Parasympathetic System Activity Research Articles

Music therapy with adult burn patients in the intensive care unit: short-term analysis of electrophysiological signals during music-assisted relaxation

Burn patients often face elevated pain, anxiety, and depression levels. Music therapy adds to integrative care in burn patients, but research including electrophysiological measures is limited. This study reports electrophysiological signals analysis during Music-Assisted Relaxation (MAR) with burn patients in the Intensive Care Unit (ICU). This study is a sub-analysis of an ongoing trial of music therapy with burn patients in the ICU. Electroencephalogram (EEG), electrocardiogram (ECG), and electromyogram (EMG) were recorded during MAR with nine burn patients. Additionally, background pain levels (VAS) and anxiety and depression levels (HADS) were assessed. EEG oscillation power showed statistically significant changes in the delta (p < 0.05), theta (p = 0.01), beta (p < 0.05), and alpha (p = 0.05) bands during music therapy. Heart rate variability tachograms high-frequencies increased (p = 0.014), and low-frequencies decreased (p = 0.046). Facial EMG mean frequency decreased (p = 0.01). VAS and HADS scores decreased − 0.76 (p = 0.4) and − 3.375 points (p = 0.37) respectively. Our results indicate parasympathetic system activity, attention shifts, reduced muscle tone, and a relaxed state of mind during MAR. This hints at potential mechanisms of music therapy but needs to be confirmed in larger studies. Electrophysiological changes during music therapy highlight its clinical relevance as a complementary treatment for ICU burn patients.Trial registration: Clinicaltrials.gov (NCT04571255). Registered September 24th, 2020. https//classic.clinicaltrials.gov/ct2/show/NCT04571255.

Pupillometry to show stress release during equine sports massage therapy

Anecdotal reports state that wellness treatments for horses, such as massage therapy, relaxes the treated animal. Massage therapists and horse owners typically report an ”improvement” without verifying or quantifying the treatment results. This paper shows that the effect of wellness treatment and stress release can be measured with pupillometry. One of the horse’s pupils was photographed at the beginning and end of the treatment to determine the changes in the balance between the sympathetic and parasympathetic system activities. The owners assigned horses to two experimental groups: animals receiving a massage (N = 18) and horses standing with a person next to the horse for the time of a massage in the stable lane (N = 10). Six animals in the experimental group were excluded from the analysis because the pupils could not be traced. We opened the images of the pupil with Fiji (ImageJ) and used the elliptical selection tool to measure the pupils’ and iris’ areas. The ratio between the pupils’ aperture and the iris’ area was a normalized measure for pupil size. At the end of the experiment, we compared the normalized size of the pupils with a two-tailed paired t-test within groups and a two-tailed t-test between groups. For the experimental group, it was before and after the treatment, and for the control group, before and after the horse was placed in the stable lane. Comparisons between the experimental and control groups were made at the procedure's beginning and end. The treatment significantly decreased the normalized pupil area in the experimental group, on average, by a factor of 0.78 ± 0.15 (P = 0.042). For the horses in the control group, the pupil size increased, on average, by a factor of 1.14 ± 018. Changes were statistically not significant (P = 0.19). The initial pupil size of the horses in the experimental group was 1.88 times larger than that in the control group. After the treatment, the difference was reduced to a factor of 1.25. At the beginning of the experiment, the horses in the experimental group had, on average, larger pupil sizes than the horses in the control group, indicating that the horses in the experimental group were more stressed before the treatment than the control animals. The observed changes in pupil size in the experimental group likely resulted from enhanced parasympathetic and diminished sympathetic activity resulting from the treatment. Observed changes in pupil size agree with the anecdotal horse owner reports and the therapist’s treatment notes.

Effects of Walking Football During Ramadan Fasting on Heart Rate Variability and Physical Fitness in Healthy Middle-Aged Males.

