Parasympathetic Function Tests Research Articles

AN ANALYTICAL CROSS SECTIONAL STUDY ON CARDIAC AUTONOMIC FUNCTIONS IN HYPO-THYROID PATIENTS

Background: Primary Hypothyroidism is a chronic endocrine disorder of thyroid gland with multifarious etiology 1 having a prevalence of 5 to 15% in India. The prevailing literature reports an increased risk of cardiovascular morbidity in hypothyroid patients and proposes derangements in the autonomic nervous system as an antecedent causative event. The present study was designed to explore these undermined autonomic nervous system derangements posing a risk of subsequent development of cardiovascular problems in hypothyroid patients. Aim and Objective: The objective of the current study was to explore and compare the cardiovascular autonomic functions in hypothyroid patients with age and sex-matched healthy controls. Materials and Methods: The present study was conducted in the Upgraded Department of Physiology, Sawai Man Singh Medical College and Attached Hospitals, Jaipur, enrolling 30 hypothyroid patients of both gender, recruited from the Department of Endocrinology and 30 age & gender-matched healthy controls recruited amongst the attendants and family members accompanying the hypothyroid patients. Prior approval and consent were obtained from the institutional ethics committee and research review board before commencement of the study. For assessing the autonomic functions, parasympathetic function tests namely E:I ratio, 30:15 ratio (lying to standing ratio), and valsalva ratio were resorted to, whereas, tests like blood pressure (BP) response to standing and sustained handgrip were used for the assessment of sympathetic functions. Results: When the subjects were tested for assessment of the sympathetic function, rise in diastolic BP during isometric handgrip exercise came out to be signicantly lower in hypothyroid patients (P < 0.05) in comparison to controls. Similarly, the fall in systolic BP on immediate standing was higher in the hypothyroid group (P < 0.05). On assessing the subjects for parasympathetic functions, E: I ratio (Expiration: Inspiration), 30:15 ratio and Valsalva ratio were found to be signicantly decreased (P < 0.05) in hypothyroid patients in comparison to healthy controls. Conclusion: The deranged autonomic function tests in hypothyroid patients suggest an underlying cardiovascular autonomic dysfunction putting hypothyroid patients at a greater risk of cardiovascular diseases later in life. Due to these prognostic implications, the present study recommends regular and periodic assessment of autonomic functions in hypothyroid patients.

The effect of smoking on the cardiovascular autonomic functions tests

Tobacco smoking is one of the major causes of preventable morbidity and mortality all over world. Smoking affects the cardiovascular system by several mechanisms. The present study was planned to study the effect of smoking on the cardiovascular autonomic functions among smokers.This study comprises 50 male subjects aged between 20 to 30 years, who included 25 smokers who formed cases and 25 non-smokers who formed the control groups were selected for this study. The design for this study is cross-sectional survey. The subjects were from patients who attended medicine OPD. Inclusion and exclusion criteria are followed in selecting participants. 1: Prior informed written consents were obtained from them after explaining to them, the procedure and the purpose of the study tests; 2. Ethical approval was taken from ethical committee of BMCH, Chitradurga.The cardiovascular autonomic function tests were assessed by using a CANWIN AUTONOMIC ANALYSER which was available in the department.In our study, it was observed that there was significant difference between the mean values of the para-sympathetic function tests among the smokers and the non-smokers (i.e. p<0.01) The Resting Heart Rate had significantly increased and the Expiration: Inspiration Ratio, the 30:15 Ratio (Response to standing) and the Valsalva Ratio had significantly decreased in the smokers as compared to those in the non-smokers. In this study, it was observed that there was no significant difference between the mean values of the Postural hypotension test (i.e. p>0.05) and that there was a highly significant difference between the mean values of the Sustained handgrip test in the smokers and the non-smokers (i.e. p<0.01). The Resting Heart Rate had significantly increased in case of smokers as compared to non-smokers due to increased sympathetic activity due to release of catecholamines. The Expiration: Inspiration Ratio, 30:15 Ratio (Response to standing) and the Valsalva Ratio had significantly decreased in the smokers as compared to those in the non-smokers due to derangement in parasympathetic activity.In sustained handgrip test, rise in blood pressure is decreased in smokers as compared to non-smokers due to reduced sympathetic activity.

