RESULTS: Of the 54 individuals evaluated without previous cardiovascular disease consecutively, 26 of them (48%) presented with subclinical carotid atherosclerosis (ATE+). A reduction in heart rate variability was observed in the ATE+group represented by the low frequency (LF) spectrum (P < .0001). The parasympathetic activity specifically represented in the high frequency (HF) band was also lower in the ATE+group in the univariate analysis (P < .0001), same as the total spectral power (P < .0001), an index of integral autonomic regulation. No significant differences were found in the LF/HF analysis (P = .1598). After analysing variables with significant differences in the univariate analysis with a logistic regression model, only systolic blood preassure and the total spectral power were shown to be independent predictors of ATE+. CONCLUSION: A reduction in heart rate variability was found in subjects with carotid atherosclerosis. Some spectral components of heart rate variability, like low frequency or total spectral power, were better predictors of carotid atherosclerosis than the parasympathetic autonomic balance. In this study it seems that total spectral power is an adequate measurement for analysing autonomic function


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Aterosclerose/diagnóstico por imagem , Estudos de Viabilidade , Estudos Prospectivos , Modelos Logísticos , Pressão Sanguínea , Estudos de Casos e Controles , Antropometria , Hipolipemiantes/uso terapêutico , Índice de Massa Corporal , Hipertensão/terapia , Fatores de Risco
6.
BMJ ; 370: m2930, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878745

RESUMO

OBJECTIVE: To evaluate the association between quadrivalent human papillomavirus vaccination and syndromes with autonomic dysfunction, such as chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome. DESIGN: Population-based self-controlled case series. SETTING: Information on human papillomavirus vaccinations and selected syndromes with autonomic dysfunction (chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome) identified using ICD-10 (international classification of diseases, revision 10) diagnostic codes from Danish nationwide registers. PARTICIPANTS: 869 patients with autonomic dysfunction syndromes from a cohort of 1 375 737 Danish born female participants aged 10 to 44 years during 2007-16. MAIN OUTCOME MEASURES: Self-controlled case series rate ratios (95% confidence intervals) of the composite outcome of chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome, adjusted for age and season, comparing female participants vaccinated and unvaccinated with the quadrivalent human papillomavirus vaccine. Chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome were also considered separately in secondary analyses. RESULTS: During 10 581 902 person years of follow-up, 869 female participants with syndromes of autonomic dysfunction (136 with chronic fatigue syndrome, 535 with complex regional pain syndrome, and 198 with postural orthostatic tachycardia syndrome) were identified. Quadrivalent human papillomavirus vaccination did not statistically significantly increase the rate of a composite outcome of all syndromes with autonomic dysfunction in a 365 day risk period following vaccination (rate ratio 0.99, 95% confidence interval 0.74 to 1.32) or the rate of any individual syndrome in the risk period (chronic fatigue syndrome (0.38, 0.13 to 1.09), complex regional pain syndrome (1.31, 0.91 to 1.90), or postural orthostatic tachycardia syndrome (0.86, 0.48 to 1.54)). CONCLUSIONS: When vaccination is introduced, adverse events could occur in close temporal relation to the vaccine purely by chance. These results do not support a causal association between quadrivalent human papillomavirus vaccination and chronic fatigue syndrome, complex regional pain syndrome, or postural orthostatic tachycardia syndrome, either individually or as a composite outcome. An increased risk of up to 32% cannot be formally excluded, but the statistical power of the study suggests that a larger increase in the rate of any syndrome associated with vaccination is unlikely.