This study aimed to investigate the effect of a walking football (WF) program during Ramadan fasting (RF) on heart rate variability (HRV) indices, body composition, and physical fitness in middle-aged males. Thirty-one healthy sedentary men were randomized to WF (n = 18) and control (n = 13) groups. Both groups participated in RF. The WF group were involved in a training program (small-sided games) of three sessions a week during RF. The time and frequency domains of HRV, body composition, handgrip, lumbar strength, Modified Agility Test (MAT), and 6-minute walk test (6MWT) were measured before Ramadan (BR), during Ramadan (DR), and after Ramadan (AR). We reported that RF has significantly altered some parameters of HRV DR; the mean HR decreased while the mean RR, LF, and HF increased. WF had a significant effect on HRV and mean HR DR compared with BR and AR decreased while mean RR, HF and LF increased. DR, body mass decreased in both groups, while body mass index (BMI) decreased and lean mass increased only in WF group. Lower body mass and BMI levels were reported AR only in WF group. Physical capacity improved AR, compared with BR, only in the WF group with longer distance in 6MWT, shorter time(s) in MAT, and higher lumbar strength levels. We conclude that RF increases parasympathetic system activity. WF practice during RF is safe and might improve body composition, physical fitness, autonomic cardiac function, and physical fitness in middle-aged males.

Effects of a Single-Dose of Mind-Body Practice on the Heart Rate Variability, Brain Activity and Shooting Performance in Archers: A Pilot Study

Objective: Factors affecting performance of archery are categorized into psychological, skill, and fitness perspectives. Increase in attention, relaxation and parasympathetic system activity is believed to enhance the shooting performance of archers during competition. This pilot study aims to investigate the effects of single-dose of Tai Chi practice on archer’s performance and the feasibility of an investigation protocol under a competition scenario. Methods: This was a randomized controlled trial (RCT) with a crossover study design. Pre- and post-intervention measurements were conducted to evaluate the effects of Tai Chi practice on the archer’s autonomic nervous system activity, attention and relaxation through electroencephalography investigation, and shooting performance when compared with stretching as control. Results: The protocol of the study was found to be feasible during a competition setting. No significant difference was detected in the outcome measures under the two intervention conditions. Participants after practicing Tai Chi were found to improve significantly in their shooting performance (p = 0.021). Conclusion: This pilot study showed that a real-time measurement of autonomic nervous system and brain wave activities in the competition field was feasible and it did not hinder the archers’ performance. There was a significant improvement observed in the shooting performance of archers after Tai Chi practice when compared with baseline. The findings of this pilot study provide the basis for the conduction of a larger RCT study to examine the potential beneficial effects of Tai Chi practice on archers.

Heart Rate Variability Analysis by Multiscale Entropy for Autonomic Nervous System Identification

Information technology in the medical field has a role in improving patient treatment quality by tracking patient condition in real time using heart rate variability (HRV). There is a correlation between HRV and autonomic nervous system (ANS), where HRV analysis can be used in an invasive way for monitoring ANS activity. There are many analytical methods related to cardiac autonomic modulation, for instance, time domain, frequency domain, and nonlinear analyses. The previous study has been using PUCK as a new index to evaluate the ANS activity and MSE for analysis of cardiovascular disease. However, the indication of PUCK showed another possibility of the cardiac modulation. Therefore, the objective of this research is to know the relation between MSE with ANS activity from several physical activities using treadmill exercise. An accurate control of heartbeat interval during exercise is measured using wearable electrocardiograph to get high precision. MSE analysis may provide to detect several cardiovascular diseases. The information related to the entanglement of the ANS of the heart rate using MSE is lacking, even though the MSE method in the clinical analysis is widely accepted. As a result, MSE in the large scales tend to decrease following the change of posture and the increasing of speed during treadmill exercise. The present study shows that MSE could indicate the activity of ANS in the large scales for the parasympathetic system activity. Further research is needed to know the specific parameters in the MSE method to get the results that can quantify ANS activity correctly.

