Sympathetic Function Tests Research Articles

Effect of combined hormone replacement therapy on sympathetic nervous system function in postmenopausal women – A cross-sectional study

Background: There is an increased prevalence of cardiovascular and metabolic diseases in postmenopausal women. Estrogen plays an important role in the regulation of blood pressure (BP) and autonomic function. Various hormone therapies are widely used in postmenopausal women, especially combination therapy of low-dose estrogen and progesterone. Hormone therapy might be useful not only in alleviating menopausal symptoms but help in reducing cardiovascular risk factors and improving quality of life. Aims and Objectives: The aim of the study is to study the effect of combined estrogen and progesterone hormone therapy on BP and sympathetic overactivity in postmenopausal women. Materials and Methods: The study included two groups of 50 women each. Group I included postmenopausal women of age 45–55 years who were taking combined hormone therapy while Group II included postmenopausal women of the same age group who were not on any replacement therapy heart rate and BP in resting state was noted in both the groups. Sympathetic function assessment was done by performing cold pressor test, handgrip test, and BP response to standing on all the participants. Statistical analysis was done using the student’s t-test. Results: There was a statistically significant difference in resting heart rate, BP, and sympathetic function tests in both groups. Conclusion: There is a facilitatory role of combined estrogen and progesterone therapy in menopausal women in reducing BP and sympathetic system dysregulation.

Water immersion skin wrinkling: modulation by common participant characteristics.

Water immersion skin wrinkling (WISW) has been used as a noninvasive test of a limb's sympathetic function. To date, research has not sufficiently explored this phenomenon. The primary aim of this study was to determine the impact of common individual characteristics on WISW. Demographic information was collected on 39 apparently healthy adults varying widely in age. Each participant submerged one hand in 40°C water for 30 minutes. The degree of WISW was assessed using computer software. Because WISW is often associated with peripheral edema and facial wrinkling, we also evaluated facial wrinkling and hand volume expansion following prolonged immersion. Sex, body mass index, and physical activity habits were not correlated with any of the WISW measures. Age was a predictor of the WISW score (β = -0.38, P = 0.02, R2 = 0.15). WISW score was significantly lower for participants who reported relevant medical history (cardiovascular, pulmonary, or psychological) than those with no such report. WISW was not associated with face wrinkling or hand volume expansion. We concluded that WISW was reduced in older age and those with medical history but was not affected by physical activity. These results are consistent with the prevalent notion that WISW may be a sympathetically mediated phenomenon.

Impact of menopause on anthropometric indices and sympathetic nervous system activity – A comparative study

Background: Obesity and metabolic syndrome is very common now a days in postmenopausal women. Increased deposition of visceral fat can lead to autonomic dysfunction. Obesity and autonomic derangements can cause various cardiovascular diseases in women after menopause. Early detection of changes in body weight and autonomic disturbances can help formulate preventive strategies for menopausal women. Aims and Objectives: The aim of the study is to compare anthropometric indices and sympathetic nervous system activity between menstruating and postmenopausal women. Materials and Methods: The study included two groups of 50 women each. Group I included menstruating women of age 25–35 years while Group II included postmenopausal women of age group 50–60 years. Anthropometric parameters such as body weight, height, body mass index, and waist hip ratio were recorded in both the groups. Sympathetic function tests such as cold pressor test, handgrip tests, and blood pressure response to standing was performed on all the participants. Statistical analysis was done using Student’s t-test. Results: There was statistically significant difference in anthropometric indices and sympathetic function tests in both the groups. Conclusion: There is increased incidence of obesity with sympathetic hyperactivity in menopausal women as compared to menstruating women.

Relationship between Obesity and Sympathetic Nerve Function Status

In order to assess the effect of obesity on sympathetic nervous system a cross-sectional observational study was carried out in the Department of Physiology, Sylhet MAG Osmani Medical College between January 2017 and December 2017. Fifty obese and age-sex matched 50 non-obese subjects were included. Two non-invasive cardiovascular sympathetic function tests like blood pressure response to postural change (orthostatic test) and blood pressure response to sustained handgrip were done to assess sympathetic nerve function status.The fall in systolic blood pressure (SBP) in orthostatic test of obese group (9.02 ± 2.29 mmHg) was significantly higher compared to non-obese group (4.84 ± 0.96) (p<0.001). Increase in diastolic blood pressure (DBP) in handgrip test of obese group (12.36 ± 2.78 mmHg) was significantly lesser than that of non-obese group (20.12 ± 2.64 mmHg) (p<0.001). The results of this study suggested that obese adults have reduced sympathetic activity.

