Evaluation Of Autonomic Nervous System Research Articles

Acute Effect of Vertebral Manipulation Technique on the Autonomic Nervous System

The term "stress" refers to the state induced by perceiving stimuli that trigger emotional and hormonal responses in the body's balance. In acute stress situations, adrenaline, neurotransmitters, and cortisol are released, causing systemic changes and physiological disruptions, keeping the body alert. Heart rate variability assesses the autonomic nervous system. Joint manipulation, involving high-speed, low-amplitude movements, was chosen based on the patient's dysfunction. The study aimed to assess the immediate effects of this technique on the sympathetic and parasympathetic systems, analyzing heart rate variability in university students in Fortaleza. This cross-sectional, randomized, quantitative study at the Ateneu University Center involved 20 participants divided into two groups: G1 – vertebral manipulation application and G2 – a control group with positioning only. Autonomic nervous system evaluation used a sensor connected to the earlobe and the Inner Balance app. Data was processed by Em Wave and Kubios software before and after manipulation. Range of motion was assessed using Kinovea software. Both groups experienced increased range of motion, with greater improvement in the manipulation group. Both groups showed increased parasympathetic activity and reduced sympathetic stress levels, possibly influenced by manipulation and touch, providing either nerve decompression or direct autonomic nervous system stimulation through touch.

Acute Effect of Vertebral Manipulation Technique on the Autonomic Nervous System

The term "stress" refers to the state induced by perceiving stimuli that trigger emotional and hormonal responses in the body's balance. In acute stress situations, adrenaline, neurotransmitters, and cortisol are released, causing systemic changes and physiological disruptions, keeping the body alert. Heart rate variability assesses the autonomic nervous system. Joint manipulation, involving high-speed, low-amplitude movements, was chosen based on the patient's dysfunction. The study aimed to assess the immediate effects of this technique on the sympathetic and parasympathetic systems, analyzing heart rate variability in university students in Fortaleza. This cross-sectional, randomized, quantitative study at the Ateneu University Center involved 20 participants divided into two groups: G1 – vertebral manipulation application and G2 – a control group with positioning only. Autonomic nervous system evaluation used a sensor connected to the earlobe and the Inner Balance app. Data was processed by Em Wave and Kubios software before and after manipulation. Range of motion was assessed using Kinovea software. Both groups experienced increased range of motion, with greater improvement in the manipulation group. Both groups showed increased parasympathetic activity and reduced sympathetic stress levels, possibly influenced by manipulation and touch, providing either nerve decompression or direct autonomic nervous system stimulation through touch.

Music Modulates Autonomic Nervous System Activity in Human Fetuses.

ContextFetal Autonomic Nervous sysTem Evaluation (FANTE) is a non-invasive tool that evaluates the autonomic nervous system activity in a fetus. Autonomic nervous system maturation and development during prenatal life are pivotal for the survival and neuropsychiatric development of the baby.ObjectiveAim of the study is to evaluate the effect of music stimulation on fetal heart rate and specific parameters linked to ANS activity, in particular fetal heart rate variability.MethodsThirty-two women between the 32nd and 38th week with a singleton uncomplicated pregnancy were recruited. All FANTE data collections were acquired using a 10-derivation electrocardiograph placed on the maternal abdomen. In each session (5 min basal, 10 min with music stimulus, and 5 min post-stimulus), FANTE was registered. The music stimulus was “Clair de lune” Debussy, played through headphones on the mother’s abdomen (CTR: 31927).ResultsMusic does not change the mean value of fetal heart rate. However, indices of total fetal heart rate variability statistically increase (RRsd p = 0.037, ANNsd p = 0.039, SD2 p = 0.019) during music stimulation in comparison to the basal phase. Heart rate variability increase depends mainly on the activation of parasympathetic branches (CVI p = 0.013), meanwhile, no significant changes from basal to stimulation phase were observed for indices of sympathetic activity. All the parameters of heart rate variability and parasympathetic activity remained activated in the post-stimulus phase compared to the stimulus phase. In the post-stimulus phase, sympathetic activity resulted in a significant reduction (LFn p = 0.037).ConclusionMusic can influence the basal activity of the fetal autonomic nervous system, enhancing heart rate variability, without changing fetal heart rate mean value. Music is enabled to induce a relaxation state in a near-to-term fetus, mediated by parasympathetic activation and by a parallel sympathetic inhibition.