Зміни у вегетативній нервовій системі, спричинені валентністю телевізійних новин

The pattern and nature of autonomic nervous system responses largely depend on the type of emotion. The study was aimed at defining shifts in the autonomic nervous system that accompany the emotional activation under the influence of emotionally accented TV news. Results indicated that a heart rate decelerated in a few minutes after the watching neutral video set. At the same time, throughout the viewing of the video, the activity of the parasympathetic system and the stress index decreased. Negatively accented TV news caused more complex changes. For men, the significant changes in heart rate were recorded only during the first TV news items. On the other hand, negative TV news stories elicited the most significant changes in parasympathetic system and stress index – these changes occurred in the middle of exposure to negative TV news set. The impact was stronger and more complicated for women and consisted of decreasing heart rate while watching TV news stories and accelerating heartbeats in the pause between them. A significant decrease in the parasympathetic system activity occurred after watching negative TV news. Regarding all the parameters, negative TV news stories exerted more significant influence on the psycho-physiological condition of the volunteers than neutral TV stories. Our study revealed the short-term media effects of negative and neutral TV news on the activation patterns of the autonomic nervous system. The short-term reactions of the individual to the mass media are those bricks that underlie a large-scale picture of the media impact on a mass audience. The fact of the existence of short-term media effects gives the base for a further research on the cumulative nature of TV news content’s impact on people, including the longitudinal perspective of media effects.

Is heart rate recovery index a predictive factor for cardioinhibitory syncope?

Cardioinhibitory syncope is related with excessive bradycardia or asystole due to parasympathetic response. We investigated whether patients with cardioinhibitory syncope have higher heart rate recovery index (HRRi) considered as a parasympathetic system activation in exercise stress testing (EST) than in those with other neurogenic syncope forms. A total of 262 patients who had neurogenic syncope documented by head-up tilt test (HUTT) and 199 healthy control individuals were examined. A maximal EST was applied to all patients after the HUTT. The HRRi was obtained by subtracting the heart rate that was measured at the first (HRRi-1), second (HRRi-2), and third minute (HRRi-3) of the recovery period from the maximal heart rate that was measured during the test. Eighty patients had cardioinhibitory syncope, 118 patients had vasodepressor syncope, and 64 patients had mixed-type syncope. The HRRi-1 was higher in patients with syncope (43.3 ± 7.7) compared to the control group (34.5 ± 4.8; p < 0.001). Post hoc analysis showed that among the syncope groups, there was no difference between patients with vasodepressor syncope (42.2 ± 7.6) and those with mixed type syncope (40.7 ± 4.1) in terms of HRRi-1 (p = 0.420). However, patients with cardioinhibitory syncope (47 ± 8.7) had a higher HRRi-1 than vasodepressor and mixed-type syncope groups (p < 0.05). The threshold value of the HRRi-1, which can be used for the prediction of cardioinhibitory syncope development, was determined to be 41 with 75% sensitivity and 72% specificity. The HRRi-1 was higher in patients with cardioinhibitory syncope compared to the controls. The HRRi-1 has the predictive feature of differentiating cardioinhibitory syncope from other syncope types.

P-216: Effects of heart rate variability biofeedback on sympathovagal modulation in hypertensives

Background Stress can cause hypertension through repeated blood pressure elevation. It stimulates nervous system to produce large amounts of vasoconstricting hormones, which increase blood pressure. Early studies demonstrate that heart rate variability biofeedback (HRV-BF) sessions reduce the perceived stress. Our aim was to investigate whether HRV-BF results have equivalent effects on autonomic cardiovascular responses control during stressful conditions in hypertensives. Methods For this study fifty men, ages 40 to 60, with stage 1 hypertension, were observed while taking antihypertensive drugs. The parameters of HRV before and after 20 HRV-BF sessions were measured. Results After HRV-BF session total power (TP) of spectral density has changed due to parasympathetic system activation. TP has significantly changed from (1436 ± 99,55) to (2843 ± 334,3) ms2, (p Conclusions HRV-BF sessions reduce stress index and normalize autonomic balance. It should be noted that although during HRV-BF sessions in this subgroup a significant decrease of heart rate was achieved (p

May BDNF Be Implicated in the Exercise-Mediated Regulation of Inflammation? Critical Review and Synthesis of Evidence.

