Autonomic Regulation In Patients Research Articles

The effectiveness of medical and psychological rehabilitation of patients with nervous tension

Abstract. The prevalence of anxiety disorders during life among residents of developed countries reaches 34 %. The low effectiveness of pharmacotherapy and psychotherapy determines the search for comprehensive technologies for the treatment of patients with nervous tension. The purpose of the study: to determine the prognosis of the effectiveness of medical and psychological rehabilitation (MPR) in patients with nervous tension and to identify its determinants. Methods: 254 patients aged 32 (19–50) years with nervous tension (ICD–X code R45.0) were studied. The complex of medical and psychological rehabilitation included physical exercises, courses of audiovisual polysensory relaxation, transcranial magnetic therapy, alpha massage, sodium chloride baths, climatotherapy, cognitive behavioral psychotherapy and therapeutic nutrition. The total duration of the MPR course is 10–20 days. To determine the relationship between integral health parameters and individual clinical and functional signs of nervous tension, correlation analysis was performed, canonical correlation analysis was used to select the most informative signs, and discriminant analysis was used to determine the prognosis of MPR and the dominants of its effectiveness. Results: A significant improvement in clinical and psychological status, physical health, increased physical performance, increased adaptive potential and autonomic regulation in patients was revealed. Significant high correlations of improvement of adaptive potential and physical performance with SAD (0.77), double product (0.81), Martin — Kushelevsky breakdown (0.74), average — with heart rate (0.58), DBP (0.69), level of physical health (0.54), weak — with BMI (0.47) were established. The effectiveness of MPR in patients with FA is 90 %. The determinants of effectiveness are indicators characterizing the heart rate, SAD, double product, BMI, age, Kerdo vegetative index, DAD, indicators of the Martinet — Kushelevsky test and physical performance PWC170–1. Conclusion: Various components of the pathogenesis of nervous tension determine the choice of rehabilitation technologies, the combination of mechanisms of therapeutic action of which determine the high effectiveness of MPR in patients with nervous tension.

Evaluation of autonomic disorders in miners with vibration disease

Introduction. Autonomic disorders in the form of autonomic neuropathy develop in vibration disease already at the early stages. As the disease progresses, the compensatory mechanisms of autonomic regulation are depleted, which leads to a worse prognosis for life and an increased risk of sudden cardiac death in patients with a severe degree of autonomic neuropathy. 
 The aim of the study was to evaluate the severity of autonomic disorders and the preservation of compensatory reserves of autonomic regulation in patients with vibration disease. 
 Materials and methods. One hundred thirty six miners with a proven diagnosis of vibration disease and 60 apparently healthy men of similar age without complaints and who had never worked under the conditions of exposure to industrial vibration were examined. Heart rate variability was analyzed at rest and during an active orthostatic test.
 Results. A decrease in the spectral parameters of heart rate variability in the patients with vibration disease was revealed. In a subgroup of the patients with an initially low level of very low frequency oscillations (less than 30 ms2/Hz), a decrease in the non-linear entropy index (less than 180) was determined; when performing an active orthostatic test, the power of very low frequency spectrum oscillations in the patients of this subgroup decreased by more than 50% of the initial values. In all patients with vibration disease under orthostatic load, a decrease in the oscillations of high and low frequencies of the spectrum of heart rate variability was revealed, whereas in the control group, the low frequency oscillation power remained at the initial level.
 Limitations. The study was limited to the evaluation of spectral and non-linear indices of heart rate variability in 136 miners with vibration disease. 
 Conclusion. The criteria for a severe course of autonomic neuropathy in the patients with vibration disease were identified: an initial decrease in the power of very low frequency oscillations and a non-linear entropy index of heart rate variability, as well as a decrease in the power of very low frequency oscillations by more than 50% during an orthostatic test. According to these criteria, in 40.4% of the miners with vibration disease, pronounced violations of the autonomic support with a lack of compensatory mechanisms of autonomic regulation were found to be detected.

Nocturnal Heart Rate Variability Might Help in Predicting Severe Obstructive Sleep-Disordered Breathing.