Evaluation of cardiovascular autonomic function in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a type of inflammatory arthritis that affects people all over the world. RA is a chronic systemic inflammatory autoimmune disease. It primarily affects the joints and is frequently accompanied by extra-articular symptoms such as rheumatoid nodules, neuropathy, and normochromic normocytic anaemia. Objectives- The aim of this study was to evaluate cardiac autonomic function in patients with rheumatoid arthritis and compare with healthy individuals. An observational, cross-sectional study was done between 50 having RA & 50 normal healthy subjects not on any medication, on both males & females between the age group of 30-60 years. Evaluation of autonomic nervous system was done with the help of non-invasive tests. Parasympathetic system was assessed by heart rate response to standing & heart rate response to lying down position. Sympathetic system was assessed by blood pressure response to standing, BP response to Valsalva Maneuverer & BP response to sustained hand grip. In individuals with Rheumatoid Arthritis, the diastolic blood pressure in standing position was significantly lower(p<0.01) than control group. Other parameters showed non- significant changes in RA group compared to control group. Discussion- study confirmed autonomic dysfunction occurs in patient with rheumatoid arthritis. Therefore, autonomic function may be the part of routine clinical examination in RA to reduce the cardiovascular autonomic morbidity Cardiovascular autonomic function tests in daily clinical examination helpful in early detection of autonomic dysfunction in rheumatoid arthritis.

A Study Protocol on Assessment of Heart Rate Variability as a Prognostic Marker in Critically Ill Patients

Background: Calculation of heart rate variability (HRV) is the most popular approach of actual evaluation of autonomic nervous system (ANS) dysregulation, representing natural physiological changes. The natural changes take place in the interim among successive heart beats when sympathetic and parasympathetic expression is balanced on the heart's electrical conduction system. Numerous adult studies have shown that reductions in HRV predate clinical decline, indicate therapy response in correlation with results. Therefore, HRV can be functional as a measure of more accurate clinical perception. This study aims to determine role of heart rate variability and other risk factors as a prognostic marker for 90-day survival among patients admitted to critical care units.
 Methods: This will be an Observational Cross-sectional Study with Control Group and will include hypertension, diabetes mellitus, Myocardial Infarction, Stroke, Sepsis cases and control cases. The patients admitted in Medicine critical care unit will be included in the study and they will be evaluated for HRV and APACHE IV scoring. Patients demographic profile, anthropometric measurements and history of other comorbid conditions will be documented. Patients’ outcome indicators like duration of hospital stay, 90-day survival and mortality will be obtained .Data will be analyzed by appropriate statistical tests.
 Expected Results: Mixed effects models will demonstrate that the result of three HRV will be relatively lower from the start of day and night compared to the last day and night of MICU admission. The significant relationship between the variability of time from enrollment and log heart rate values is expected over the last day and night of MICU stay. Also, average HRV is expected to persist significantly higher as compared with that of the first day and night.

Autonomic nervous system dysfunction in Wilson's disease - A systematic literature review.

In Wilson's disease (WD), copper accumulation can result in neurological manifestations, particularly extrapyramidal symptoms. There are some data that the autonomic nervous system (ANS) may also be affected, and we aimed to systematically review available studies evaluating ANS dysfunction in WD. We conducted a systematic review of the literature using the PubMed database (up to 31st August 2020), with search terms including "autonomic" and "function" and "Wilson's disease". Fourteen studies, including 297 patients with neurological, hepatic or psychiatric forms of WD were retrieved. The most frequent methods used for ANS evaluation were orthostatic tests, which were performed in seven studies, with a number of other tests less frequently used. The incidence of ANS abnormalities ranged from ~8% to 79.2%, depending on the evaluation method. ANS abnormalities in patients with WD were often clinically asymptomatic. The features of dysautonomia were more common among patients with neurological symptoms and ANS abnormalities were more common in patients with severe brain injury. Studies confirmed both sympathetic and parasympathetic ANS impairment. The pathophysiology of ANS damage was not clear but may result from central, peripheral nervous system and direct cardiac involvement. Clear improvements were observed in four studies after anti-copper therapy initiation. Both sympathetic and parasympathetic divisions of the ANS may be affected in WD. The observed ambiguities regarding ANS abnormalities in WD patients may arise from small study groups, differences in methodology, and a lack of comprehensive ANS evaluation; however, the results indicate that further studies are warranted.

Evaluation of autonomic nervous system in children with spastic cerebral palsy: clinical and electophysiological study

BackgroundCerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically.ResultsAge of the studied children ranged from 4 to 12 years. Quadriplegic type of spastic cerebral palsy constituted 82.5% of CP children while diplegic type constituted 17.5%. Based on Gross Motor Function Classification System (GMFCS), the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards sympathetic skin response, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test.ConclusionsAutonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.