Exercise attenuates inflammation and enhances levels of brain-derived neurotrophic factor (BDNF). Exercise also enhances parasympathetic tone, although its role in activating the cholinergic anti-inflammatory pathway is unclear. The physiological pathways of exercise's effect on inflammation are obscure. To critically review the evidence on the role of BDNF in the anti-inflammatory effects of exercise and its potential involvement in the cholinergic anti-inflammatory pathway. Critical literature review of studies published in MEDLINE, PubMed, CINAHL, Embase, and Cochrane databases. BDNF is critically involved in the bidirectional signaling between immune and neurosensory cells and in the regulation of parasympathetic system responses. BDNF is also intricately involved in the inflammatory response: inflammation induces BDNF production, and, in turn, BDNF exerts pro- and/or anti-inflammatory effects. Although exercise modulates BDNF and its receptors in lymphocytes, data on BDNF's immunoregulatory/anti-inflammatory effects in relation to exercise are scarce. Moreover, BDNF increases cholinergic activity and is modulated by parasympathetic system activation. However, its involvement in the cholinergic anti-inflammatory pathway has not been investigated. Converging lines of evidence implicate BDNF in exercise-mediated regulation of inflammation; however, data are insufficient to draw concrete conclusions. We suggest that there is a need to investigate BDNF as a potential modulator/mediator of the anti-inflammatory effects of exercise and of the cholinergic anti-inflammatory pathway during exercise. Such research would have implications for a wide range of inflammatory diseases and for planning targeted exercise protocols.

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

Cardiac resynchronization therapy (CRT) improves heart rate variability (HRV) and heart rate turbulence (HRT) parameters. Herein, our aim was to compare these parameters with intracardiac-cardioverter defibrillator (ICD) patients with similar functional status to detect possible additional benefits of CRT on autonomic functions. Patients who had systolic HF (NYHA class II and III) with an ejection fraction <35% were enrolled in this observational, cross-sectional study. These patients were implanted either an ICD or a CRT device. A 24-hour Holter recording was obtained to assess HRV and HRT parameters in 2 groups. Unpaired t-test and Chi-square test were used for comparisons between 2 groups. Logistic regression analysis was performed to determine the variables affecting functional status. Of 105 patients included in the study; 55 had CRT and 50 had ICD device. The baseline characteristics of the patients were similar in both groups. SDNN, SDANN, SDNN index, and LFnu were similar in both groups; however, RMSSD, pNN50, HFnu, LF/HF ratio, turbulence slope and albeit to a non-significant value turbulence onset were better in CRT group. When the HRV and HRT parameters were compared according to functional status, patients in functional class II had significantly better HRV and HRT parameters when compared to the ones in class III (p<0.05 for all). Regression analysis showed that only SDNN was associated with functional class [OR: 0.89 (95% CI: 0.80-0.98), p=0.03]. After the covariance analysis to eliminate the effects of functional status on HRV and HRT parameters; the parameters mostly related with the parasympathetic system activity, namely RMSSD, pNN50, HFnu, LF/HF ratio, turbulence onset and turbulence slope were still better in CRT group. The most striking finding in our study is that HRV and HRT values related with parasympathetic activation are better in CRT patients when compared to ICD patients with similar functional status. Therefore, upgrading to CRT may have additional benefits on autonomic functions, which needs further investigation.