Obstructive sleep apnea (OSA) can have long-term cardiovascular and metabolic effects. The identification of OSA-related impairments would provide diagnostic and prognostic value. Heart rate variability (HRV) as a measure of cardiac autonomic regulation is a promising candidate marker of OSA and OSA-related conditions. We took advantage of the Physionet Apnea-ECG database for two purposes. First, we performed time- and frequency-domain analysis of nocturnal HRV on each recording of this database to evaluate the cardiac autonomic regulation in patients with nighttime sleep breathing disorders. Second, we conducted a logistic regression analysis (backward stepwise) to identify the HRV indices able to predict the apnea-hypopnea index (AHI) categories (i.e., "Severe OSA", AHI ≥ 30; "Moderate-Mild OSA", 5 ≥ AHI < 30; and "Normal", AHI < 5). Compared to the "Normal", the "Severe OSA" group showed lower high-frequency power in normalized units (HFnu) and higher low-frequency power in normalized units (LFnu). The standard deviation of normal R-R intervals (SDNN) and the root mean square of successive R-R interval differences (RMSSD) were independently associated with sleep-disordered breathing. Our findings suggest altered cardiac autonomic regulation with a reduced parasympathetic component in OSA patients and suggest a role of nighttime HRV in the characterization and identification of sleep breathing disorders.

Preoperative state of autonomic regulation in patients with adolescent idiopathic scoliosis

Objective. To analyze the state of autonomic regulation of the heart rate in patients with adolescent idiopathic scoliosis before the upcoming surgical treatment of spinal deformity.Material and Methods. The study included 30 patients with adolescent idiopathic scoliosis who were admitted for surgical treatment from January to April 2021. There were 28 female and 2 male patients. The heart rate variability (HRV) registration was carried out on the VNS-micro vegetotester, with Poly-Spectrum.NET software, Neurosoft (Russia). The study was conducted for 5 minutes in the supine position and for 5 minutes after the active orthostatic test. Temporal and spectral indicators of heart rate were analyzed.Results. When analyzing HRV at rest, an increase in the temporal indicators of the heart rate and the power of high-frequency wave oscillations was recorded, which indicates both an increased activity of autonomic regulation in general and the predominance of the regulatory influence o of the parasympathetic division of the autonomic nervous system. A decrease in all spectral components during an active orthostatic test and an increase in stress index values by 3.5 times indicate a significant stress of regulatory systems.Conclusion. Analysis of HRV in patients with adolescent idiopathic scoliosis at rest revealed increased autonomic activity with a predominant effect of the parasympathetic division of the autonomic nervous system. The state of exercise-induced energy deficit, registered after an active orthostatic test, indicates a significant preoperative stress of the regulatory systems and refers this category of patients to a group of increased risk of complications associated with hemodynamic instability.

The State of Vegetative Regulation in Patients with Ischemic Stroke in the Acute and Peracute Periods: an Observational Cohort Study

Background. The high number of stroke cases is predetermined by risk factors, pathogenetic heterogeneity, genetic predisposition to the disease. Neurovascular changes can serve as a marker for the severity of the patient’s condition. By means of cardiointervalography, the reactions of the autonomic nervous system in patients with ischemic stroke were studied, depending on the territory of the cerebral infarction and its period. With a favorable outcome of the disease, the detected changes in regulatory mechanisms can be considered adaptive, while with fatal outcome — disadaptive. Objectives. Determination of the state of the autonomic nervous system by means of cardiointervalography in patients with stroke in various pools of blood supply.Methods. 52 patients with a verifi ed diagnosis of ischemic stroke in the acute and peracute periods were examined. All patients were divided into 3 groups. Group 1 — patients with ischemic stroke in the middle cerebral artery territory on the left. Group 2 — with ischemic stroke in the middle cerebral artery territory on the right. Group 3 — with ischemic stroke in the vertebrobasilar territory. Patients with a fatal outcome are separately described. The functional state of the autonomic nervous system was assessed by the method of mathematical analysis of heart rate variability according to R.M. Baevsky (1984). Cardiointervalography was performed in the morning on the 1st day from the onset of the stroke and on the 10th day.Results. The state of autonomic regulation in patients with ischemic stroke depends on the localization and size of the lesion. According to cardiointervalography, parasympathetic effects on the rhythm of the heart prevailed in patients with ischemic stroke in the middle cerebral artery territory on the left and in the vertebrobasilar territory in the peracute period, while the sympathetic one predominated in patients with ischemic stroke in the middle cerebral artery territory on the right. In the acute period, the general tendency for the increase in activity of the opposite part of the autonomic nervous system was observed.Conclusion. Statistically signifi cant changes in the indicators of the total power of the wave oscillation spectrum and the indicator of ultra-low-frequency waves in the peracute and acute periods of stroke in the examined patients indicate the importance of neurohumoral mechanisms of regulation in the dynamics of the pathological state