Effect of smoking on cardiovascular autonomic functions

Introduction: Cigarette smoking is a prime risk factor for cardiovascular morbidity and mortality. Chronic smoking results in autonomic dysfunction leading to increased cardiovascular risk in smokers. The present study was planned to study the effect of smoking on the Cardiovascular Autonomic Functions among smokers. Materials and Methods: Fifty male subjects who were in the age group of 25 to 45 years. They were grouped into 25 smokers and 25 non-smokers. The participant subjects were selected among the staff members, residents and the patients from the routine OPD in SVIMS. Prior to study, they were informed about the procedure and the purpose of the study tests and written consents were obtained from them. The Cardiovascular Autonomic Function Tests were assessed by using a POLYGRAPH which was available in the department. Results and Conclusion: After applying the ‘t’-test for the difference between the two sample means, it was observed that there was a highly significant difference between the mean values of the BMI(i.e.p<0.01) and the para-sympathetic function tests among the smokers and the non – smokers(i.e.p<0.00). The Resting Heart Rate had significantly increased and the Deep breathing difference, the postural tachycardial index (Response to standing) and the Valsalva Ratio had significantly decreased in the smokers as compared to those in the non – smokers. After applying the ‘t’-test for the difference between the two sample means, it was observed that there was no significant difference between the mean values of the Postural hypotension test (i.e. p>0.05) and that there was a highly significant difference between the mean values of the Sustained handgrip test in the smokers and the non – smokers (i.e. p<0.00). KEY WORDS: Cardiovascular autonomic function tests, Smoking, Resting heart rate.

Assessment of autonomic dysfunction in bronchial asthma patients

Introduction: Many aspects of airway functions are controlled by autonomic nerves. Bronchospasm, airway edema and excessive mucus secretion may occur due to abnormality in autonomic regulation of airways. All these events lead to airway obstruction in bronchial asthma. Objective: The aim of the study was to compare the autonomic functions between bronchial asthma patients and normal controls. Materials and Methods: As per American Thoracic Society guidelines thirty bronchial asthma patients in the age group of 18-50 years were chosen. Thirty age and sex matched controls were chosen for comparison. Standardized autonomic function tests were done. Statistical analysis was done using students unpaired t’ test. Results: Significantly higher basal heart rate was found in asthmatics in comparison with controls. Parasympathetic function tests showed significantly higher values in asthmatics compared with controls. Statistically significant difference is also found in the sympathetic function tests between asthmatics and normal controls. Conclusion: Our study shows that autonomic dysfunction is present in asthmatic patients. Parasympathic activity is enhanced in asthmatics, thus supporting the hypothesis of enhanced parasympathetic reactivity as an integral factor in pathophysiology of bronchial asthma. Keywords: Bronchial asthma, Autonomic dysfunction, Parasympathetic tests, Sympathetic tests.

