Circadian studies of autonomic nervous balance in patients with fibromyalgia: A heart rate variability analysis

Abstract

Objective. To determine the accumulated 24-hour cardiovascular autonomic modulation and its circadian variations in patients with fibromyalgia, by means of heart rate variability analysis. Methods. Thirty patients with fibromyalgia and 30 age-and sex-matched controls were studied prospectively. Assessments included a 24-hour ambulatory recording of heart rate variability, time-domain analysis of the accumulated 24-hour R-R interval variations, and power spectral analysis to determine the sympathol vagal balance at different hours (calculated as the power spectral density of the low-frequency rO.04-0.15-Hzl sympathetic band divided by the power of the high-frequency [0.15-0.50-Hz] parasympathetic band). Results. Fibromyalgia patients had diminished accumulated 24-hour heart rate variability, manifested by a decreased standard deviation of all R-R intervals (mean-C SD 126-C 35 ms, versus 150-C 33 ms in controls; P = 0,008) and a decreased ratio of pairs of adjacent R-R intervals differing by >SO ms (mean-C SD 12.0 & 9.0% versus 20.1 f 18.0%; P = 0.031). Patients lost the circadian variations of sympathohagal balance, with nocturnal values significantly higher than those of controls at time 0 (mean f SD 3.5 2 3.2 versus 1.2 f 1.0; P = 0.027) and at 3 hours (3.3 2 3.0 versus 1.6 k 1.4; P = 0.01). Conclusion. Individuals with fibromyalgia have diminished 24-hour heart rate variability due to an increased nocturnal predominance of the low-frequency band oscillations consistent with an exaggerated sym

A comprehensive study of autonomic dysfunction in the fibromyalgia patients

“…This finding is important especially because the blood pressures of our patients with fibromyalgia, though higher are within a normal clinical range and have only a statistically significant higher value. Our finding is in sync with the outcome of other studies that the patients with fibromyalgia have a higher vascular sympathetic tone [4,5,8].…”

“…A reduced vagally mediated variability in heart rate is present in the overall HRV over 24 h in patients with fibromyalgia in terms of SDNN, SDANN and pNN50 indices [4]. In our study the time domain measures are significantly lower in the fibromyalgia patients than the controls indicating lesser parasympathetic activity in case of patients ( Table 1).…”

“…The heart rate variability (HRV) analysis results corroborate these findings further and show that fibromyalgia patients have a baseline sympathetic hyperactivity. A 24 h HRV analysis in a circadian-variation study has shown an increased nocturnal predominance of the low-frequency band oscillations indicating an exaggerated sympathetic modulation of the sinus node [4]. Impaired sympathetic reactivity to orthostatic stress is also seen in fibromyalgia patients [5].…”

Sleep and cardiovascular regulation

“…For example, aging is associated with a reduction in delta activity and an increase in the LF/HF ratio during NREM sleep [8,30]. Similarly, a number of disorders have been identified that are characterized by low levels of delta activity and high sympathovagal balance, including insomnia [28], fibromyalgia [41], sleep apnea [29], and alcohol dependence [26]. Further, acute stress imposed before sleep has been shown to reduce the amount of delta activity and increase sympathovagal balance during sleep [21].…”

A Pilot Study of the Efficacy of Heart Rate Variability (HRV) Biofeedback in Patients with Fibromyalgia

“…Because autonomic dysfunction has been linked to many of the common features of FM including pain (Burr, Heitkemper, Jarrett, & Cain, 2000;Schurmann et al, 2000), chronic fatigue (Naschitz et al, 2000), sleep disturbances (Wiklund et al, 2000), depression (Agelink et al, 2001;Rechlin, 1994;Yeragani, Balon, Pohl, & Ramesh, 1995) generalized anxiety disorder (Thayer, Friedman, & Borkovec, 1996), and panic disorder Asmundson & Stein, 1994;Rechlin, Weis, Spitzer, & Kaschka, 1994), autonomic dysfunction has been the target of a number of investigations (Bou-Holaigah, Rowe, Kan, & Calkins, 1995;Clauw, Radulovic, Heshmat, & Barbey, 1996;Cohen et al, 2001;Elam, Johansson, Wallin, 1992;Kelemen, Lang, Balint, Trocsanyi, & Muller, 1998;Martinez-Lavin et al, 1997;Martinez-Lavin, Hermosillo, Rosas, & Soto, 1998;Qiao, Vaeroy, & Morkrid, 1991). Preliminary evidence supports the hypothesis that autonomic dysfunction, characterized by a high baseline state of sympathetic arousal and decreased parasympathetic activity resulting in a blunted sympathetic response to stressors, is a potential pathogenic mechanism in FM (Clauw & Chrousos, 1997;Martinez-Lavin, 2004).…”