Comprehensive medical rehabilitation using therapeutic physical factors including hydrokinesiotherapy in a pool with mineral water and its effect on circadian rhythms of arterial pressure and autonomic regulation in patients with arterial hypertension and with chronic psychoemotional stress

To study the effect of the course-based comprehensive rehabilitation using the therapeutic physical factors of the Belokurikha resort, including hydrokinesiotherapy in a pool with mineral water on the circadian rhythms of arterial pressure and its autonomous regulation in patients with arterial hypertension (AH) associated with chronic psychoemotional stress (CPES). The study involved 83 patients with stage I-II grade 1-2 of AH, whose professional activities were associated with CPES. Each participant had 24-hours Holter blood pressure monitored, and cardiointervalography (CIG) was performed before and after the medical rehabilitation course. The rehabilitation complex of the main group (II) included medication therapy for AH, diet, morning hygienic gymnastics, manual massage, total magnet therapy, and hydrokinesiotherapy in a pool with mineral water. Patients in the comparison group (I) were exposed to similar therapeutic physical factors with identical parameters of the procedures, except hydrokinesiotherapy, which was replaced by full baths with mineral water. Medical rehabilitation using the therapeutic physical factors of the Belokurikha resort with hydrokinesiotherapy in a pool promotes a decrease in the activity of a sympathetic nervous system and increase of vagal effects contribute to the regulation of vital functions of the AH patients, associated with CPES, thus minimizing the frequency of abnormal daily profiles night-peaker and over-dipper to 12.5% and 1.78% of cases, respectively, and increasing the percentage of subjects with its normal type (dipper) to 57.1% (p=0.039). The study results show the benefits of hydrokinesiotherapy in a pool with mineral water as a part of the course-based comprehensive rehabilitation in patients with hypertension and chronic psychoemotional stress in terms of normalizing circadian rhythms of arterial pressure and optimizing the activity of higher autonomous centers, which largely determine the cardiovascular system performance in this setting.

Comparison of Cardiac Autonomic Function in Type 2 Spinocerebellar Ataxia With Normal Control Using Heart Rate Variability as a Tool: A Cross-Sectional Study in Eastern India.

Background: Spinocerebellar ataxia (SCA) is a disease that refers to a category of inherited ataxias that are characterized by degenerative alterations in the cerebellum, pons, and spinocerebellar tracts. There are several different varieties of SCA and they are classified based on the mutant (altered) gene that causes the disease.Objective: To analyze the cardiovascular autonomic regulation in patients with type-2 spinocerebellar ataxia (SCA-2) from the heart rate variability (HRV) of 20 minutes resting electrocardiogram (ECG) and compare with the age and gender-matched controls.Materials and methods: HRV of 27 type-2 spinocerebellar ataxia patients was calculated offline from the resting ECG recording and compared with 23 age and gender-matched controls. The HRV was analyzed by HRV software module MLS 310. The frequency and time domain parameters were computed and compared.Result: Type-2 spinocerebellar ataxia patients have significantly low HRV and parasympathetic activity at rest compared to normal control. The total power in SCA-2 is 13491.63 ± 7660.77 ms2 and the normal control is 21784.76 ± 11008.67 ms2. High-frequency power (HF) which is a marker of parasympathetic activity in SCA-2 is 3823.1 ± 364 ms2 and in normal control is 9006.1 ± 920.64 ms2. The standard deviation of all NN intervals (SDNN), the square root of the mean-squared differences of successive intervals (RMSSD), spectral interval, and delta NN is significantly low in SCA-2.Conclusion: There is decreased parasympathetic tone and low HRV in SCA-2 as compared to normal controls.