The Assessment of Autonomic Nervous System Activity Based on Photoplethysmography in Healthy Young Men.

Noninvasive assessment of autonomic nervous system (ANS) activity is of great importance, but the accuracy of the method used, which is primarily based on electrocardiogram-derived heart rate variability (HRV), has long been suspected. We investigated the feasibility of photoplethysmography (PPG) in ANS evaluation. Data of 32 healthy young men under four different ANS activation patterns were recorded: baseline, slow deep breathing (parasympathetic activation), cold pressor test (peripheral sympathetic activation), and mental arithmetic test (cardiac sympathetic activation). We extracted 110 PPG-based features to construct classification models for the four ANS activation patterns. Using interpretable models based on random forest, the main PPG features related to ANS activation were obtained. Results showed that pulse rate variability (PRV) exhibited similar changes to HRV across the different experiments. The four ANS patterns could be better classified using more PPG-based features compared with using HRV or PRV features, for which the classification accuracies were 0.80, 0.56, and 0.57, respectively. Sensitive features of parasympathetic activation included features of nonlinear (sample entropy), frequency, and time domains of PRV. Sensitive features of sympathetic activation were features of the amplitude and frequency domain of PRV of the PPG derivatives. Subsequently, these sensitive PPG-based features were used to fit the improved HRV parameters. The fitting results were acceptable (p < 0.01), which might provide a better method of evaluating ANS activity using PPG.

P-38 UTILITY OF PUPILLARY REACTIVITY IN THE FUNCTIONAL ASSESSMENT OF THE AUTONOMOUS NERVOUS SYSTEM IN PATIENTS WITH CHRONIC LIVER DISEASE: PRELIMINARY RESULTS

Autonomic nervous system (ANS) dysfunction in patients with chronic liver disease (CLD) is associated with greater severity. Heart rate variability (HRV) allows the assessment of ANS, but its implementation is complex. Pupillary reactivity (PR) by automatic pupillometry (AP) also provides this information; however its usefulness in patients with CLD is unknown. To validate the usefulness of PR in the evaluation of ANS in healthy subjects and patients with CLD through association with HRV. Cross-sectional study that includes healthy controls (n = 11) and patients with DHC (n = 26). ANS balance was determined by HRV by Holter rhythm of 5 minutes and RP by AP. HRV / RP of healthy subjects and with CLD, and correlation parameters of both measurements were compared. Significant differences were found between both groups in the parameters of both HRV and RP, demonstrating an imbalance of the ANS in CLD patients. Differences were significant in 2 of 3 time parameters, in 2 of 3 frequency parameters in HRV and in 5 of 7 objectified by AP. The imbalance increases directly according to the Child stage (p <0.001). Patients with CLD have an unbalanced ANS and AP was useful in this study to demonstrate this. The most altered parameters in patients with DHC are directly correlated with the function of the parasympathetic ANS.

Impact of shorter MDR tuberculosis regimen drugs on heart rate variability in MDR tuberculosis patients at tertiary care hospital

Background: Tuberculosis is major cause of death in India. Analysis of heart rate variability is one of the most popular methods of autonomic nervous system evaluation. Shorter MDR-TB regimen drugs affect both central nervous system as well as peripheral nervous system. Existing research suggests that active pulmonary tuberculosis causes ANS dysfunction. So, by HRV measurement impact of shorter MDR-TB regimen drugs on autonomic dysfunction can be correlated. Aim of the current investigation was to evaluate effect of shorter MDR-TB regimen drugs on cardiac autonomic regulation in MDR-TB patients with respect to heart rate variability as a parameter.Methods: Fifty newly diagnosed MDR-TB patients of either gender on shorter MDR- TB regimen were enrolled in this study after taking consent. After 20 minutes rest, ECG was taken by “physiopac digital polygraph” software for 5 minutes. Two follow-up HRV assessments were done on 2nd month and 4th or 6th month of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD) and low frequency and high frequency ratio.Results: Repeated measures ANOVA showed no statistically significant difference in HRV parameters between baseline, 2 months and 6 months groups. So, sympathetic and parasympathetic modulation in terms of HRV remains unchanged during treatment of MDR-TB with shorter MDR-TB regimen drugs.Conclusions: Shorter MDR-TB regimen drugs don’t have any significant impact on HRV in MDR- TB patients, No correlation was observed between HRV and heart rate in MDR-TB patients.

