Autonomic Nerve Function In Patients Research Articles

Correlation between Palpitations below the Heart in Traditional Chinese Medicine and Autonomic Nerve Function Based on Heart Rate Variability: A Case-Control Study.

Objective To explore the autonomic nerve rhythm and the correlation between palpitations below the heart (PBTH) and autonomic nerve function in patients with PBTH based on heart rate variability (HRV). Methods The outpatients or ward patients of Wenzhou Hospital of Traditional Chinese Medicine were collected and divided into two groups: the PBTH group and the normal group. The HRV of each group was detected. Single-factor statistical methods, Spearman correlation analysis, and logistic regression were used to describe and analyze the rhythm and characteristics of autonomic nerves in patients with PBTH and the correlation between PBTH and autonomic nerve function. Results (1) In the comparison of HRV in different time periods in the same group, the SDNN, RMSSD, pNN50, TP, and HF in the PBTH group at night were significantly higher than those in the daytime (P < 0.01), while the LF/HF ratio was significantly lower than that in the daytime (P < 0.01). (2) In the comparison of HRV between the two groups in the same time period, the RMSSD and pNN50 of the PBTH group during the daytime period were significantly higher than those of the normal control group (P < 0.05), and the LF/HF was significantly lower than that of the normal group (P < 0.05). (3) In the Spearman correlation analysis, PBTH was significantly correlated with RMSSD, pNN50, and LF/HF ratio in the daytime period, with correlation coefficients of 0.424, 0.462, and −0.524, respectively (P < 0.05). (4) Logistic regression analysis showed that the decrease of LF/HF ratio during the daytime period was an independent risk factor for PBTH in TCM (OR = 0.474, 95% CI: 0.230–0.977, P < 0.05). Conclusions The changes in parasympathetic nerve function in patients with PBTH have a circadian rhythm, which is characterized by increased activity during the nighttime. At the same time, the autonomic nerve activity of people with PBTH during the daytime is unbalanced, and the decrease of LF/HF ratio during the day is an independent high risk factor for PBTH.

Study on the relationship of National Institutes of Health Stroke Scale score with heart rate variability and cardiac complication in elderly patients with acute cerebral infarction

Objective To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score. Methods One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups. Results In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05). Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke. Key words: Cerebral infarction; Heart rate; Autonomic agents

Association between laryngopharyngeal reflux disease and autonomic nerve dysfunction.

To assess autonomic nerve function in patients with laryngopharyngeal reflux disease (LPRD) and determine the correlation between LPRD and autonomic nerve dysfunction. Patients with suspected LPRD who visited our outpatient department were assessed using the reflux symptom index (RSI) and reflux finding score (RFS) scales. Eighty-one suspected LPRD patients with RSI > 13 and RFS > 7 were examined using 5-min short-range heart rate variability, and all were given proton pump inhibitor diagnostic treatment. The root mean square of successive R-R intervals, high-frequency (HF) power, standardized HF, and HF% were significantly lower in the case group than in the control group (p < 0.05); however, the low frequency (LF)/HF ratio was significantly higher in the case group (p < 0.05). There were no significant differences in the standard deviation of the average normal-to-normal interval, total power, LF power, and LF% between the two groups (p > 0.05). RSI, RFS, and disease duration were negatively correlated with HF power (r = - 0.89, -0.77, and -0.315, respectively; p < 0.05). The LF/HF ratio and disease duration were positively correlated (r = 0.315, p < 0.05). Autonomic nerve dysfunction was observed in our patients with LPRD. LPRD severity was significantly correlated with autonomic nerve dysfunction and negatively correlated with vagal nerve function.