A cross-sectional study on cardiac autonomic functions in psoriasis patients

Background: Psoriasis is a chronic, genetically determined and immune-mediated inflammatory disease of unknown etiology with a prevalence of 0.44–2.8% in India. The literature reports an increased risk of cardiovascular diseases in psoriatic patients. The present study was designed to explore the autonomic nervous system functions in psoriatic patients. Aim and Objective: The objective of the present study was to assess cardiac autonomic functions in psoriasis patients aged 30–40 years as compared to age- and sex-matched healthy controls. Materials and Methods: The present study was conducted in the Department of Physiology, SMS Medical College, Jaipur. Forty psoriatic patients of both genders were recruited from the Dermatology Department and forty, age- and gender-matched healthy subjects were taken as controls subjects from among employees of SMS Medical College, Jaipur. Prior approval and consent were obtained by the institutional ethics committee and institutional research review board. Parasympathetic function tests include E:I ratio, 30:15 ratio (lying to standing ratio), and Valsalva ratio; sympathetic function tests included blood pressure (BP) response to standing and sustained hand grip. Results: Change in diastolic BP during isometric hand grip exercise was significantly lower in psoriasis patients (P < 0.05). Change in systolic BP on immediate standing was higher in psoriasis group (P < 0.05). E:I ratio, Valsalva ratio, and 30:15 ratio were also significantly decreased (P < 0.05) in psoriasis patients as compared to the healthy controls. Conclusion: The deranged autonomic function tests in psoriasis patients suggested definite cardiac autonomic dysfunction. Autonomic dysfunction might put the psoriasis patients at greater cardiovascular disease risk. Therefore, autonomic function assessment of psoriasis patients is necessary for a better prognosis.

Cardiovascular Autonomic Function in Normotensive Men with High Salt and Low Salt Intakes

Background and Aim: The autonomic nervous system may play an important role in saltinduced increases in blood pressure (BP). The aim of this study is to assess and compare the heart rate (HR) responses to Valsalva maneuver, deep breathing and standing and BP responses to standing and sustained handgrip between normotensive men with habitual high salt intake (HSI) and low salt intake (LSI). Methods: Twenty-fourty years old normotensive men (n=34; n=17 for HSI and n=17 for LSI) were recruited by collecting 4 early morning spot urine samples. Average estimated 24-hr sodium (Na+) excretion of 4 urine samples of ≥166 mmol/day was regarded as HSI and &lt;115 mmol/day as LSI. Heart rate responses to Valsalva maneuver, deep breathing and standing (parasympathetic function tests) and BP responses to standing and sustained handgrip (sympathetic function tests) were investigated in both groups. Results: Valsalva ratio (VR) [1.64±0.36 (HSI) vs 1.78±0.49 (LSI)], deep breathing difference (DBD) [24.51±9.56 beats/min (HSI) vs 22.93±6.37 beats/min (LSI)] and 30:15 ratio [1.34 (1.12–1.46) (HSI) vs 1.19 (1.13–1.52) (LSI)] were not significantly different in both groups. Systolic blood pressure (SBP) change from lying to standing [-0.67 (-4.00–9.00) mmHg (HSI) vs 0.00 (-3.34–2.34) mmHg (LSI)] was not significantly different between the two groups whereas diastolic blood pressure (DBP) rise in sustained handgrip [18.20±3.49 mmHg (HSI) vs 14.77±4.71 mmHg (LSI)] was significantly higher in the HSI (p=0.022). Conclusion: Cardiovascular sympathetic activity appears to increase in normotensive men with habitual high salt intake.

TO FIND OUT THE VARIATION OF SYMPATHETIC & PARASYMPATHETIC TESTS BETWEEN MALE & MENSTRUAL PHASE OF MENSTRUAL CYCLE IN FEMALE.

The hormonal fluctuations that occur during normal menstrual cycle has profound influence on autonomic functions. This influence on autonomic nervous system may affect cardiovagal control. The aim of the study is to find out the variation of Parasympathetic function tests during different phases of menstrual cycle in young healthy females.&#x0D; The mean E:I ratio in Menstrual Phase of menstrual cycle in females is 1.34 ± 0.06.&#x0D; The mean E:I ratio in males is 1.41 ± 0.12.&#x0D; The mean Postural SBP in Menstrual Phase of menstrual cycle in females is 97.76 ± 5.13 mmHg. The mean Postural SBP in males is 103.24 ± 6.88 mmHg.&#x0D; The study concludes that there was statistically significant heart rate variability during three phases of the menstrual cycle, as observed by the increased sympathetic discharge in the luteal phase compared to the increased parasympathetic discharge in the follicular phase. The results of our study have emphasized the complexity of the relationship between ovarian steroids and various hemodynamic regulatory systems.&#x0D; Keywords: Sympathetic, Parasympathetic &amp; Menstrual.