Characteristics of Emotional Status and Autonomic Regulation in Patients with Ischemic Heart Disease and Sleep Disorders

Characteristics of Emotional Status and Autonomic Regulation in Patients with Ischemic Heart Disease and Sleep Disorders

Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P &lt; 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P &lt; 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P &lt; 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

Estimation of the Effect of the Course of Short-Term Sessions of Dry Immersion on Autonomic Regulation in Patients with Parkinsonism

Estimation of the Effect of the Course of Short-Term Sessions of Dry Immersion on Autonomic Regulation in Patients with Parkinsonism

Parameters of autonomic regulation in patients with focal frontal and temporal epilepsy

Aim. This study aimed to investigate the mechanisms of autonomic regulation and autonomic support in focal frontal and temporal lobe epilepsy.&#x0D; Materials and Methods. Thirty-six individuals were examined (19 men and 17 women; mean age 33.71.4 years) in the control group (without history of epileptic seizures) and 68 patients (32 men and 36 women, 34.11.5 years) with focal epilepsy (36 patients with frontal lobe epilepsy, of which 32 had temporal lobe epilepsy). Physiological parameters of heart rate variability and of skin sympathetic evoked potentials were evaluated.&#x0D; Results. Predomination of sympathetic influences in both groups of patients was found. According to the analysis of skin sympathetic evoked potentials, a high activity of the suprasegmental autonomic centers was determined in patients with epilepsy. Based on the results of the correlation analysis, the initial state in patients with temporal lobe epilepsy was characterized by greater intrasystemic tension that reflects the high level of physiological costs. The logit regression analysis model makes it possible to distribute patients with focal epilepsy into groups with different disease courses on the basis of the parameters of the autonomic support of the activity.&#x0D; Conclusion. In patients with focal epilepsy, predomination of sympathetic influences was observed, as well as greater activity of the suprasegmental centers of the autonomic regulation. Intrasystemic ratios of autonomic regulation parameters demonstrate an increase in the intrasystemic tension and a limitation of functional reserves in patients with temporal lobe epilepsy. A complex of parameters of autonomic support allows, based on the logit regression analysis, to distribute patients into groups with different courses of focal epilepsy.

Features of emotional status and autonomic regulation in patients with ischemic heart disease with sleep disorders

To study the features of the emotional status and autonomic regulation in patients with coronary heart disease and sleep disorders. Patients with angina pectoris of II-IV functional class (n=244), aged 36 to 72 years (average age 56.9±0.5 years), were examined. Emotional status was assessed by the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory, the State-Trait Anxiety Inventory. The vegetative status was studied by heart rate variability based on 5-minute recordings of cardiointervalogram and D.J. Ewing cardiovascular tests and a vegetative disorders questionnaire. Patients were divided into 2 groups depending on the severity of sleep disorders. Sixty-two patients (25.4%) had no sleep disorders (≥22 points on the sleep quality questionnaire), they were included in the 2nd group; 113 patients (46.3%) had severe sleep disorders (≤18 points on the sleep quality questionnaire), these patients were included in the 1st group, 69 patients (28.3%) had sleep disorders assessed as insignificant (from 19 to 21 points on the sleep quality questionnaire). The HADS scores for anxiety and depression were 9.2±0.4 and 7.7±0.4, respectively, in the 1st group; in the 2nd group the levels of anxiety and depression were 5.9±0.4 and 3.9±0.4 points (p<0.001). Clinically expressed autonomic disorders were observed in 100% of patients in the 1st group and in 75.8% in the 2nd group (p<0.001). The average score on the questionnaire of autonomic disorders was 41.8±1.2 in the 1st group, and 25.6±1.6 points in the 2nd group (p<0.001). In patients with sleep disorders, a higher level of anxiety, depression, autonomic disorders and lower heart rate variability were detected, which is an unfavourable prognostic sign that should be considered in treatment and rehabilitation of these patients.

A Simple Home-Based Lifestyle Intervention Program to Improve Cardiac Autonomic Regulation in Patients with Increased Cardiometabolic Risk

Lifestyle modification programs (LMP) represent a new approach to cardiometabolic/oncologic risk reduction. Successful LMP in clinical practice must be feasible, cost effective, efficacious and consider home-based exercise. Likewise, multiple mechanisms implied in cardiometabolic risk reduction such as cardiac autonomic regulation (CAR) should be easily evidenced, in spite of the computational complexity involved. This goal could be facilitated by employing novel, friendlier, simpler techniques, such as the Autonomic Nervous System Index (ANSI), which can be treated as a proxy of CAR. In this observational study, we introduce a simple LMP (based on cognitive behavioral strategies and patient-tailored prescription of nutrition and home-based exercise, managed by a single physician) into the currently existing clinical practice of secondary cardiometabolic prevention. In 26 subjects, we assessed CAR (autoregressive spectral analysis of cardiovascular variabilities), body mass composition (bioelectrical impedance analysis) and stress perception (questionnaires). After LMP, ANSI and lipid profile were improved; % of fat mass, waist circumference and stress perception were reduced. We conclude that this preliminary, proof of concept study provides significant evidence in favor of the hypothesis that it is possible to introduce a convenient, cost effective LMP into the currently existing clinical practice of secondary cardiometabolic prevention. Findings suggest a successful comprehensive behavioral change, possibly facilitated by the simplified approach employed in this study, capable of improving cardiac autonomic regulation in addition to body mass composition and stress perception.