553-P: Differential Effects of High-Intensity Interval Training on Somatosensory and Autonomic Nerve Function in Patients with Type 2 Diabetes

It remains unclear, whether exercise training as part of lifestyle intervention has favorable effects on the development or progression of diabetic neuropathy in patients with type 2 diabetes (T2D). Therefore, we assessed peripheral and autonomic nerve fiber function and morphology in patients with T2D as well as in individuals with normal glucose tolerance (CON) before and after a high intensity interval training (HIIT) intervention program over 12 weeks. The T2D group included 20 male individuals ([median (1st; 3rd quartile)] age: 56 (53; 63) years; diabetes duration: 5 (2; 9) years; BMI: 31.2 (28.6; 32.8) kg/m²; HbA1c: 6.9 (6.4; 8.0)%). The CON group was matched for age, sex, and BMI (n=23; age: 57 (53; 60) years; BMI: 30.3 (28.4; 32.2) kg/m²; HbA1c: 5.4 (5.2; 5.7)). Somatosensory and autonomic nerve tests included nerve conduction velocity, quantitative sensory testing, skin biopsy, corneal confocal microscopy, cardiovascular autonomic function tests (CAFT), and spontaneous baroreflex sensitivity (BRS). After 12 weeks of HIIT, no improvement in somatosensory nerve tests was detected in T2D or CON. In both groups, resting heart rate decreased ([mean±SEM] baseline vs. follow-up: T2D: 68.8±2.3 vs. 63.4±1.8 bpm; CON: 65.1±1.8 vs. 60.2±1.9 bpm; both P&amp;lt;0.05). The change in systolic blood pressure after standing up (-13.9±2.6 vs. -9.4±2.2 mmHg) and three BRS sequence analysis indices (e.g., BRS-slope: 7.9±1.9 vs. 12.6±5.1 ms/mmHg) improved in T2D (P&amp;lt;0.05), while the standard deviation of normal RR intervals (SDNN; 36.1±2.6 vs. 55.3±8.8 ms; P&amp;lt;0.05) and coefficient of variation (CV; 3.8±0.3 vs. 5.2±0.7%; P&amp;lt;0.05) improved in CON. In conclusion, while cardiovascular autonomic function improved moderately after 12 weeks of HIIT in male T2D patients, a longer training period may be required to achieve favorable effects on somatosensory nerve function or morphology. Disclosure G.J. Bönhof: None. A. Strom: None. M. Apostolopoulou: None. D. Pesta: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc. D. Ziegler: Advisory Panel; Self; Allergan, TrigoCare. Consultant; Self; Mitsubishi Tanabe Pharma Corporation, Mylan, Novartis Pharmaceuticals Corporation, Wörwag. Speaker's Bureau; Self; Berlin-Chemie AG. Funding German Ministry of Culture and Science of the State of North Rhine-Westphalia; German Federal Ministry of Health; German Federal Ministry of Education and Research

Visceral sensitivity, gut barrier function and autonomic nerve function in patients with diarrhea-predominant irritable bowel syndrome

To evaluate visceral sensitivity, gut barrier function and autonomic nerve function (ANF) in patients with diarrhea-predominant irritable bowel syndrome (IBS-D), and to explore their roles in IBS-D pathophysiology. Methods: A total of 46 IBS-D patients (IBS-D group) were selected from the Department of Gastroenterology of China-Japan Friendship Hospital from October 2015 to March 2016, and 20 healthy volunteer were served as a control group (HC group). Clinical and psychological symptoms were evaluated by questionnaire, and visceral sensitivity to rectal balloon distention, gut barrier function and autonomic nerve function (ANF) were examined. The difference in the above-mentioned indexes were compared between the 2 groups, and the correlations in the parameters were analyzed in the IBS-D group. Results: The scores of IBS symptom severity scale (IBS-SSS), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD) and visceral sensitivity index (VSI) were significantly higher in the IBS-D group than those in the HC group (P<0.01). In the visceral sensitivity test, maximum tolerable threshold in the IBS-D group was significantly decreased compared to that in the HC group (P<0.01); there was no significant difference in first sensation threshold and defecating sensation threshold between the two groups (P>0.05). As gut barrier function markers, the serum diamine oxidase (DAO) and d-lactate were significantly increased in the IBS-D group (P<0.05). In ANF test, the total score and parasympathetic score as well as the proportion of abnormal scores in the IBS-D group were significantly higher than those in the HC group (P<0.05). In IBS-D group, the HAMA, VSI and serum DAO were positively correlated with IBS-SSS (r=0.528, 0.575, 0.507; P<0.01), while the 3 visceral sensitivity thresholds were negatively correlated with IBS-SSS (r= -0.636, -0.476, -0.697; P<0.01); in addition to the IBS-SSS, the HAMA, HAMD, VSI and serum DAO were also significant negatively correlated with the visceral sensitivity thresholds (all P<0.05); no significant correlations were found between the ANF and the other parameters. Conclusion: IBS-D patients show psychological symptoms, visceral hypersensitivity, impaired gut barrier function and abnormal ANF characterized by parasympathetic dysfunction; the former 3 factors are all associated with disease severity, and thus may play vital roles in IBS-D pathophysiology.