2245-PUB: The Epidemiology and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy: A Multicenter Clinical Study

Objective: To evaluate the risk factors of cardiovascular autonomic neuropathy(CAN) in Chinese diabetic patients, estimate the optimal CAN diagnostic method to different diabetics, assess CAN prevalence in our dataset. Methods: 2, 048 subjects randomly sampled from 13 hospitals were available for data analysis, including 73 type 1 diabetes mellitus (T1DM) and 1, 975 type 2 diabetes mellitus (T2DM). The general data of patients were collected and sympathetic and parasympathetic function tests were executed to CAN preliminary diagnosis. The final CAN diagnosis was based on Ewing's test in which heart rate variation (HRV values were evaluated through deep-breathing (DB), lying-to-standing (LS), Valsalva (V) tests and systolic blood pressure (SBP) variation values was evaluated through LS. Results: 1) In T1DM group, 61.64% patients were diagnosed with CAN; baseline data and clinical data of CAN group had no difference with those of none-CAN group (P&amp;gt;0.05);while in T2DM group, 62.58% patients were diagnosed with CAN; there were significant differences between CAN and none-CAN group in age, course of the disease, use of metformin, course of metformin treatment, retinopathy and hypertension history (P&amp;lt;0.05). 2) Among various symptoms in CAN group, most frequent symptoms were weakness (28.65%), dizziness (23.42%), frequent urination (19.59%), upper body sweating (18.35%) and enuresisnocturna (15.93%). 3) Course of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. 4) For T1DM, the optimal CAN diagnostic method was Vtest+LStes (sensitivity=97.62% , AUC=0.887); while for T2DM, DBtest had the highest sensitivity (83.62%) and Vtest+DBtest had the maximal AUC (0.856). Conclusion: The prevalence of diabetes with CAN was up to 63%.The course of disease and age are independent risk factors of CAN in TIDM and T2DM, respectively. Furthermore, Vtest+LStest and Vtest+DBtest were the optimal CAN diagnostic method for T1DM and T2DM, respectively. Disclosure Q. Pan: None. L. Guo: None. X. Wang: None. L. Zhang: None. T. Xian: None. F. Man: None. L. Liu: None.

Correlation of C1q/TNF-Related Protein-3 with Cardiac Autonomic Tone and Metabolic Parameters in Obesity.

ObjectivesThe current study aimed at investigating the correlation of circulating levels of serum C1q/TNF-related protein-3 (CTRP3) with cardiac autonomic functions and metabolic parameters in obesity.MethodsThirty drug naïve subjects newly diagnosed with obesity and body mass index (BMI) 25 - 35 kg/m2 of both genders aged 19 - 40 years, with no associated comorbidity were recruited as cases. Same number of age, gender and socioeconomic status matched subjects with BMI 19 - 23 kg/m2 were taken as controls. Autonomic function test results including heart rate variability (HRV) were recorded in both groups. Serum metabolic parameters -CTRP3, leptin, adiponectin, insulin, blood glucose, glycated hemoglobin (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides were also determined and compared between the groups.ResultsSignificantly lower circulating levels of CTRP3 (P ≤ 0.001) and adiponectin (P = 0.025), and significantly higher mean of BMI (P < 0.001), fasting blood glucose (P < 0.001), LDL-cholesterol (P < 0.05), serum triglycerides (P < 0.001), insulin (P = 0.003), HOMA-IR (homeostasis model assessment of insulin resistance) (P < 0.001), and leptin (P = 0.043) were observed in the group with obesity compared to the controls. CTRP3 levels inversely correlated with serum triglyceride (r = -0.09, P < 0.001), atherogenic index (r = -0.37, P = 0.04), leptin (r = -0.39, P = 0.02), and positively with adiponectin (r = 0.42, P = 0.02) in the group with obesity. Significant reduction in the results of parasympathetic autonomic function tests (pNN50, RMSSD, excitation: inhibition (E:I) ratio, 30:15 ratio, and Valsalva ratio) and an increase in sympathovagal balance (low frequency to high frequency (LF:HF) ratio) was also observed (P < 0.05). CTRP3 levels were also positively correlated with parasympathetic indices (pNN50: r = 0.17, P < 0.05); 30:15 ratio: (r = 0.62, P < 0.01), and inversely correlated with LF: HF ratio (r = -0.35, P < 0.01) in the group with obesity.ConclusionsHigher circulating levels of CTRP3 promoted a favorable autonomic and metabolic profile in obesity. Hence, CTRP3 may be considered as a potential novel biomarker to facilitate the prognosis of obesity and its comorbidities.