Assuntos
Vacinas contra Papillomavirus/efeitos adversos , Disautonomias Primárias/epidemiologia , Disautonomias Primárias/etiologia , Vacinação/efeitos adversos , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Estudos de Casos e Controles , Criança , Estudos de Coortes , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/epidemiologia , Síndromes da Dor Regional Complexa/etiologia , Dinamarca/epidemiologia , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/etiologia , Feminino , Humanos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Síndrome da Taquicardia Postural Ortostática/etiologia , Disautonomias Primárias/diagnóstico , Adulto Jovem
7.
Ned Tijdschr Geneeskd ; 1642020 07 02.
Artigo em Holandês | MEDLINE | ID: mdl-32779921

RESUMO

Trigeminal autonomic cephalalgias (TACs) are a group of 4 different primary headache syndromes that have a lot of pathophysiological and clinical features in common. The 4 different TACs are: cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks and hemicrania continua. TACs are characterized by frequent, strictly unilateral, (very) intense headache attacks with ipsilateral cranial autonomic symptoms or intrinsic restlessness or both. A distinction can be made between the 4 TACs on the basis of the duration and frequency of the headache attacks. The treatment of cluster headache consists of an acute treatment and a maintenance treatment. Headache attacks in the context of paroxysmal hemicrania and hemicrania continua (almost) always respond to treatment with indomethacin. More and more neuromodulation therapies are becoming available, such as vagus nerve stimulation, stimulation and blocking of the sphenopalatine ganglion, stimulation and blocking of the occipital nerve and deep brain stimulation.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Cefalalgias Autonômicas do Trigêmeo/diagnóstico , Cefalalgias Autonômicas do Trigêmeo/terapia , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/terapia , Diagnóstico Diferencial , Feminino , Lateralidade Funcional , Humanos , Masculino , Cefalalgias Autonômicas do Trigêmeo/fisiopatologia
8.
Sci Rep ; 10(1): 13994, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32814782

RESUMO

To propose a new test to evaluate the autonomic nervous system in patients with syncope: Multimodal Monitoring for Diagnosis of Dysautonomia (MMDD). We included 21 patients with syncope (16 female, 6 male, mean age 43.5 years) and 21 with no-syncope subjects (15 female, 7 male, mean age 45.1 years) to perform a test of nine 2-min stages: four while resting and four during active testing of autonomic response. Transcranial-Doppler, electrocardiogram, and photoplethysmography blood pressure pulse-to-pulse monitoring, allow registering six variables from the Middle Cerebral Artery and four from the Cardiovascular System. We analyze each variable's mean differences in each stage and its change when they pass from one stage to another with the T and Z tests. To understand the significance of the change, we use a logistic regression model for a certain subgroup of variables. Since we have a small dataset, we use the bootstrap technique to infer the general behavior that characterizes a syncope. Our data confirm differences between syncope and non-syncope patients during MMDD stress stages 2, 4, 6 and 8. Bootstrap and multivariate logistic regression allow us to identify which sets of variables in each of these stages of the MMDD are sufficiently sensitive to recognizing syncope. MMDD protocol can recognize a syncope patient with some confidence by detecting subtle changes in the autonomic nervous system. This protocol encourages us to continue to study the effectiveness of MMDD protocol allowing a new approach to future research.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Sistema Cardiovascular/fisiopatologia , Disautonomias Primárias/fisiopatologia , Síncope/fisiopatologia , Adulto , Sistema Nervoso Autônomo/diagnóstico por imagem , Sistema Cardiovascular/diagnóstico por imagem , Eletrocardiografia/métodos , Estudos de Viabilidade , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Síncope/diagnóstico , Síncope/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos
9.
PLoS One ; 15(8): e0236930, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750063