Influence of the professional activity of pilots on the adaptive pattern of hemodynamic reactions to the tilt test

A comparative study of the blood circulation’s response to the tilt test was performed in three groups of healthy subjects: AF pilots (n = 72), engine drivers (n = 44), and students at the Military Institute of Radio Electronics (n = 32). In all the groups, adequate adaptive responses to the test were recorded under eukinetic hemodynamics where steady cardiac output and blood pressure values combined with an increase of the heart rate by 10–12%. Hypokinetic hemodynamics caused a 20% increase in cardiac output during the initial 5 min of orthostasis in pilots versus an 8–12% increase in the others. Hyperkinetic hemodynamics were responsible for the increase in the cardiac output in pilots but not in the other groups. Parasympathetic system activation was peculiar of hypokinetic hemodynamics, while sympathetic system activation was associated with hyperkinetic hemodynamics. These results suggest a larger body functional reserve in pilots compared to other subjects as a side effect of their profession.

Účinky tchaj-ťi čchüan na autonomní nervové regulace u studentů Masarykovy univerzity

Taijiquan is scientifically studied from many views of it’s positive infl uence on human health. Taiji as an exceptable intensity form of aerobic exercise for middle age and old people. Taiji as a form of exercise benefi cial for general inprovement of motor function at seniors. Taiji and balance control at old persons in connection to falls. Infl uence of taiji practise on the quality of sleep at people with sleep disturbances. In prosecution to many experiments specialized on the positive eff ect of taijiquan on the heart function (for example taiji and it’s harmonizing eff ect on blood preasure) we have realised an experiment focused on the connection of taiji practise and autonomous regulation of heart function. We tried to prove that one year long practise of a particular form of taiji has the eff ect on the autonomous regulation of the heart. Especially on higher activity of parasympathetic system – nervus vagus. Th is eff ect have been proved by Väänänen at al, 2002 at the level of short-time change. We have used system VariaCardio TF-4 with telemetric transmision of the pulse rate able to measure and analyse spectral analysis of heart rate variability. Participants were 32 Masaryk university students aged between 19 and 25. Th e data we have collected prove that we do not disapprove hypothesis of the infl uence of taijiquan practise on the activity of nervus vagus. Thus we have succeeded in proving the eff ect of taiji on heart regulations even at young people.This fi ndings can even support the idea of using taiji as an eff ective and at the same time available form of training of cardiovaskular system at poeple suff ering from diseases of this kind.

Cambios en la variabilidad de la frecuencia cardiaca (VFC) en jugadores de hockey hierba durante el Campeonato del Mundo de 2006

The aim of this study is to determine the changes in heart rate variability (HRV) in field hockey players during the course of a world championship. The Spanish national team took part in the study by making daily records of the R-R interval (Omegawave System) on the days when matches took place. The baseline heart rate (HR) and several parameters of HRV were measured. The evolution of the average values of the HR and the various parameters of HRV during the 7 matches was compared using a MANOVA, the contrasts regarding the last match being analysed. The HR increases progressively during the seven matches, with an especially significant increase in the last match (F (18.6) = 3.27; p = .024). RMSSD and pNN50 parameters progressively decrease throughout the tournament, with an especially significant decrease for pNN50 (F (18.6) = 2.96; p = .034). Regarding the parameters of the frequency spectrum, LF and LF/HF show an increase throughout the 7 matches (for LF, F (18.6) = 2.72; p = .046), and HF presented lower values. HRV decreases progressively and the values of the parameters related to parasympathetic system activity (RMSSD and HF) reduce, which are indicative of good psychic-physical adaptability to the workload. At the same time, the value of the parameters related to sympathetic system activity (LF and LF/HF) increases, suggesting an increase in fatigue, tiredness and poor adaptability in general. Consequently, the analysis of HRV may be a good marker for monitoring the psychic-physical state, cardiovascular adaptability during exercise and a possible state of physical overload in athletes participating in competitions.