Family History, BMI and Sympathetic Hyperactivity in Healthy Offsprings of Hypertensive Parents

Objective&#x0D; Hypertension is associated with large and growing health and economic burden of Cardiovascular and renal diseases. Hypertension doubles the risk of cardiovascular disease, including coronary heart disease(CHD), congestive heart failure, ischemic and hemorrhagic stroke, renal failure and peripheral arterial disease.&#x0D; Recent study suggests prevalence of Hypertension is increasing as a consequence of increasing obesity. Both environmental and Genetic factors contribute to the increased prevalence of Hypertension. Obesity and weight gain are strong, independent risk factors for hypertension. Aim of this study was to assess relation between Family history, BMI and autonomic function tests in healthy offsprings of hypertensive parents.&#x0D; Method&#x0D; The present study was conducted in 35 normotensive healthy offsprings of Hypertensive parents (Study Group) and 35 normotensive healthy offsprings of Nonhypertensive parents (Control Group), in the age groupof 18–21 years, randomnly selected from 1st and 2nd MBBS Students of Shri. BM patil Medical College. Bijapur.&#x0D; Results&#x0D; There is also significant increase in sympathetic function tests and insignificant increase in the readings of parasympathetic function tests and significant increase in resting Respiratory rate and Resting Systolic Blood Pressure in study group compared to control group.&#x0D; Conclusion&#x0D; This cross sectional study showed increase in prevalence of cardiac autonomic dysfunction more of sympathetic overactivity in normotensive healthy offsprings of Hypertensive parents, compared to normotensive healthy offsprings of Nonhypertensive parents.

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

Dysautonomia in heavy drinkers for more than 5 years of alcoholic consumption with intact liver function

Background: It is known for long that alcoholic liver cirrhosis is characterized by autonomic dysfunction due to the underlying liver pathology. However, alcohol can have a direct effect on the autonomic functions even before the liver functions are altered. Aims and Objectives: We have undertaken this study to test and compare the autonomic function status in apparently healthy alcoholics with normal liver function tests with age- and sex-matched healthy individuals. Materials and Methods: Thirty healthy non-alcoholics with normal liver function as controls and 30 apparently healthy alcoholics for more than 5 years with normal liver function tests were taken for this study. Autonomic function tests for both parasympathetic and sympathetic functions were performed in both these groups, and the results were compared. Result: Parasympathetic function tests were within the normal range except for the resting heart rate (HR) which showed a significant increase (P < 0.01) in the study subjects compared with the controls. Sympathetic tests showed a very significant increase in blood pressure (BP) response to postural change and a significant change in handgrip test. Conclusion: Resting HR and BP response to postural change were increased and BP response to handgrip test has shown a significant change in study subjects compared to controls which suggest that both sympathetic and parasympathetic functions are altered in them. We will conclude this study with the findings that alcohol has a direct effect on the autonomic nervous system even without any liver function tests alteration.