RESUMO

BACKGROUND: Maturation of multiple neurobehavioral systems, including autonomic regulation, is altered by preterm birth. The purpose of this study was to determine the long-term effects of Family Nurture Intervention (FNI) in the NICU on autonomic regulation of preterm infants and their mothers. METHOD: A subset of infants and mothers (48% of infants, 51% of mothers) randomly assigned to either standard are (SC), or SC plus the FNI in the NICU in a prior RCT (ClincalTrials.gov; NCT01439269) returned for follow-up assessments when the children were 4 to 5 years corrected age (CA). ECGs were collected for 10 minutes in mothers and their children while children were in their mothers' laps. Heart rate, standard deviation for heart rate, respiratory sinus arrhythmia (RSA)-an index of parasympathetic regulation, and a measure of vagal efficiency were quantified. RESULTS: Both children and mothers in the FNI group had significantly greater levels of RSA compared to the SC group (child: mean difference = 0.60, 95% CI 0.17 to 1.03, p = 0.008; mother: mean difference = 0.64, 95% CI 0.07 to 1.21, p = 0.031). In addition, RSA increased more rapidly in FNI children between infancy and the 4 to 5-year follow-up time point (SC = +3.11±0.16 loge msec2, +3.67±0.19 loge msec2 for FNI, p<0.05). These results show that the rate of increase in RSA from infancy to childhood is more rapid in FNI subjects. CONCLUSION: Although these preliminary follow-up results are based on approximately half of subjects originally enrolled in the RCT, they suggest that FNI-NICU led to healthier autonomic regulation in both mother and child, when measured during a brief face-to-face socioemotional interaction. A Pavlovian autonomic co-conditioning mechanism may underly these findings that can be exploited therapeutically.


Assuntos
Doenças do Sistema Nervoso Autônomo/terapia , Sistema Nervoso Autônomo/fisiopatologia , Recém-Nascido Prematuro/fisiologia , Unidades de Terapia Intensiva Neonatal , Relações Mãe-Filho , Mães , Adulto , Sistema Nervoso Autônomo/fisiologia , Pré-Escolar , Estudos de Coortes , Seguimentos , Humanos , Arritmia Sinusal Respiratória
10.
Artigo em Inglês | MEDLINE | ID: mdl-32823577

RESUMO

Postural orthostatic tachycardia syndrome (POTS) is a multifactorial condition capable of chronically reducing the quality of life and the work ability of patients. The study aim was to assess the burden of autonomic symptoms in a cohort of POTS patients over 2 years. Patients' clinical profiles were assessed by the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS 31) and a visual analog scale (VAS). One-way ANOVA for repeated measures followed by Dunnett's post-hoc test were used to compare symptoms at baseline and at 1 and 2 years. Out of 42 enrolled patients, 25 had a 1-year follow-up and 12 had a 2-year follow-up. At baseline, the reported burden of autonomic symptoms was high (overall COMPASS 31 = 49.9 ± 14.3 /100). Main complaints were related to orthostatic intolerance according to both COMPASS 31 and VAS. Fourteen patients were rendered inactive because of symptoms. At 1-year follow-up, a statistically significant improvement in pupillomotor function and overall score was detected by the COMPASS 31. These findings were confirmed at 2 years, together with a significant reduction in quality of life impairment, assessed by VAS. However, these improvements did not change patients' occupational status. Awareness of POTS diagnosis, patient monitoring, and tailored therapies can help to improve patients' condition.


Assuntos
Sistema Nervoso Autônomo , Síndrome da Taquicardia Postural Ortostática , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Qualidade de Vida , Fatores de Tempo , Adulto Jovem
11.
Arq Bras Cardiol ; 115(1): 52-58, 2020 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32785491