Bronchodilatory effects of NVA237, a once daily long-acting muscarinic antagonist, in COPD patients

NVA237 is a novel, once daily inhaled long-acting muscarinic antagonist administered via a dry powder inhaler. This study aimed to assess the 24-h bronchodilatory effect following 14 days of treatment with inhaled NVA237 in patients with mild, moderate or severe COPD. This was a randomized, double-blind, placebo-controlled, two-period, crossover, multicenter study. A total of 33 patients (≥ 40 years; smoking history of ≥ 10 pack-years) were randomized to receive NVA237 50 μg once daily followed by placebo or placebo followed by NVA237 50 μg for 14 days. Treatment periods were separated by a 7-14 day washout period. The primary variable was the mean forced expiratory volume in 1 s (FEV(1)) derived from the area under the curve (AUC) between 0 and 24 h post-dose on Day 14. The 24-h FEV(1) profiles showed a consistent bronchodilator effect for NVA237 versus placebo on Day 14. Least square (LS) mean difference in FEV(1) AUC(0-24 h) values between NVA237 and placebo was 163 mL (P < 0.001). There were significant increases in mean FEV(1) AUC(0-12 h) (LS mean difference 165 mL, P = 0.001) and FEV(1) AUC(12-24 h) (161 mL, P < 0.001) versus placebo. NVA237 significantly improved peak FEV(1) (by 208 mL, P < 0.001) and trough FEV(1) (by 154 mL, P = 0.003) versus placebo on Day 14. NVA237 was well tolerated; all adverse events were mild or moderate in intensity and not related to study drug. NVA237 50 μg once daily was well tolerated and showed significant and sustained 24-h bronchodilation in patients with COPD.

Ttiotropium increases cytosolic muscarinic M3 receptors and acetylated H3 histone proteins in induced sputum cells of COPD patients

ObjectiveChronic obstructive pulmonary disease (COPD) is characterized by irreversible progressive airflow limitation related to tobacco smoking. This limitation is caused by chronic inflammation of the airways and lung parenchyma and is associated with increased activity of parasympathetic system. The most effective bronchodilators in COPD are muscarinic receptor antagonists (MRA), which reverse, at least in part, compromised respiratory function. MRA also contribute to control inflammatory processes via interactions with inflammatory signaling molecules. The use of the long-acting cholinolytic bronchodilatator - tiotropium, with high affinity to M3 receptors, is suggested as a first line maintenance treatment in COPD patients.Materials and methodsIn this study we assessed M3 receptor protein expression in induced sputum of 27 stable COPD patients before and after therapy consisting of 18 μg once daily tiotropium for 12 weeks. Lung function tests including spirometry, lung volumes, and DLCO were performed before and after therapy in all COPD patients. The patients were subjected to the sputum induction procedures before and after therapy. Sputum cells were isolated, sample-specific cell profiles were characterized, and the cells were processed to isolate pure cytosolic fractions. Cytosolic M3 protein and HDAC2 levels and nuclear acetylated histone H3 (AcH3) expression was quantified using specific antibodies against human proteins and Western blot with enhanced luminescence detection.ResultsTherapy significantly increased the mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) volume (P < 0.05). The mean expression of M3 protein was higher by 37% after therapy (P < 0.05), HDAC2 expression was not altered, while AcH3 level was increased by about 90% (P < 0.01), compared with the corresponding data before therapy. HDAC2 expression before therapy was positively correlated with AcH3 expression (r = 0.74), while after therapy no correlation was detected. FEV1, FCV, and cytosolic M3 protein expression did not correlate with other biochemical parameters tested.ConclusionsTwelve weeks of tiotropium therapy in COPD patients improves clinical indices of lung function and involves alterations in sputum cell chromatin acetylation and also increased cholinergic M3 receptor internalization.

Some physiological and psychophysiological signs of neuroticism level in healthy persons.