A comparative study on vagal activity in normotensive, pre-hypertensive, and hypertensive individuals

Background: Hypertension is the most common non-communicable disease which on a long term can lead to coronary artery disease and stroke. Pre-hypertension is one step toward hypertension. Pre-hypertension if detected at an earlier stage and intervened, the risk of hypertension and consequently the cardiovascular risk of the individual can be reduced. Vagal tone is an indirect measure of the baroreflex arc integrity. The present study was done to evaluate the vagal (parasympathetic) activity in normotensive (NT), pre-hypertensive (PT), and hypertensive (HT) individuals. Aims and objectives: The aims of this study were to compare the differences in vagal activity in NT, PT, and HT individuals. Materials and Methods: The following parasympathetic function tests were performed on 30 NT, 30 PT, and 30 HT subjects: (1) Heart rate (HR) response to standing, (2) HR response to deep breathing, and (3) Valsalva maneuver. Results: Our findings showed that there is a severely impaired parasympathetic activity in HTs and a mildly impaired parasympathetic activity in PTs. Conclusion: In PTs, non-pharmacological measures like deep breathing exercises and yoga might improve the vagal tone and help in the prevention of hypertension and its complications in future.

Natural history of pure autonomic failure: A United States prospective cohort.

To define the clinical features and biomarkers that predict which patients with pure autonomic failure will develop Parkinson disease, dementia with Lewy bodies, or multiple system atrophy. One hundred patients who presented with pure autonomic failure were recruited at 5 medical centers in the United States. Seventy-four patients agreed to be followed prospectively. Patients underwent clinical evaluations including neurological rating scales, sleep questionnaires, smell test, and sympathetic and parasympathetic cardiovascular autonomic function tests. At enrollment, patients were 68 ± 12 years old (median ± interquartile range) and had had autonomic failure for 5 ± 7 years. Within 4 years of follow-up, 25 of 74 subjects (34%) developed dementia with Lewy bodies (n = 13), Parkinson disease (n = 6), or multiple system atrophy (n = 6). The presence of probable rapid eye movement (REM) sleep behavior disorder was strongly associated with the development of a manifest central nervous system (CNS) synucleinopathy (odds ratio = 7.1). Patients who phenoconverted to multiple system atrophy had younger age at onset of autonomic failure, severe bladder/bowel dysfunction, preserved olfaction, and a cardiac chronotropic response upon tilt > 10 beats per minute. Those who phenoconverted to Parkinson disease or dementia with Lewy bodies had decreased olfaction, a lesser chronotropic response to tilt, and a longer duration of illness. The small group of patients retaining the pure autonomic failure phenotype had very low plasma norepinephrine levels, slow resting heart rate, no REM sleep behavior disorder, and preserved smell. Patients presenting with pure autonomic failure are at high risk of phenoconverting to a manifest CNS synucleinopathy. Specific clinical features predict future diagnosis. Ann Neurol 2017;81:287-297.

Assessment of cardiovascular autonomic functions in substance abusers - A cross-sectional study

Background: Drug abusing is a worldwide major cause of preventable morbidity and mortality. Substance abusing affects the cardiovascular system by several mechanisms. Aims and Objectives: The objective of the present study was to study the effect of drugs on the cardiovascular autonomic functions among different drug abusers and also to identify early neurological damage in autonomic system so that proper counseling and timely intervention can be undertaken. Materials and Methods: This cross-sectional study was done at GGS Medical College, Faridkot, Punjab, during the period from August 2012 to July 2013 in 50 drug abusers within the age group of 15-45 years, as well as in age matched 50 healthy controls. The subjects were recruited from Faridkot region of Punjab which included subjects from general population and the patients admitted in Drug De-addiction Centre of GGS Medical College and Hospital, Faridkot, Punjab. Prior informed written consents were obtained from them after explaining to them, the procedure and the purpose of the study tests. Lying to standing test was carried out for assessing parasympathetic reactivity and hand grip test for sympathetic reactivity. Results: After applying the ‘t’ test for the difference between the two sample means, it was observed that there was a highly significant difference between the mean values of the parasympathetic function tests among the drug abusers and the controls (i.e., P < 0.001). The 30:15 ratio (response to standing) had significantly decreased in the drug abusers as compared to those in the controls. Also a highly significant difference was observed between the mean values of the sustained handgrip test in the drug abusers and controls (i.e., P < 0.001). Conclusion: This study provides good evidence for autonomic dysfunction following chronic abuse of different drugs. By using these simple tests, we can detect the early involvement of the autonomic nervous system before the clinically related symptoms appear and they are thus useful in taking steps to prevent the further progress of the disease.