Assessment of cardiovascular sympathetic function tests in premenstrual syndrome patients visiting tertiary care hospital: A case–control study

Background: Premenstrual syndrome (PMS) is a stress-induced disorder and is showing a rising prevalence but its etiopathogenesis is not yet understood. Stress disturbs the balance of the sympathetic and parasympathetic nervous system. Alteration in heart rate and blood pressure is the most important physiological response following stress-induced sympathetic changes. Aims and Objectives: The present study was designed to test the hypothesis of an association between sympathetic functions and PMS and to observe the degree of changes (if any) in these sympathetic functions. The study also aims to provide timely interventions to prevent the development of cardiovascular complications and improve lifestyle. Materials and Methods: A Menstrual Distress Questionnaire was used to evaluate physical, emotional, and behavioral symptoms accompanying the menstrual cycle of the subjects who fulfilled the inclusion criteria. Based on the scores obtained by their questionnaire, subjects with the higher scores formed the PMS group, while the age-matched females with low score served as controls. Cardiovascular sympathetic functions were assessed by standardized, simple, non-invasive tests which included Handgrip test and orthostatic hypotension test. Unpaired Student’s t-test was used for statistical analysis. Results: The results revealed that the sympathetic reactivity is insignificantly higher in PMS group during the follicular phase. During the luteal phase, sympathetic activity is significantly increased. Conclusion: PMS involves psychoneuroendocrinal turmoil, thus early screening of high-risk groups and interventions such as relaxation techniques and lifestyle modification can prevent further cardiovascular complications in patients of high sympathetic responses.

Differences in sympathetic activity in normotensive, prehypertensive and hypertensive individuals

Introduction: Hypertension is a major health hazard which at a later stage might lead onto various cardiovascular complications. Prehypertension is a precursor of Stage-I hypertension. Thus, the present study was done to assess the sympathetic activity in normotensive, prehypertensive and hypertensive individuals. Aims and Objectives: To compare the differences in sympathetic activity in normotensive, prehypertensive and hypertensive individuals. Materials and Methods: The study was conducted on 30 normotensive, 30 prehypertensive and 30 hypertensive subjects. Autonomic function tests were recorded using the instrument Physiopac-PP4, Medicaid system, Chandigarh. The following sympathetic function tests were performed: 1. Blood pressure response to standing, 2. Cold pressor test, 3. Isometric handgrip test. Results: Our findings on hypertensives showed that there is sympathetic dysfunction and on prehypertensives showed that there is sympathetic overactivity. Conclusion: Autonomic function tests can be used as a routine screening test to predict the future risk of hypertension at an earlier stage and also for a better prognosis during treatment. Keywords: Hypertensive, Prehypertensive, Autonomic function tests, Sympathetic dysfunction, Sympathetic overactivity.

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.

Water Immersion Skin Wrinkling: The Influence Of Age, Sex, And Adiposity

From the evolutionary perspective, water immersion skin wrinkling (WISW) is the perceived water drainage to enhance grip in wet conditions. In modern medicine, it is a noninvasive test of limb sympathetic function and can be used to assess peripheral neuropathy. WISW occurs as sympathetically-mediated contraction of subcutaneous glomus bodies after perturbation of ion concentration in palmar sweat glands. This phenomenon has not been studied well and it is not clear if common demographic variations (e.g. age, sex, and adiposity) that impact overall cardio-autonomic health status also affect WISW. PURPOSE: The purpose of the present study is to determine if peak WISW is modulated by age, sex, and body adiposity, additionally, we addressed if this phenomenon is associated with osmotic reactions or edema. METHODS: So far 12 apparently healthy adults (5 females) aged 34.5±17.6 years were studied. Participants hands were submersed in 40°C water for 30 minutes with degree of wrinkling being assessed via 5-point scale (0 to 4) at 10-minute intervals. Final ratings for digits 2-5 were summed and used to determine peak WISW with a score of 16 being the highest and 0 being the lowest possible scores. Additionally, hand and forearm volume were measured via water displacement before and after submersion to quantify hand volume expansion. RESULTS: Peak WISW ranged from 5 to 16 with the mean (±SEM) score of 13.2±1.3. Peak WISW was moderately correlated with age (r=-0.54), BMI (r=-0.39), body fat percentage (r=-0.51). Males demonstrated a greater degree of WISW with a mean rating of 16 compared with females with a mean rating of 9 (p<0.01). Hand and forearm volume did not change with water immersion (497±29 vs. 500±30 ml). Changes in hand and forearm volume were not associated with peak WISW (r=-0.03). CONCLUSION: The preliminary results indicate that water immersion skin wrinkling varies widely with age, sex, and body adiposity and is not associated with edema or osmotic reactions.