Cognitive Function and Autonomic Regulation in Patients With Migraine

Cognitive Function and Autonomic Regulation in Patients With Migraine

Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation.

Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence. We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1-2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio. During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups. Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.

Effects of decompressive operation on cardiac autonomic regulation in patients with cervical spondylotic myelopathy: analysis of blood pressure, heart rate, and heart rate variability.

To investigate the effects of cervical decompression operation on cardiac autonomic regulation and its relationship to recovery of somatic neurological function in cervical spondylotic myelopathy (CSM) patients. One hundred and thirty-two consecutive patients were enrolled in this study, in which 73 patients received decompression operation and the remaining 59 were treated non-operatively. The follow-up period was 6months. Baseline and follow-up evaluation included Japanese Orthopaedic Association (JOA) score, office-based blood pressure (BP) measurement, heart rate (HR), and 24-h heart rate variability (HRV) assessment. Relationship between achieved JOA score (final JOA score-baseline score) and changes of BP, HR, and HRV parameters in both operative and non-operative groups was analyzed. In operative group, patients' JOA score and markers of parasympathetic activity in HRV assessment were significantly higher than baseline level 6months later. Blood pressure, especially systolic blood pressure (SBP), was significantly downregulated in both hypertension and non-hypertension patients. Mean heart rate was also significantly decreased. Furthermore, achieved JOA score was significantly negatively correlated with changes of SBP, minimal HR, mean HR, maximum HR, but significantly positively correlated with changes of HRV parameters reflecting parasympathetic activity. However, changes of JOA score, BP, HR, and HRV parameters in non-operative group were not significant. Cervical decompression operation could improve both somatic neurological function and cardiac autonomic regulation in CSM patients, and achieved JOA score was significantly positively correlated with improvement in HRV and cardiac parasympathetic activity. These slides can be retrieved under Electronic Supplementary Material.

Features of autonomic regulation in cholelithiasis before and after cholecystectomy

It is appropriate and necessary to examine the functional state of the autonomic nervous system and the quality of life in patients with cholelithiasis using the mathematical analysis of the heart rhythm at the present-day level. Materials and methods: 136 patients (115 women and 21 men) were examined, of which 70 patients after cholecystectomy with cholelithiasis and 66 patients with cholelithiasis. Fractional chromatic minute-type duodenal intubation with an analysis of the biochemical and microscopic composition of the bile was used to assess the biliary system condition. The examination of the autonomic nervous system was carried out by determining the heart rhythm using the cardiointervalography method with further mathematical analysis of the structure and variational pulsometry. Changes in the autonomic status in patients with cholelithiasis before and after cholecystectomy differ in general patterns: adaptive possibilities decrease and sympathetic activity of the autonomic regulation increases. An increase in the lithogenicity of bile, which positively correlates with the level of sympathicotonia, is characteristic for patients with cholelithiasis before and after cholecystectomy. The autonomic regulation in patients with cholelithiasis after cholecystectomy improves, however, the high bile lithogenicity persists.

Basal sympathetic predominance in periodic limb movements in sleep after continuous positive airway pressure.