Exercise induced changes in autonomic nerve function in patients with irritable bowel syndrome by power spectral analysis

Background: Altered autonomic nerve function has been reported by various investigators in IBS and moderate to vigor­ous physical exercise causes autonomic nerve function improvement both in healthy and various clinical conditions. Objective: To observe the effect of brisk walking on the autonomic nerve function by analysis of heart rate in patients with Irritable bowel syndrome.Methods: This prospective interventional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) between January to December 2013. For this purpose 77 male patients aged 20-50 years with IBS were included in this study, they were enrolled from OPD, Gastroen­terology, BSMMU, Dhaka. For comparison, 28 apparently healthy male were also included as control. HRV measures were recorded once before exercise and also after 3 months of brisk walking. For assessing HRV, frequency domain measures such as total power, LF power, HF power, LF norm and HF norm were recorded by Polyrite D machine. ANOVA, Independent sample t-test and paired t-tests were performed for statistical analysis.Results: The pre-exercise values of HF power, HF norm and total power were significantly lower (p&lt;0.05) whereas values of LF power and LF norm were higher (p&lt;0.05) in all IBS patient compared to those of control. The post exercise data demonstrated signifi­cantly higher (p&lt;0.05) HF power, HF nu and total power in all IBS patients compared to their pre-exercise values.Conclu­sion: This study concluded that the frequency domain measures of HRV were decreased in IBS patients but all these parameters can be improved by regular moderate physical exercise.

Efficacy of Qingxin Huatan therapy in regulating cardiac autonomic nerve function in patients with chronic stable angina: study protocol for a randomized controlled trial

Background: Coronary heart disease is a chronic degenerative disease of the coronary arteries characterized by atherosclerosis. Lianxia Ningxin granules, a traditional Chinese medicine, is a representative preparation of Qingxin Huatan therapy, which has been confirmed to be effective in improving autonomic nerve dysfunction in patients with coronary heart disease. Methods/Design: We herein describe a prospective, single-center, randomized, double-blind, placebo-controlled trial to be performed by the Department of Cardiovascular Medicine, Third Affiliated Hospital of Beijing University of Chinese Medicine, China. Eighty patients with chronic stable angina will be randomly assigned to receive 4 weeks of treatment with either Western medicine plus Lianxia Ningxin granules (traditional Chinese medicine group) or Western medicine plus placebo (control group). All patients will be followed up for 8 weeks. The primary outcome is frequency of angina attacks. The secondary outcomes include heart rate variability, plasma catecholamine concentrations, nitroglycerin consumption, duration of angina, severity of angina pain, efficacy of traditional Chinese medicine treatment, and quality of life. Discussion: This study is designed to assess the efficacy of Qingxin Huatan therapy in treating chronic stable angina, and simultaneously investigate the regulatory effects of this therapy on cardiac autonomic nerve function and related neurotransmitter concentrations. The outcomes will provide information concerning the clinical use of Qingxin Huatan therapy to treat chronic stable angina and its ability to regulate cardiac autonomic nervous function. Trial registration : This protocol was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR-TRC-14004699). Ethics: Written approval has been obtained from the Medical Ethical Committee, Third Affiliated Hospital of Beijing University of Chinese Medicine, China (approval number: KTPJ-BZYSY-2003-003). Informed consent: Written informed consent will be obtained from patients or their guardians prior to inclusion in this study.