Autonomic Nervous System Profiling In Response to Liver Transplantation: Prognostic Evaluation and Preliminary Study

Liver cirrhosis leads to autonomic dysfunction (AD). We present a pilot study and review of published literature to investigate the long-term changes in the Autonomic Nervous System (ANS) of patients who underwent liver transplant. We propose Autonomic Function Tests (AFT) can be used as a predictor of liver transplant outcome. Twenty-eight patients (19 men and 9 women; mean age 45 years) with cirrhosis due to different etiologies underwent a noninvasive ANS evaluation test, pre- and post-liver transplant at 3 to 6 months, 8 to 12 months, and 14 to 24 months. Data were compared with 45 age-matched controls (14 men and 31 women). We investigated changes in the following 3 adrenergic measures: percentage of cutaneous vasoconstriction in the hand and foot in response to cold stress test and cutaneous blood flow adjustment ratio; and 3 cardiovagal measures: change in heart rate in relation to deep respiration, forced respiration represented as Valsalva Ratio, and head-up tilting (30/15 ratio). A total of 23 of 28 patients (82%) had impairment in AFT before transplant, 16 of 28 (57%) in the sympathetic adrenergic measures, and 15 of 28 (54%) in the parasympathetic cardiovagal measures. There was a gradual improvement in ANS function posttransplant, with a significant improvement in the cardiovagal measure of Valsalva Ratio (P < .05 from baseline). These data suggest some temporary decline in ANS functions within the first 6 months posttransplant. To optimize outcomes in liver transplant patients with autonomic dysfunction, autonomic testing perhaps combined with frailty testing can be used as objective measures of mortality in the pre-liver transplant stage.

The possible association between COVID-19 and postural tachycardia syndrome

The possible association between COVID-19 and postural tachycardia syndrome

Reliability of ultra-short indices for autonomic dysfunction in dyslipidemia.

Dyslipidemia is associated with autonomic nervous system (ANS) dysfunction. Heart rate variability (HRV) is a powerful tool for evaluating the ANS and for cardiovascular risk stratification. Yet, the methodologies used are impractical in most clinical settings and therefore, are usually not applied. The current study aimed to evaluate the reliability of ultra-short HRV parameters, which are easily calculated from any standard ECG, as a practical method for ANS study, with a focus on patients with dyslipidemia. Fifty-nine volunteers with dyslipidemia underwent HRV study of parametric and power spectral indices according to accepted methods. Correlations were calculated between ultra-short HRV indices (five 1-min and five 10-s segments) and standard 5-min recordings. Correlations were found between 10-s and 1-min RMSSD and 5-min recordings (mean Pearson ρ correlation coefficients of 0.913 and 0.944, respectively, and mean concordance correlation coefficients of 0.855 and 0.938, respectively). Associations were found between other ultra-short HRV parameters (SDNN, maximum RR, minimum RR, pNN50, ln(RMSSD) and 5-min recordings. In addition, average RR, HRV-TI, NN50, TP, LF/HF, ln(SDNN), ln(HRV-TI), ln(TP) and ln(LF/HF) from 1-min recordings were associated with 5-min values. In conclusion, some ultra-short HRV parameters can be used for ANS evaluation and presumably, for cardiovascular risk stratification among patients with dyslipidemia. These parameters seem to be of great practical value for both inpatient and outpatient settings, because most can be calculated from a standard 10-s ECG strip. The prognostic implications of ECG-derived, ultra-short HRV parameters in patients with dyslipidemia should be further evaluated in future studies.

Geometry of the Poincaré plot can segregate the two arms of autonomic nervous system – A hypothesis