This study investigated the basal autonomic regulation in patients with obstructive sleep apnea (OSA) showing periodic limb movements in sleep (PLMS) emerging after therapy with continuous positive airway pressure (CPAP). Data of patients with OSA undergoing a first polysomnography for diagnosis and a second polysomnography for therapy with CPAP were reviewed. Patients with OSA showing PLMS on the first polysomnography were excluded. By using heart rate variability analysis, epochs without any sleep events and continuous effects from the second polysomnography were retrospectively analyzed. Of 125 eligible patients, 30 with PLMS after therapy with CPAP (PLMS group) and 30 not showing PLMS on both polysomnography (non-PLMS group) were randomly selected for the analysis. No significant differences in the demographic characteristics and variables of polysomnographies were identified between the groups. Although one trend of low root mean square of successive differences (RMSSD) between intervals of adjacent normal heart beats (NN intervals) in the PLMS group was observed, patients in the PLMS group had significantly low normalized high-frequency (n-HF) and high-frequency (HF) values, but high normalized low frequency (n-LF) and high ratio of LF to HF (LF/HF ratio). After adjustment for confounding variables, PLMS on the second polysomnography was significantly associated with RMSSD (β = - 6.7587, p = 0.0338), n-LF (β = 0.0907, p = 0.0148), n-HF (β = - 0.0895, p = 0.0163), log LF/HF ratio (β = 0.4923, p = 0.0090), and log HF (β = - 0.6134, p = 0.0199). Patients with OSA showing PLMS emerging after therapy with CPAP may have a basal sympathetic predominance with potential negative cardiovascular effects.

Temporal Analysis of Cardiovascular and Respiratory Complexity by Multiscale Entropy Based on Symbolic Dynamics.

The effect of an orthostatic stress on cardiovascular and respiratory complexity was investigated to detect impaired autonomic regulation in patients with vasovagal syncope (VVS). A total of 16 female patients and 12 age-matched healthy female subjects were enrolled in a passive 70° head-up tilt test. Also, 12 age-matched healthy male subjects were enrolled to study gender differences. Analysis was performed dynamically using various short-term (5 min) windows shifted by 1 min as well as by 20 min of orthostatic phase (OP) to evaluate local and global complexity. Complexity was determined over multiple time scales by the established method of refined composite multiscale entropy (RCMSE) and by a new proposed method of multiscale entropy based on symbolic dynamics (MSE-SD). Concerning heart rate variability (HRV) during OP, both methods revealed the highest complexity for female controls followed by lower complexity in male controls (p < 0.01) and by the lowest complexity in female patients (p < 0.01). For blood pressure variability (BPV), no gender differences in controls were shown by any method. However, MSE-SD demonstrated highly significantly increased BPV complexity in patients during OP (p < 0.01 on 4 time-scales after 7 min, p < 0.001 on 5 time-scales after 11 min) while RCMSE did not reveal considerable differences (p < 0.05 on 2 time scales after 7 min). Respiratory complexity was further increased in patients primary shown by MSE-SD. Findings indicated impaired autonomic regulation in VVS patients characterized by predominantly increased BPV complexity accompanied with decreased HRV complexity. In addition, results suggested extending the concept of complexity loss with disease.

Effects of Progressive Resistance Training on Cardiovascular Autonomic Regulation in Patients With Parkinson Disease: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of a progressive resistance training (RT) on cardiac autonomic modulation and on cardiovascular responses to autonomic stress tests in patients with Parkinson disease (PD). DesignRandomized clinical trial. SettingThe Brazil Parkinson Association. ParticipantsPatients (N=30) with PD (modified Hoehn & Yahr stages 2–3) were randomly divided into 2 groups: a progressive RT group (PD training [PDT] group) and a control group (PD control [PDC] group). In addition, a group of paired healthy control (HC) subjects without PD was evaluated. InterventionsThe PDT group performed 5 resistance exercises, 2 to 4 sets, 12 to 6 repetitions maximum per set. Individuals in the PDC group maintained their usual lifestyle. Main Outcome MeasuresThe PDT and PDC groups were evaluated before and after 12 weeks. The HC group was evaluated once. Autonomic function was assessed by spectral analysis of heart rate variability and cardiovascular responses to autonomic stress tests (deep breathing, Valsalva maneuver, orthostatic stress). ResultsCompared with baseline, the normalized low-frequency component of heart rate variability decreased significantly after 12 weeks in the PDT group only (PDT: 61±17 normalized units [nu] vs 47±20nu; PDC: 60±14nu vs 63±10nu; interaction P<.05). A similar result was observed for systolic blood pressure fall during orthostatic stress that also was reduced only in the PDT group (PDT: −14±11mmHg vs −6±10mmHg; PDC: −12±10mmHg vs −11±10mmHg; interaction P<.05). In addition, after 12 weeks, these parameters in the PDT group achieved values similar to those in the HC group. ConclusionsIn patients with PD, progressive RT improved cardiovascular autonomic dysfunction.