Abstract
Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.
Highlights
Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms that might be related to dysautonomia [1]
Autonomic function and cardiovascular control have been frequently assessed in FMS and their evaluation has been typically based on the analysis of spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) [2,3,4,5,6]
These studies have reported that patients with FMS feature an increased sympathetic control and a reduced vagal modulation in supine position at rest (REST) [4,7,8], a lower cardiac baroreflex sensitivity compared to age-matched healthy subjects at REST [4,7,8], an inability of reducing further baroreflex sensitivity during an orthostatic challenge such as active standing (STAND) [6] and a limited involvement of the baroreflex control in regulating arterial blood pressure during STAND as detected by Granger causality analysis [6]
Summary
Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms that might be related to dysautonomia (i.e., insomnia, irritable bowel, anxiety, depression) [1]. Autonomic function and cardiovascular control have been frequently assessed in FMS and their evaluation has been typically based on the analysis of spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) [2,3,4,5,6] These studies have reported that patients with FMS feature an increased sympathetic control and a reduced vagal modulation in supine position at rest (REST) [4,7,8], a lower cardiac baroreflex sensitivity compared to age-matched healthy subjects at REST [4,7,8], an inability of reducing further baroreflex sensitivity during an orthostatic challenge such as active standing (STAND) [6] and a limited involvement of the baroreflex control in regulating arterial blood pressure during STAND as detected by Granger causality analysis [6]. This analysis is limited to traditional markers derived from HP and SAP variabilities but it includes even those quantifying the strength of the causal relation along a given time direction (e.g. from SAP to HP along cardiac baroreflex) computed according to Granger causality analysis
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