Dysautonomia, dysfunction of the autonomic nervous system, presents with heterogeneous clinical features from an imbalanced regulation of the sympathetic and parasympathetic nervous systems. Low Vitamin D levels can explain the heterogeneous clinical features of migraine headaches, cardiac and gastrointestinal dysfunction, and oxidative stress evident in dysautonomia patients. The role of Vitamin D in modulating pain sensitivity has been recently established. However, there is a lack of research and understanding regarding the association between Vitamin D deficiency and autonomic dysfunction. Vitamin D is a neuroactive hormone that modulates autonomic balance, regulating the sympathetic and parasympathetic nervous systems, and has multisystem benefits. The following review explores the literature and addresses the relationship between Vitamin D deficiency and autonomic dysfunction. Overall, this literature review implicates Vitamin D deficiency in autonomic dysfunction and elucidates the potential therapeutic role of Vitamin D in autonomic disorders. PubMed search was performed for English articles from 1996 to 2016. Following keywords: Vitamin D, autonomic dysfunction and orthostatic hypotension, Vitamin D receptor, migraine and traumatic brain injury, Vitamin D, cardiac and gastrointestinal disease, Vitamin D, glutathione, oxidative stress, and serotonin were included. Only articles reporting primary data relevant to the above question were included in the study.
A 23-year-old female with a past medical history of gastroesophageal reflux disease presented with shortness of breath induced by exercise and certain odors. She reported the symptoms of autonomic dysfunction including fatigue, chest pain, lightheadedness, headaches, numbness/tingling in the arms and legs, and exercise intolerance. Vital signs were significant for orthostatic intolerance. Volume flow loop in the pulmonary function tests showed a flattening of the inspiratory portion characteristic of vocal cord dysfunction. Laryngoscopy showed dyskinesia of the left vocal cord, especially after exercise. Multifactorial approach was used including increased fluid intake and breathing exercises. After 6 weeks of breathing and isometric exercises, the patient reported improvement in dyspnea after exercise. This case report demonstrates the therapeutic role of breathing and isometric exercises in the management of vocal cord and autonomic dysfunction.
Introduction: Depression screening may not be feasible for all stroke patients during their hospitalization, and depression may be missed if screening is not performed in the outpatient setting. Hypothesis: We sought to assess the proportion of patients with depression, and describe the severity of depressive symptoms in patients who could not be screened during hospitalization. We hypothesized that depressive symptoms can be missed in those who are not screened. Methods: Ischemic strokes (July 2014- July 2015) were identified from the clinic registry. In the clinic, we use Patient Health Questionnaire 9 (PHQ-9) to assess depressive symptoms for all patients. Univariate and multivariable linear regression analyses were used to evaluate associations between PHQ-9 and age, sex, race, baseline National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and antidepressant use for patients who missed inpatient depression screening. Results: Among 159 ischemic stroke patients, 136 completed outpatient PHQ-9 within 90 days from stroke onset. Of these 41 (30%) were missing inpatient PHQ-9. Reasons for missing scores included aphasia or cognitive impairment (20), failed inpatient attempt (16), or unspecified reasons (5). Among the 41 patients, median time to follow-up was 40 days (IQR 33 - 50). Mean (SD) age was 63.7 (13.8) and 51.2% were female. Mean (SD) PHQ-9 score was 8.0 (6.61). The overall proportion of patients having at least mild depression was 60.1% (95 % CI 45.3, 76.5) and PHQ-9 scores were distributed as follows: none to minimal depressive symptoms, 39.0%; mild to moderate, 43.9%, moderately severe to severe, 17.1%. In the regression model, mRS at follow-up (dichotomized < 3 & ≥ 3) was associated with severity of depressive symptoms after adjusting for age, sex, and baseline NIHSS, (coefficient 4.1, 95% CI 1.38, 6.82). Other variables were not associated with severity of depressive symptoms. Conclusions: Patients who cannot be screened for depression during hospitalization may have depressive symptoms and should be screened as soon as feasible after discharge. Alternative methods to screen cognitively impaired patients need to be developed.
Introduction: Depression is prevalent after ischemic stroke and is associated with increased morbidity. No studies have described subsequent changes in depressive symptoms detected during the acute stage of stroke. Hypothesis: We sought to assess changes in depressive symptoms from hospitalization to clinic follow-up and to explore variables associated with worsening depressive symptoms at clinic follow-up. Methods: Ischemic strokes (7/14- 7 /15) were identified from the stroke prevention clinic registry. Prior to hospital discharge, patients are screened for depressive symptoms using Patient Health Questionnaire 9 (PHQ-9; range 0 - 27) and then re-assessed in clinic. Higher scores reflect more severe symptoms. Univariate and multivariable linear regression analyses were used to evaluate associations between change in PHQ-9 and age, sex, race, baseline NIHSS, mRS, and antidepressant use. Results: Among 160 ischemic stroke patients, 82 had both baseline and follow-up PHQ-9 scores. Median time to follow-up was 41.5 days (IQR 35-50). Mean age was 60.7 (SD 14.5) and 40.2% were female. Median PHQ-9 scores were 2 (IQR 0, 5) and 5.5 (IQR 1, 10) for inpatient and clinic, respectively. During inpatient stay, 67% of patients had 0 to minimal depressive symptoms; 31.7% mild to moderate; and 1.3% moderately severe to severe. At follow-up 43.9% had 0 to minimal symptoms; 46.3% mild to moderate; and 9.7% moderately severe to severe symptoms. There was a statistically significant increase in PHQ-9 at follow-up [mean change 2.79 (SD 5.7); paired t-test p < 0.001] and a significant difference in depression category (Wilcoxon rank-sum test, p < 0.0001). Neither age, sex, race, marital status, admission NIHSS, baseline or clinic mRS, nor antidepressant treatment were associated with change in depressive symptoms. Conclusions: Depressive symptoms were more severe at clinic follow-up for ischemic stroke patients who were initially screened during hospitalization. Depression screening should be repeated at clinic follow-up.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.