RESUMO

Background The family history of hypertension (FHH) imposes consistent risk for diverse chronic diseases that are accompanied by hypertension. Furthermore, the heart rate variability (HRV) and flow-mediated dilation (FMD) are both related to maximal oxygen uptake (VO2max), and are usually impaired during hypertension Objective To compare the autonomic modulation, the endothelial function (EF) and maximum oxygen uptake (VO2max) of young athletes, separated according to their parents' blood pressure (BP) history, in order to study the influence of their genetic background on those parameters. Methods A total of 46 young male soccer players (18±2 years of age) were divided into four groups: 1-normotensive father and mother (FM-N); 2-only father was hypertensive (F-H); 3-only mother was hypertensive (M-H); 4-father and mother were hypertensive (FM-H). Measurements of BP, FMD, HRV and VO2maxwere performed. The significance level adopted in the statistical analysis was 5%. Results The standard deviation of normal RR intervals (SDNN; FM-N=314±185; FM-H=182.4± 57.8), the square root of the mean squared differences in successive RR intervals (RMSSD; FM-N=248±134; FM-H=87±51), the number of interval differences of successive NN intervals greater than 50ms (NN50; FM-N=367±83.4; FM-H=229±55), the ratio derived by dividing NN50 by the total number of NN intervals (pNN50; FM-N=32.4±6.2; FM-H=21.1±5.3) and the high (HF; FM-N=49±8.9; FM-H=35.3±12) and low-frequency (LF; FM-N=50.9±8.9; FM-H=64.6±12) components, in normalized units (%), were significantly lower in the FM-H group than in the FM-N group (p<0.05). On the other hand, the LF/HF ratio (ms2) was significantly higher (p<0.05). We found no significant difference between the groups in VO2maxand FMD (p<0.05). Conclusions In young male soccer players, the FHH plays a potentially role in autonomic balance impairment, especially when both parents are hypertensive, but present no changes in VO2maxand FMD. In this case, there is a decrease in the sympathetic-vagal control, which seems to precede the endothelial damage (Arq Bras Cardiol. 2020; 115(1):52-58).


Assuntos
Endotélio/fisiologia , Hipertensão , Futebol , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Humanos , Hipertensão/genética , Masculino , Oxigênio , Consumo de Oxigênio , Adulto Jovem
12.
Sci Rep ; 10(1): 10924, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616805

RESUMO

Considering that neurogenic oropharyngeal dysphagia is a prevalent condition with or without cardiac disease we should contemplate issues surrounding cardiovascular difficulties during rehabilitation. This study aims to evaluate the effects of effortful swallowing maneuver (ESM) on heart rate variability (HRV) in subjects with neurogenic oropharyngeal dysphagia. We studied 22 individuals [8 Stroke and 14 Parkinson Disease (PD) subjects aged between 41 and 75 years old] with neurogenic oropharyngeal dysphagia regardless of gender. HRV was assessed under two circumstances: spontaneous swallowing versus ESM. Surface electromyography of the suprahyoid muscles was undertaken to measure the swallowing muscle excitation, which then confirmed higher muscle activity during ESM. We attained no changes in HRV between the two swallowing events [HR: spontaneous swallowing 78.68 ± 13.91 bpm vs. ESM 102.57 ± 107.81 bpm, p = 0.201; RMSSD (root-mean square of differences between adjacent normal RR intervals in a time interval): spontaneous swallowing 16.99 ± 15.65 ms vs. ESM 44.74 ± 138.85 ms, p = 0.312; HF (high frequency): spontaneous swallowing 119.35 ± 273 ms2 vs. ESM 99.83 ± 194.58 ms2, p = 0.301; SD1 (standard deviation of the instantaneous variability of the beat-to-beat heart rate): spontaneous swallowing 12.02 ± 1.07 ms vs. ESM 31.66 ± 98.25 ms, p = 0.301]. The effortful swallowing maneuver did not cause clinically significant changes in autonomic control of HR in this group of subjects with oropharyngeal dysphagia.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Deglutição/fisiologia , Sistema de Condução Cardíaco/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças do Sistema Nervoso Autônomo/reabilitação , Comorbidade , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/reabilitação , Eletromiografia , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Esforço Físico , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia
13.
Sci Rep ; 10(1): 11661, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32669640

RESUMO

Mild cognitive impairment (MCI) is a heterogeneous syndrome with two main clinical subtypes, amnestic (aMCI) and non-amnestic (naMCI). The analysis of heart rate variability (HRV) is a tool to assess autonomic function. Cognitive and autonomic processes are linked via the central autonomic network. Autonomic dysfunction entails several adverse outcomes. However, very few studies have investigated autonomic function in MCI and none have considered MCI subtypes or the relationship of HRV indices with different cognitive domains and structural brain damage. We assessed autonomic function during an active orthostatic challenge in 253 oupatients aged ≥ 65, [n = 82 aMCI, n = 93 naMCI, n = 78 cognitively normal (CN), neuropsychologically tested] with power spectral analysis of HRV. We used visual rating scales to grade cerebrovascular burden and hippocampal/insular atrophy (HA/IA) on neuroimaging. Only aMCI showed a blunted response to orthostasis. Postural changes in normalised low frequency (LF) power and in the LF to high frequency ratio correlated with a memory test (positively) and HA/IA (negatively) in aMCI, and with attention/executive function tests (negatively) and cerebrovascular burden (positively) in naMCI. These results substantiate the view that the ANS is differentially impaired in aMCI and naMCI, consistently with the neuroanatomic substrate of Alzheimer's and small-vessel subcortical ischaemic disease.