Autonomic Nervous System (ANS) operates to achieve the optimum physiological functioning and maintains homeostasis in a tonic and continuous manner. Evaluation of ANS profile is crucial in assessing autonomic dysfunction. Conventional ANS evaluation procedures fail to capture minute dynamic alterations of ANS activities.The ANS output pattern is appropriately reflected in the fine alteration of the resting heart rate (HR). HR is a non-stationary variable, results from the dynamic interplay between the multiple physiologic mechanisms. The control of cardiac rate or the chronotropic regulation of heart is considered as a coupled network of oscillators, each representing a specific facet of the cardiovascular reflex. The slower vasomotor oscillation via sympathetic system is combined with rapid respiratory oscillation by parasympathetic system to modulate the intrinsic oscillation pattern of the SA Node.Heart Rate Variability (HRV) is used to understand the autonomic influence on cardiovascular system in health and disease. Fourier decomposition of HRV offers us mainly two different frequency components. High frequency (HF) variation indicates parasympathetic variability due to respiration and Low frequency (LF) mainly implicates tonic sympathetic influence, due to slower vasomotor modulation of heart rate. However, different studies show conflicting results and direct recording of sympathetic nerve activity also failed to correlate with LF power in either healthy subjects or in patients with increased cardiac sympathetic drive.A scatter-plot where each R-R interval is plotted against the preceding R-R interval forms a distributed elliptic point cloud in two dimensional plane. The phase space realization of this plot with dimension two and delay one is referred to as Poincaré plot analysis, an emerging quantitative-visual technique where the shape of the plot is categorized into different functional classes. The plot provides summary as well as detailed beat-to-beat information of the heart. This plot can be extended to three dimensions and with multi-lag, offering more insight and information.A mathematical expression was developed by an interventional study by Toichi et al., using pharmacological blockers during different physiological variables that calculated the lengths of transverse and longitudinal axes of the Poincaré plot to derive two quantitative expressions of sympathetic and vagal influence on HRV: ‘cardiac sympathetic index’ (CSI)) and ‘cardiac vagal index’ (CVI).In the present study, we emulate Poincaré plot patterns seen in normal range of sympatho-vagal balances and also in Diabetes Mellitus (DM), known to cause autonomic dysfunction. The emerging pattern of R-R interval time series would provide valuable insight into the altered temporal dynamics and also extract crucial features embedded within. DM is a major public health crisis globally and particularly in Indian population.We hypothesize that, CSI and CVI will effectively segregate the two arms of ANS and can be utilized as an effective evaluation tool to explore the disease status in patients of Diabetes Mellitus.We also propose that, the dynamics of fluctuations in physiological rhythms that exhibit long-term correlation and memory, can also be explored and expressed quantitatively by incorporating various degrees of ‘lag’ in these recurrence plots.

Cardiovascular and sudomotor dysfunction in Hirayama disease.

Hirayama disease is a disease of young males causing atrophy of small muscles of the affected hand and forearm. Localized autonomic dysfunction of the affected upper limb such as cold skin and excessive sweating has been described in some patients. In this study, we looked for local as well as systemic involvement of autonomic nervous system in patients with Hirayama disease. Forty-four patients with a median duration of illness of 3years were included in the study. Assessment of symptom profile and evaluation of autonomic nervous system were done at the time of enrolment. The mean age at presentation was 21.9 (10-32) years, with a delay in seeking medical attention of around 3 (1-11) years. Localized clinical autonomic dysfunction was present in 39 (88.6%) patients, while objective generalized autonomic dysfunction was present in 33 (75%) patients. Cold skin and excessive sweating showed good correlation with the presence of objective autonomic dysfunction (P < 0.05). In three patients, sympathetic skin response (SSR) could not be recorded in one of the four limbs. Compared to controls, the SSR results in patients with Hirayama disease showed increased latency (1.64 ± 0.21 vs. 1.57 ± 0.14, P 0.04) and decreased amplitude in upper limbs (0.65 ± 0.19 vs. 0.86 ± 0.40, P 0.01). Hirayama disease has both localized and systemic dysautonomia. Careful longitudinal evaluation during the progressive phase of the disease may help in diagnosing subtle systemic autonomic dysfunction.

Autonomic response to a short and long bout of high-intensity functional training

ABSTRACTThe evaluation of Autonomic Nervous System (ANS) recovery following exercise provides insight into the transient stress placed on the cardiovascular system. High-Intensity Functional Training (HIFT) is a form of intense exercise that is prescribed in various modalities and durations; however, little is known about the influence of HIFT duration on ANS recovery. Ten apparently healthy males (28.1 ± 5.4 yrs) performed two HIFT sessions (<5-minute and 15-minute) in a crossover fashion. ANS activity was measured using plasma Epinephrine (E) and Norepineprine (NE); Heart Rate Variability markers of the log transformed Root Mean Square of Successive Differences (lnRMSSD) and High-Frequency power (lnHF). No trial dependent differences were observed in lnRMSSD (p = 0.822), lnHF (p = 0.886), E (p = 0.078), or NE (p = 0.194). A significant main time effect was observed in both trials with a depression in lnRMSSD and lnHF following the trials (p < 0.05) and recovering by 2-hours post (p = 0.141, p > 0.999) respectively. A trial dependent increase in E and NE occurred immediately post (p < 0.05) and recovered by 1-hour post (p > 0.999, p > 0.999) respectively. The HIFT bouts examined within this study demonstrated similar transient strain of the ANS.

Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission.

Aghdasi-Bornaun H, Kutluk G, Keskindemirci G, Öztarhan K, Dedeoğlu R, Yılmaz N, Tosun Ö. Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission. Turk J Pediatr 2018; 60: 407-414. Heart Rate Variability (HRV) is one of the reliable and noninvasive parameters to evaluate autonomic control of the cardiovascular system in patients. The aim of our study was to assess autonomic function in pediatric patients with inflammatory bowel disease (IBD) in remission using Power Spectral Analysis of HRV. Autonomic cardiovascular function was evaluated by time and frequency-domain indexes of spontaneous heart rate in 36 IBD children patients in remission phase and 36 sex and age matched healthy controls. Twenty children with Ulcerative Colitis (UC) and 16 patients with Crohn`s disease (CD) were diagnosed according to their history, physical and laboratory examination, endoscopic, histopathological and radiological findings of upper and lower gastrointestinal system. Significant decrease was observed at HRV parameters in IBD patients when compared with control group. These differences was found in some of time domain parameters (NNmean, SDNNtotal, SDNNday) and frequency domain parameters (TP, LF,VLF) (p < 0.05). Also, there was a significant higher minimum heart rate ratio (p < 0.04) in patients in comparison to the control group. In the IBD group, there was a relative tendency for parasympathetic suppression and sympathetic predominance which reflects an autonomic dysfunction. This imbalance has a circadian rhythm and it is more obvious during the day. These observations may suggest a previously unrecognized role of chronic inflammation for autonomic modulation in IBD.

Baseline heart rate as a predictor of post-spinal hypotension in patients undergoing a caesarean section: An observational study

Background: Hypotension is a well-known side effect of spinal anaesthesia in obstetrics patients undergoing caesarean section. This is likely to affect both mother and fetal well-being. Systemic haemodynamics are modulated by autonomic nervous system (ANS). Evaluation of ANS may be helpful in predicting hypotension. The present study is designed to identify the subset of pregnant patients at higher risk of developing post-spinal hypotension based on baseline heart rate (HR) prior to administration of anaesthesia. Materials and Methods: This was a prospective study conducted on 100 patients aged 20–30 years, of American Society of Anaesthesiologists (ASA) grade I or II, scheduled for elective caesarean section under spinal anaesthesia. Patients were divided into two groups based on their baseline HR. Incidence of hypotension and ephedrine requirement following spinal anaesthesia were noted. Results: Thirty nine patients out of 100 developed hypotension (39%), of whom 27 were in the group with HR >91 beats per minute (bpm) (50.9%) and 12 patients were in the group with HR 91 bpm than group with HR

The potential role of a unique, simple, quick, accurate, inexpensive, routine evaluation of Autonomic Nervous System (ANS) Sympathetic (S) and Parasympathetic (P) activity in Cardiovascular Diseases (CVD)

The potential role of a unique, simple, quick, accurate, inexpensive, routine evaluation of Autonomic Nervous System (ANS) Sympathetic (S) and Parasympathetic (P) activity in Cardiovascular Diseases (CVD)

Evaluation of Autonomic Nervous System, Saliva Cortisol Levels, and Cognitive Function in Major Depressive Disorder Patients.

Major depressive disorder (MDD) is associated with changes in autonomic nervous system (ANS) and cognitive impairment. Heart rate variability (HRV) and Pulse pressure (PP) parameters reflect influences of the sympathetic and parasympathetic nervous system. Cortisol exerts its greatest effect on the hippocampus, a brain area closely related to cognitive function. This study aims to examine the effect of HRV, PPG, salivary cortisol levels, and cognitive function in MDD patients by using noninvasive techniques. We have recruited MDD patients, diagnosed based on DSM-V-TR criteria compared with healthy control subjects. Their HRV and PP were measured by electrocardiogram (ECG) and photoplethysmography (PPG). Salivary cortisol levels were collected and measured on the same day. MDD patients exhibited elevated values of mean HR, standard deviation of HR (SDHR), low frequency (LF) power, low frequency/high frequency (LF/HF) ratio, mean PP, standard deviation of pulse pressure (SDPP), and salivary cortisol levels. Simultaneously, they displayed lower values of mean of R-R intervals (mean NN), standard deviation of R-R intervals (SDNN), high frequency (HF) power, and WCST scores. Results have shown that the ANS of MDD patients were dominated by the sympathetic activity and that they have cognitive deficits especially in the domain of executive functioning.