Assessment of Autonomic Nerve Function In Patients With Irritable Bowel Syndrome

Background: Autonomic nerve function impairment is related to development of Irritable Bowel Syndrome (IBS). Heart rate variability (HRV) is a useful tool to measure autonomic nerve function activity and also sympatho-vagal balance.Objective: To assess autonomic nerve function activity by heart rate variability analysis in patients with Irritable Bowel Syndrome.Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 1st July 2010 to 30th June 2011. Ninety patients aged 20-50 years of both sexes with Irritable bowel syndrome were included in the study group. They were enrolled from the OPD of Gastroenterology in BSMMU. For comparison age and sex matched 30 apparently healthy subjects were also studied as control. The power spectral HRV parameters were recorded by a digital Polyrite. For statistical analysis ANOVA, independent sample t-test were performed.Results: Mean resting pulse rate, mean HR, SBP, DBP, LF, LF norm and LF/HF were significantly higher(P&lt;0.001) and total power, HF, HF norm were significantly lower(P&lt;0.001) in IBS group compared to those of control.Conclusion: This study concludes markedly lower parasympathetic with concomitant higher sympathetic activity and shifting of sympathovagal balance towards sympathetic predominance in patients of IBS. DOI: http://dx.doi.org/10.3329/jbsp.v7i1.11163 J Bangladesh Soc Physiol. 2012, June; 7(1): 53-59

Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder that is characterized by recurrent episodes of intense vomiting. There are several postulated mechanisms involved in its pathogenesis and one potential explanation for this disorder may be linked to autonomic dysfunction. The aim of our study was to evaluate autonomic nerve function in patients with CVS prospectively. We tested the sympathetic nervous system through postural changes in heart rate (HR) and blood pressure and the thermoregulatory sweat test. The parasympathetic nervous system was tested through the HR response to deep breathing (R-R variability on EKG). A total of 20 patients who met Rome III criteria for CVS, 14 (70%) women and 6 (30%) men, and 20 controls were enrolled in the study. A total of 17 (85%) CVS subjects and 2 (10%) controls had abnormalities on thermoregulatory sweat testing (P < 0.001). A total of 7 (35%) patients and one control subject had evidence of postural tachycardia (P = 0.04) with an increase in HR > 30 on standing. Of the subjects, 18 (90%) had either abnormal sudomotor function or postural tachycardia or both. The HR response to deep breathing was normal in 19 (95%) subjects with CVS and 18 (95%) controls. The results of this study suggest that the majority of subjects (90%) with CVS have impairment of the sympathetic nervous system with postural tachycardia and/or sudomotor dysfunction while parasympathetic nerve function appears to be intact. These findings of dysautonomia in CVS have implications in both the diagnosis and treatment of these patients.

The Vagus Nerve: A Tonic Inhibitory Influence Associated With Inflammatory Bowel Disease in a Murine Model

The recently proposed Inflammatory Reflex describes an interaction between the vagus nerve and peripheral macrophages, resulting in attenuation of proinflammatory cytokine release in response to systemic exposure to bacterial endotoxin. The purpose of this study was to determine whether a similar vagus/macrophage axis modulates the inflammatory responses in the colon in mice. We assessed the Disease Activity Index (DAI), macroscopic and histologic damage, serum amyloid-P level, and myeloperoxidase activity in colitis induced by administration of dextran sodium sulfate (DSS) in healthy and vagotomized C57BL/6 and in mice deficient in macrophage-colony stimulating factor (M-CSF)-induced and in hapten-induced colitis. A pyloroplasty was performed in vagotomized mice. DAI, macroscopic and histologic scores, myeloperoxidase activity, levels of serum amyloid-P, and colonic tissue levels of interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha were increased significantly in vagotomized mice 5 days post-DSS and 3 days after hapten-induced colitis compared with sham-operated mice that received DSS or the hapten. Pretreatment with nicotine significantly decreased each of these markers in vagotomized mice with DSS colitis, and all markers except DAI and IL-6 in sham-operated DSS-treated mice. Conversely, hexamethonium treatment significantly increased each of these markers in the sham-operated DSS-treated mice. Vagotomy had no effect on the colitis in M-CSF-deficient mice. The vagus nerve plays a counterinflammatory role in acute colitis via a macrophage-dependent mechanism, involving hexamethonium-sensitive nicotinic receptors. The identification of a counterinflammatory neural pathway would open new therapeutic avenues for treating acute exacerbations of inflammatory bowel disease.