Assuntos
Amnésia/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Córtex Cerebral/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Coração/fisiopatologia , Hipocampo/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Amnésia/diagnóstico por imagem , Atenção/fisiologia , Sistema Nervoso Autônomo/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Estudos Transversais , Tontura/diagnóstico por imagem , Tontura/fisiopatologia , Função Executiva/fisiologia , Feminino , Coração/diagnóstico por imagem , Frequência Cardíaca/fisiologia , Hipocampo/diagnóstico por imagem , Humanos , Masculino , Memória/fisiologia , Neuroimagem , Testes Neuropsicológicos , Equilíbrio Postural/fisiologia , Índice de Gravidade de Doença
14.
Sci Rep ; 10(1): 12439, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32709890

RESUMO

Familial history of hypertension is associated with autonomic dysfunction and increase in blood pressure (BP). However, an active lifestyle has been found to improve a number of health outcomes and reduce all-cause mortality. The aim of the present study was to investigate the effects of an active lifestyle on hemodynamics, heart rate variability (HRV) and oxidative stress markers in offspring of hypertensive parents. One hundred twenty-seven subjects were assigned into four groups: sedentary offspring of normotensives (S-ON) or hypertensives (S-OH); and physically active offspring of normotensives (A-ON) or hypertensives (A-OH). Diastolic BP and heart rate were reduced in the physically active groups when compared to S-OH group. A-ON and A-OH groups presented increased values of RR total variance when compared to the sedentary ones (A-ON: 4,912 ± 538 vs. S-ON: 2,354 ± 159; A-OH: 3,112 ± 236 vs. S-OH: 2,232 ± 241 ms2). Cardiac sympato-vagal balance (LF/HF), systemic hydrogen peroxide and superoxide anion were markedly increased in S-OH group when compared to all other studied groups. Additionally, important correlations were observed between LF/HF with diastolic BP (r = 0.30) and hydrogen peroxide (r = 0.41). Thus, our findings seem to confirm an early autonomic dysfunction in offspring of hypertensive parents, which was associated with a systemic increase in reactive oxygen species and blood pressure. However, our most important finding lies in the attenuation of such disorders in offspring of physically active hypertensives, thus emphasizing the importance of a physically active lifestyle in the prevention of early disorders that may be associated with onset of hypertension.


Assuntos
Estilo de Vida Saudável/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/genética , Estresse Oxidativo/fisiologia , Disautonomias Primárias/prevenção & controle , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/genética , Determinação da Pressão Arterial , Exercício Físico/fisiologia , Predisposição Genética para Doença , Humanos , Hipertensão/fisiopatologia , Masculino , Anamnese , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/genética , Disautonomias Primárias/fisiopatologia , Espécies Reativas de Oxigênio/sangue , Comportamento Sedentário , Adulto Jovem
15.
Open Heart ; 7(2)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32727853

RESUMO

INTRODUCTION AND OBJECTIVE: Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns. METHODS: Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI). RESULTS: We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI. CONCLUSIONS: The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists ('Neuro-psycho-heart Team'). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies. TRIAL REGISTRATION NUMBER: NCT02759341.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Córtex Cerebral/fisiopatologia , Angina Microvascular/fisiopatologia , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Mapeamento Encefálico , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Saúde Mental , Angina Microvascular/diagnóstico , Angina Microvascular/psicologia , Testes Neuropsicológicos , Percepção da Dor , Estudos Prospectivos , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/psicologia
16.
Am J Physiol Regul Integr Comp Physiol ; 319(1): R106-R113, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32493036