A case-control study of cardiovascular parasympathetic function tests in offsprings of type 2 diabetes mellitus parents

Background: Type 2 diabetes mellitus (DM) has a strong genetic component. Individuals of a parent with type 2 DM have an increased (40%) risk of diabetes. If both parents have type 2 DM, the risk approaches to 70%. Thus, this study was designed to evaluate cardiovascular parasympathetic functions in offsprings of type 2 diabetic parents. Aims and Objectives: Study was done to compare and observe the degree of changes (if any) in the cardiovascular parasympathetic function tests in the offsprings of diabetic parents (cases) with offsprings of non-diabetic parents (controls) and provides timely lifestyle modifications to prevent the development of diabetes and its complications. Materials and Methods: The cardiovascular parasympathetic function tests were carried out in 50 healthy offsprings of type 2 diabetic parents (study group) and 50 healthy offsprings of non-diabetic parents (control group) in the age range of 18-25 years randomly selected medical and para-medical students. Statistical analysis was done by unpaired Student’s t-test. Results: Study shows decrease in all the three parasympathetic function tests (heart rate variability in response to deep breathing, heart rate variation in response to standing, and valsalva maneuver) in offsprings of type 2 diabetic parents (cases) as compared to non-diabetic parents (controls). However, the results were not statistically significant. Conclusion: Our observations indicate that genetic factors in the form of altered genes could pass from diabetic parents to their offsprings and could manifest as altered response in parasympathetic function tests in healthy offsprings of diabetic parents even before the offsprings developing diabetes.

A Study to Evaluate the Involvement of Parasympathetic Nervous System in Tension Type Headache

Context: Headache is one of the most common disorders of the nervous system seen in medical practice. Tension-type headache although most prevalent is yet understudied subtype of primary headache known to cause substantial disability and diminished quality of life in patients. The neurobiology of symptoms in tension-type headache is still speculated. A few studies done earlier have suggested sympathetic autonomic dysfunction associated with etiopathogenesis of tension-type headache. Altered stress reactivity of autonomic nervous system is now known to be associated with increased risk of cardiovascular mortality. Objectives: There is a lack of data as regards involvement of parasympathetic limb of autonomic nervous system in tension type headache patients especially in the Indian population. The objective of the study is to evaluate the involvement of parasympathetic nervous system in tension type headache. Methods: Various parasympathetic function tests were done to assess the parasympathetic activity in 50 tension-type headache patients. The evaluation was done by standard, bedside, non-invasive tests like deep breathing test, Valsalva manoeuvre and orthostatic test. The reference values of Ewing and Clark were used to interpret the results of the test. ­­­­­Results: In the present study the basal heart rate was significantly decreased in tension type headache patients as compared to healthy controls. However parasympathetic function as evaluated by the different tests was found to be normal as compared to controls. Conclusion: We conclude that the decrease in resting heart rate in tension type headache patients could be suggestive of sympathetic hypo function as reported by previous studies. However parasympathetic function is unaltered in tension type headache patients. Key words: Parasympathetic nervous system, Deep breathing test, Valsalva manoeuvre, Orthostatic test, TTH

A comparative study of cardiovascular autonomic functions in healthy urban postmenopausal women

Background and Objectives: Menopause marks the period of many changes in women. The risk of cardiovascular disease increases after menopause. The autonomic nervous system responsible for control of many visceral functions is under the influence of female reproductive hormones. Hormonal changes after menopause bring alteration in these functions. This study was aimed to assess the physiological changes in the cardiovascular autonomic functions in healthy urban postmenopausal women. Material and Methods: 72 healthy women were chosen for the study. They were divided into 2 groups of 36each, control group (premenopausal) and Study group (postmenopausal). The parasympathetic function tests included the Heart rate response to postural change (30:15 ratio) heart rate variation during deep breathing(I-E difference), Heart rate response to valsalva maneuver (VR) and the sympathetic function tests like the blood pressure response to the Isometric handgrip (IHG) and the Blood pressure response to standing (BPS) were done in the control and study subjects. Results: By the student ‘t’ test, we found the significant difference in mean of the heart rate response to deep breathing, the 30:15 ratio, the valsalva ratio and the IHG test, between premenopausal and postmenopausal women, with a ‘p’ value

The association between glycemic variability and diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes.