Differences in autonomic nerve function in patients with silent and symptomatic myocardial ischaemia.

Autonomic neuropathy provides a mechanism for the absence of symptoms in silent myocardial ischaemia, but characterisation of the type of neuropathy is lacking. To characterise and compare autonomic nerve function in patients with silent and symptomatic myocardial ischaemia. The Valsalva manoeuvre, heart rate variation (HRV) in response to deep breathing and standing, lower body negative pressure, isometric handgrip, and the cold pressor test were performed by patients with silent (n = 25) and symptomatic (n = 25) ambulatory ischaemia and by controls (n = 21). No difference in parasympathetic efferent function between patients with silent and symptomatic ischaemia was recorded, but both had significantly less HRV in response to standing than the controls (p < 0.005 for silent and p < 0.01 for symptomatic). Patients with silent ischaemia showed an increased propensity for peripheral vasodilatation compared with symptomatic patients (p < 0.02) and controls (p < 0.04). Impaired sympathetic function was found in patients with pure silent ischaemia (n = 4) compared with the remaining patients with silent ischaemia whose pain pathways were presumed to be intact. Patients with silent ischaemia and pain pathways presumed to be intact have an enhanced peripheral vasodilator response, and if this applied to the coronary vasculature it could provide a mechanism for limiting ischaemia to below the pain threshold. Patients with pure silent ischaemia have evidence of sympathetic autonomic dysfunction.

Cardiovascular autonomic nerve function in patients with hypoxaemic chronic obstructive pulmonary disease

Intraneural hypoxaemia is recognized as a pathogenic mechanism in diabetic neuropathy. A similar pathophysiological process may occur in chronic obstructive pulmonary disease (COPD). Autonomic neuropathy is not recognized in COPD. We compared 96 patients with hypoxaemic COPD to 22 age-matched control subjects to see whether autonomic dysfunction occurs in COPD and whether there was any correlation with the severity of hypoxaemia. The cardiovascular autonomic tests consisted of heart rate responses (mainly parasympathetic function) to a Valsalva manoeuvre, deep breathing and postural change and blood pressure responses (mainly of sympathetic origin) to postural change and sustained handgrip. Early autonomic neuropathy is defined as one abnormal test and definite autonomic neuropathy as two abnormal tests according to the normal range. These autonomic tests were reproducible in our study population. Although the symptoms and signs of autonomic neuropathy were rare, definite autonomic dysfunction was found in 35%, and early autonomic neuropathy in a further 47%, of patients whose arterial oxygen tension (PaO2) was less than 8 kPa (60 mmHg). Only 18% of the control group had evidence of an age-related early autonomic dysfunction. Parasympathetic autonomic dysfunction was significantly correlated with PaO2 whilst the sympathetic tests were relatively normal. Correction of hypoxaemia for one hour or administration of ipratropium bromide or terbutaline had no effect on autonomic function. Subclinical autonomic neuropathy is a feature of hypoxaemic COPD. Its importance in the disease process and its role in prognosis needs evaluation.

Disturbed Autonomic Nerve Function in Patients with Crohn's Disease

Autonomic nerve function was evaluated in 33 patients with Crohn's disease (age range, 19-66 years; mean, 36 years) by three established non-invasive tests based on the heart reactions to deep breathing (E/I ratio) and to tilt (acceleration and brake indices). Peripheral nerve function was evaluated neurographically and by measuring thresholds to vibration and temperature changes. None of the patients were diabetic, and all had normal thyroid function. In spite of normal peripheral nerve function, almost half of the patients, 48% (16/33), showed signs of autonomic neuropathy (AN). The occurrence of AN was not related to duration or severity of Crohn's disease or to biochemical evidence of inflammation or malabsorption of vitamins and trace elements. We conclude that autonomic nerve dysfunction is a feature of Crohn's disease which may be relevant with regard to the frequent disturbance in bowel function in patients with this disorder.