RESUMO

Electroacupuncture (EA) is widely used as an effective method to treat stress-related disorders. However, its mechanisms remain largely unknown. The aim of this study was to investigate the effects and mechanisms of EA on gastric slow wave (GSW) dysrhythmia and c-Fos expression in the nucleus of the solitary tract (NTS) induced by stress in a rodent model of functional dyspepsia (FD). Rats in the neonatal stage were treated using intragastric iodoacetamide. Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of GSW and electrodes into accupoints ST36 for EA. Autonomic functions were assessed by spectral analysis of heart rate variability. Rats were placed for 30 min in a cylindrical plastic tube for acute restraint stress. The involvement of a central afferent pathway was assessed by measuring c-Fos-immunoreactive cells in the NTS. 1) EA normalized restraint stress-induced impairment of GSW in FD rats. 2) EA significantly increased vagal activity (P = 0.002) and improved sympathovagal balance (P = 0.004) under stress in FD rats. 3) In FD rats under restraint stress, plasma norepinephrine concentration was increased substantially (P < 0.01), which was suppressed with EA. 4) The EA group showed increased c-Fos-positive cell counts in the NTS compared with the sham EA group (P < 0.05) in FD rats. Acute restraint stress induces gastric dysrhythmia in a rodent model of FD. EA at ST36 improves GSW under stress in FD rats mediated via the central and autonomic pathways, involving the NTS and vagal efferent pathway.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Dispepsia/fisiopatologia , Dispepsia/terapia , Eletroacupuntura , Gastropatias/terapia , Estresse Psicológico/complicações , Vias Aferentes/fisiopatologia , Animais , Animais Recém-Nascidos , Esvaziamento Gástrico , Iodoacetamida , Masculino , Norepinefrina/sangue , Proteínas Proto-Oncogênicas c-fos/biossíntese , Ratos , Ratos Sprague-Dawley , Restrição Física , Núcleo Solitário/metabolismo , Gastropatias/induzido quimicamente , Nervo Vago/fisiopatologia
17.
Vet Res Commun ; 44(2): 73-81, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32500313

RESUMO

BACKGROUND: Sildenafil improves autonomic dysfunction caused by pulmonary hypertension (PH) in humans, but its effect is unknown in dogs with PH. This prospective study aimed to evaluate the autonomic nervous system function of a canine model of chronic embolic PH (CEPH) and the autonomic nervous system function of a canine model of CEPH in which sildenafil was administered. METHODS: This study used five clinically healthy female beagle dogs. Evaluation parameters included hemodynamic parameters, heart rate (HR) and heart rate variability (HRV). Each evaluation parameter was compared before and after creating the CEPH model (before, BL; after, CEPHBL) and between the CEPHBL model and after the administration of sildenafil (1 mg/kg, BID) in the CEPH model dogs (CEPHSil). RESULTS: In the CEPHBL model, the hemodynamic parameters indicated cardiac hypofunction, and HR was significantly increased and HRV was significantly decreased compared with BL. Further, in the CEPHSil model, the hemodynamic parameters suggested improvement in cardiac function, and HRV was significantly increased. CONCLUSIONS: From the results of the CEPH model dogs, autonomic dysfunction was shown to occur in PH dogs. In addition, the administration of 1 mg/kg of sildenafil to CEPH model dogs may improve autonomic dysfunction.