Assessment of Sympathetic Function Test in Breast Cancer Patients after Chemotherapy Treatment (Anthracycline Group of Drug Particular Doxorubicin)

Assessment of Sympathetic Function Test in Breast Cancer Patients after Chemotherapy Treatment (Anthracycline Group of Drug Particular Doxorubicin)

Correlation between cotinine urinary levels & cardiovascular autonomic function tests among smokeless tobacco chewers: A cross-sectional study.

Background & objectives:Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.Methods:In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.Results:Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001).Interpretation & conclusions:Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.

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.

Effect of yoga on sympathetic nervous system of human body

Introduction: Yoga is a mind and body practice with a 5,000-year history in ancient Indian philosophy. Various styles of yoga combine physical postures, breathing techniques, and meditation or relaxation. Yoga is a psycho-somatic-spiritual discipline for achieving union and harmony between our mind, body and soul and the ultimate union of our individual consciousness with the universal consciousness. Aims and Objectives: 1: To evaluate the effects of yoga on sympathetic nervous system in yoga practitioners above the age group of 35 years; 2: To compare the results of sympathetic function tests in yoga practitioners with that of non yoga practitioners in the same age group. Materials and Methods: An observational cross sectional study was carried out in 50 normal yoga practitioners and 50 normal non yoga practitioners above the age group of 35 years. Yoga practitioners were selected randomly from different yoga centers in Shimoga. Non yoga practitioners were selected randomly among non teaching staff of Shimoga institute of medical sciences, Shimoga. The ethical clearance for the study was obtained from the ethical committee. Results: In our study, there is significant decrease in the BMI (p=0.013), physiological parameters such as heart rate (p=0.002), respiratory rate (p=0.001) and blood pressure and in sympathetic tests there is significant decrease in DBP in yoga practitioners compared to non yoga practitioners. Conclusion: It can be concluded that the regular practice of a set of yoga training blunted the sympathetic drive and lateralised the autonomic function towards parasympathetic control. Keywords: Yoga, Autonomic nervous system, Hand grip exercise.

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.

Abnormal sympathetic functioning is linked to familial hypertension in nonathletic young males.

BACKGROUND:Sympathetic overactivity mediates abnormal cardiovascular outcome that is affected by stress, lack of physical activity (PA), and familial hypertension (HTN). It can be assessed by blood pressure-based sympathetic function tests.OBJECTIVE:We studied sympathetic function tests in young nonathletic males in relation to measures of obesity, PA, and familial HTN.METHODOLOGY:We recruited 100 males (mean age: 19 years) and measured body mass index (BMI) and body composition parameters by tetrapolar bioelectrical impedance such as total body fat, visceral fat, subcutaneous fat, and skeletal muscle mass. Using instrument cardiac autonomic neuropathy system of Recorders and Medicare System Company, India, blood pressures (supine, standing, and post hand grip) were recorded and studied quantitatively and qualitatively.RESULTS:Physically active and inactive individuals (n = 50 each) had comparable age, BMI, measures of obesity, and sympathetic function tests. However, individuals with familial HTN (n = 37) showed significantly higher obesity measures and blood pressures (supine: systolic blood pressure [SBP] – 133 vs. 115 and diastolic blood pressure [DBP] – 79 vs. 76; standing: SBP – 136 vs. 122 and DBP – 80 vs. 76; post hand grip: SBP – 136 vs. 125 and DBP – 86 vs. 81). Qualitatively, postural hypotension was seen in only two individuals, while worst grading was in post hand grip test significantly and more so in physically inactive group (30%, 28%, and 42% vs. 16%, 20%, and 64%) and individuals with positive familial HTN (32%, 38%, and 30% vs. 17%, 13%, and 70%).CONCLUSION:Familial HTN, but not physical inactivity, affects sympathetic functioning in nonathletic young male medical personnel. It asks for other lifestyle modifications for better cardiovascular health as primary prevention.

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

Sympathetic function tests during pre and #8209; and post and #8209;menstrual phases in young women

Sympathetic function tests during pre and #8209; and post and #8209;menstrual phases in young women

A study of sympathetic function tests in obese females

A study of sympathetic function tests in obese females

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.

Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients.

The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9%). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4%) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1% of patients with ST depression episodes vs 26.1% of those without ST changes (P<0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P<0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9% of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and