BackgroundIt is presently unclear whether glycemic variability is associated with diabetic cardiovascular autonomic neuropathy (CAN). The aim of this study was to examine whether short- and/or long-term glycemic variability (GV) contribute to CAN.MethodsA total of 110 patients with type 2 diabetes who underwent three-day continuous glucose monitoring (CGM) completed five standardized autonomic neuropathy tests. Short-term GV was measured by the standard deviation (SD), coefficient of variation (CV) of glucose, and the mean amplitude of glycemic excursions (MAGE) in CGM. HbA1c variability was calculated from the intrapersonal SD, adjusted SD, and CV of serial HbA1c over 2-year period. CAN was defined as the presence of at least two abnormal parasympathetic function tests. The severity of CAN was evaluated by total scores of five autonomic function tests.ResultsIn univariate analysis, not only SD and CV in CGM but also all parameters of HbA1c variability were significantly higher in the patients with CAN (n = 47, 42.7 %) than in those without CAN. In multivariate analysis, CV (Odds ratio [OR] 1.07, 95 % confidence interval [CI] 1.01–1.13; p = 0.033), but neither SD nor MAGE in CGM, independently correlated with the presence of CAN. All parameters of HbA1c variability, such as SD of HbA1c (OR 12.10 [95 % CI 2.29–63.94], p = 0.003), adjusted SD of HbA1c (OR 17.02 [95 % CI 2.66–108.86], p = 0.003), and log CV of HbA1c (OR 24.00 [95 % CI 3.09–186.48], p = 0.002), were significantly associated with the presence of CAN. The patients with higher HbA1c variability had an increased risk of advanced CAN.ConclusionCV in CGM and all parameters of HbA1c variability were independently associated with the presence of CAN in patients with inadequately controlled type 2 diabetes requiring CGM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0233-0) contains supplementary material, which is available to authorized users.

A comparative study of autonomic function tests in normotensive premenopausal and postmenopausal women

|| ABSTRACT Background: Premenopause is a term that encompasses the entire reproductive period up to final menstrual period, whereas menopause is the permanent cessation of menstruation. Menopause is ‘‘burning out of ovaries.’’ After menopause, the primordial follicles become atretic; hence, the ovaries fail completely to produce estrogen. The presence of estrogen receptors in the heart, vascular smooth muscles, and autonomic brainstem centers establishes a probable participation in the regulation of cardiovascular system. Aims and Objective: To compare the autonomic function tests in premenopausal and postmenopausal women. Materials and Methods: The autonomic function tests in 60 premenopausal women (25–45 years) and 60 postmenopausal women (45–60 years) were compared. The following parameters were studied: (i) body mass index (BMI); (ii) waist–hip ratio (WHR); (iii) Parasympathetic function tests—(a) heart rate response to postural change (30:15 ratio), (b) heart rate variation during deep breathing, and (c) Valsalva maneuver test; and iv) sympathetic function tests—(a) orthostatic tolerance test, (b) sustained isometric handgrip test, and (c) cold pressor test. Result: (1) BMI and WHR significantly increased in the postmenopausal women when compared with the premenopausal women. (2) The 30:15 ratio significantly decreased in the postmenopausal women when compared with the premenopausal women whereas heart rate variation during deep breathing and Valsalva maneuver test did not show any significant change. (3) All the sympathetic function test results significantly increased in the postmenopausal women when compared with premenopausal women. Conclusion: This finding showed an increased tendency of obesity and autonomic imbalance with sympathetic overactivity in the postmenopausal women when compared with the premenopausal women.