Assuntos
Sistema Nervoso Autônomo/efeitos dos fármacos , Hipertensão Pulmonar/tratamento farmacológico , Citrato de Sildenafila/administração & dosagem , Citrato de Sildenafila/farmacologia , Animais , Sistema Nervoso Autônomo/fisiopatologia , Doença Crônica , Modelos Animais de Doenças , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Hipertensão Pulmonar/fisiopatologia
18.
ACS Chem Neurosci ; 11(11): 1520-1522, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: covidwho-324525

RESUMO

Accumulating data have now shown strong evidence that COVID-19 infection leads to the occurrence of neurological signs with different injury severity. Anosmia and agueusia are now well documented and included in the criteria list for diagnosis, and specialists have stressed that doctors screen COVID-19 patients for these two signs. The eventual brainstem dysregulation, due to the invasion of SARS CoV-2, as a cause of respiratory problems linked to COVID-19, has also been extensively discussed. All these findings lead to an implication of the central nervous system in the pathophysiology of COVID-19. Here we provide additional elements that could explain other described signs like appetite loss, vomiting, and nausea. For this, we investigated the role of brainstem structures located in the medulla oblongata involved in food intake and vomiting control. We also discussed the possible pathways the virus uses to reach the brainstem, i.e., neurotropic and hematogenous (with its two variants) routes.


Assuntos
Anorexia/fisiopatologia , Regulação do Apetite/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Ingestão de Alimentos/fisiologia , Náusea/fisiopatologia , Pneumonia Viral/fisiopatologia , Núcleo Solitário/fisiopatologia , Vômito/fisiopatologia , Ageusia/etiologia , Anorexia/etiologia , Área Postrema/fisiopatologia , Barreira Hematoencefálica , Infecções por Coronavirus/complicações , Humanos , Hipotálamo/fisiopatologia , Bulbo/fisiopatologia , Náusea/etiologia , Vias Neurais/fisiopatologia , Transtornos do Olfato/etiologia , Nervo Olfatório , Pandemias , Pneumonia Viral/complicações , Nervo Vago , Vômito/etiologia
19.
PLoS One ; 15(5): e0232497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392257

RESUMO

BACKGROUND: Spleen volume reduction followed by re-expansion has been described in acute ischemic stroke in both animal and human studies. Splenic contraction might be partially due to sympathetic hyperactivity and might be accompanied by release of splenocytes in the peripheral circulation, leading to immunodepression. AIMS: To investigate whether spleen volume changes in the first week after stroke are associated with post-stroke infections, changes in lymphocytes count and autonomic dysfunction. METHODS: In patients with acute ischemic stroke, spleen sizes were calculated from abdominal CT images on day one and day seven. Spleen size reduction was defined as > 10% spleen size reduction between day one and day seven. Post stroke infections were diagnosed during the first seven days after stroke onset using the modified criteria of the US Center of Disease Control and Prevention. We assessed the time course of leukocyte subsets and analysed pulse rate variability (PRV) indices. RESULTS: Post-stroke infections occurred in six out of 11 patients (55%) with spleen size reduction versus in five out of 27 patients (19%) without spleen size reduction (p = 0,047). Spleen size reduction was associated with a drop in lymphocytes and several lymphocyte subsets from admission to day one, and a higher NIHSS at admission and at day three (p = 0,028 and p = 0,006 respectively). No correlations could be found between spleen volume change and PRV parameters. CONCLUSION: Post-stroke infections and a drop in lymphocytes and several lymphocyte subsets are associated with spleen volume reduction in acute ischemic stroke.


Assuntos
Infecções/diagnóstico por imagem , Infecções/etiologia , Baço/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Animais , Sistema Nervoso Autônomo/fisiopatologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Infecções/fisiopatologia , Contagem de Linfócitos , Subpopulações de Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Projetos Piloto , Estudos Prospectivos , Baço/patologia , Acidente Vascular Cerebral/fisiopatologia , Tomografia Computadorizada por Raios X
20.
BMC Cardiovasc Disord ; 20(1): 217, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393179

RESUMO

BACKGROUND: Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. METHODS: We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1. RESULTS: The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). CONCLUSIONS: In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function - specifically and consistently for indicators of vagal activity - measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Coração/inervação , Resistência à Insulina , Fatores Etários , Idoso , Biomarcadores/sangue , Glicemia/análise , Feminino , Humanos , Insulina/sangue , Masculino , Estudos Prospectivos , Triglicerídeos/sangue , Estados Unidos
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