To study cardiac reactivity on presentation of cardiotropic drug odour, perception of this odour and autonomic nervous system activity in high personality neuroticism healthy women. Cross sectional. 28 healthy female undergraduate university student volunteers in the age range 21 to 29 years. Eysenck Personality Questionnaire, threshold of nicethamidum odour detection, statistical parameters of electrocardiographic R-R intervals variance, Strain Index of cardiac regulatory systems (as a measure of the balance between sympathetic and parasympathetic system activities). Six subjects with low neuroticism level (LNL) and eight persons with high neuroticism level (HNL) were selected out of 28 young women volunteers using the Eysenck Personality Questionnaire. Baseline cardiac rhythm of the HNL group had a high level of stability and high values of the Strain Index which are characteristic of increased activity of the sympathetic nervous system. Increased variability of the cardiac rhythm and low values of Strain Index indicated elevated parasympathetic nervous system activity in LNL persons. HNL subjects also had low cardiac reactivity on presentation of nicethamidum solutions and high detection thresholds of odour stimuli. High neuroticism level in healthy females affects the balance between sympathetic and parasympathetic nervous system activities, cardiac reactivity on presentation of nicethamidum odour as well as perception of this odour. Low cardiac responsiveness to stimulatory effect of cardiotropic drug and increased sympathetic nervous system activity should be taken into consideration when planning treatment of neurotic subjects.

A preliminary study on the influence of obstructive sleep apnea upon cumulative parasympathetic system activity

Objective Although the autonomic nervous system plays a key role in mediating cardiovascular changes during obstructive sleep apnea (OSA), parasympathetic nervous system (PNS) activity during sleep apnea has not yet been sufficiently investigated. This study is to discuss the relationship between PNS activity and OSA. Methods Polysomnography recording was carried out in 76 patients (71 male and 5 female) with OSA. Cumulative PNS activity during sleep for each patient was derived from time series data of electrocardiogram (ECG) and analyzed by coarse graining spectral analysis of heart rate variability. The correlation between cumulative PNS activity and apnea–hypopnea index (AHI) was then discussed. Results Cumulative PNS activity and PNS peaks during sleep were lowly but significantly correlated with OSA severity ( r = −0.344, p < 0.005; and r = −0.266, p < 0.05 respectively), and a linear regression equation could be established. Furthermore, significant correlation was also observed in the adult groups and in the moderate and severe groups, but not in the juvenile and the elderly and mild groups. Conclusion These findings indicated that PNS function was obviously influenced by OSA during sleep. Cumulative PNS activity level might also serve as a useful parameter for the evaluation of OSA.

Clinical-Biochemical Correlates of Migraine Attacks in Rizatriptan Responders and Non-Responders

The present study was aimed at verifying the clinical characteristics of a typical attack in 20 migraine patients, 10 responders and 10 non-responders to rizatriptan, and at investigating any differences in the levels of neuropeptides of the trigeminovascular or parasympathetic systems [calcitonin gene-related peptide (CGRP), neurokinin A (NKA) and vasoactive intestinal peptide (VIP) measured by radioimmunoassay methods in external jugular blood] between responders and non-responders. In all responders to rizatriptan, pain was unilateral, severe, and pulsating, and in five of them at least one sign suggestive of parasympathetic system activation was recorded. Five patients who were non-responders to rizatriptan referred bilateral and non-pulsating pain, even though severe in most of them. CGRP and NKA levels measured before rizatriptan administration were significantly higher in responders than in non-responders (P < 0.0001 and P < 0.002, respectively). In the five patients with autonomic signs among rizatriptan responders, detectable VIP levels were found at baseline. One hour after rizatriptan administration, a decrease in CGRP and NKA levels was evident in the external jugular venous blood of rizatriptan responders, and this corresponded to a significant pain relief and alleviation of accompanying symptoms. VIP levels were also significantly reduced at the same time in the five patients with autonomic signs. After rizatriptan administration, CGRP and NKA levels in non-responder patients showed less significant variations at all time points after rizatriptan administration compared with rizatriptan responders. The present study, although carried out on a limited number of patients, supports recent clinical evidence of increased trigeminal activation associated with a better triptan response in migraine patients accompanied by parasympathetic activation in a subgroup of patients with autonomic signs. In contrast, the poor response seems to be correlated with a lesser degree of trigeminal activation, lower variations of trigeminal neuropeptides after triptan administration, and no evidence of parasympathetic activation at baseline.