Daily, weekly, monthly, and seasonal patterns in the occurrence of vasovagal syncope in an older population

Dijk, Nynke van; Boer, Mardi C.; Santo, Tiziana De; Grovale, Nicoletta; Aerts, Arnaud; Boersma, Lucas V.A.; Wieling, Wouter

doi:10.1093/europace/eum104

Cited by 28 publications

(27 citation statements)

References 33 publications

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“…Epidemiological evidence indicates a prominent circadian variation in the frequency of syncopal episodes exists, with a heightened risk in the morning between 0600 and 1200 (28,46,49). The current study is the first to add detailed physiological insight to these epidemiological findings.…”

Section: R57 Orthostatic Intolerance In the Morningmentioning

confidence: 64%

“…The reduced time to presyncope of ϳ6 min that we observed may seem small; however, this represents an entire phase of tilting and lower body suction, and this is a considerable orthostatic challenge. The current study can only be related to healthy young individuals; thus, individuals who are more prone to or at risk of syncope, such as the young (Ͻ40 years) and elderly (Ͼ65 years) (35), especially between 0600 and 1200 (46), and individuals with autonomic dysfunction (12) may have a different orthostatic response. Nevertheless, at-risk individuals need to be educated that there is an increased risk of syncope in the morning and how they may prevent such an occurrence.…”

Section: Perspectives and Significancementioning

confidence: 99%

“…Data from recent epidemiological studies have revealed a distinct increase in the frequency of neurally mediated syncope between 0600 and 1200 in young, middle-aged, and older individuals who experience recurrent episodes of this type of syncope (28,46,49). This time period is associated with a plethora of relevant hemodynamic influences, which hamper the interpretation of these data, these being, waking from sleep, adopting an upright posture, the initiation of physical activity, increased activation of sympathetic nervous system (3,18,19), and reductions in cerebral blood flow (CBF) and cerebral autoregulation (1).…”

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confidence: 99%

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Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge

Lewis

Atkinson

Lucas

et al. 2010

American Journal of Physiology-Regulatory, Integrative and Comp

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Epidemiological data indicate that the risk of neurally mediated syncope is substantially higher in the morning. Syncope is precipitated by cerebral hypoperfusion, yet no chronobiological experiment has been undertaken to examine whether the major circulatory factors, which influence perfusion, show diurnal variation during a controlled orthostatic challenge. Therefore, we examined the diurnal variation in orthostatic tolerance and circulatory function measured at baseline and at presyncope. In a repeated-measures experiment, conducted at 0600 and 1600, 17 normotensive volunteers, aged 26 Ϯ 4 yr (mean Ϯ SD), rested supine at baseline and then underwent a 60°head-up tilt with 5-min incremental stages of lower body negative pressure until standardized symptoms of presyncope were apparent. Pretest hydration status was similar at both times of day. Continuous beat-to-beat measurements of cerebral blood flow velocity, blood pressure, heart rate, stroke volume, cardiac output, and end-tidal PCO 2 were obtained. At baseline, mean cerebral blood flow velocity was 9 Ϯ 2 cm/s (15%) lower in the morning than the afternoon (P Ͻ 0.0001). The mean time to presyncope was shorter in the morning than in the afternoon (27.2 Ϯ 10.5 min vs. 33.1 Ϯ 7.9 min; 95% CI: 0.4 to 11.4 min, P ϭ 0.01). All measurements made at presyncope did not show diurnal variation (P Ͼ 0.05), but the changes over time (from baseline to presyncope time) in arterial blood pressure, estimated peripheral vascular resistance, and ␣-index baroreflex sensitivity were greater during the morning tests (P Ͻ 0.05). These data indicate that tolerance to an incremental orthostatic challenge is markedly reduced in the morning due to diurnal variations in the time-based decline in blood pressure and the initial cerebral blood flow velocity "reserve" rather than the circulatory status at eventual presyncope. Such information may be used to help identify individuals who are particularly prone to orthostatic intolerance in the morning. cerebrovascualr circulation; syncope; diurnal variation SYNCOPE REFERS TO A TRANSIENT loss of consciousness as a result of cerebral hypoperfusion with subsequent spontaneous recovery (41). The typical symptoms experienced just prior to syncope (presyncope) are wooziness, light-headedness, and visual dimming, and are fundamentally caused by insufficient oxygen supply to the brain which, if sustained, results in syncope. The prevalence of syncope in the general population is clinically significant, accounting for 3-5% of all emergency room visits (39). Neurally mediated (i.e., vasovagal) syncope is the most common form (20), and the incidence of syncope is nearly twice as common in people aged under 40 yr compared with individuals aged over 60 yr (35). Although syncope is also common in individuals with autonomic dysfunction, it can occur in healthy individuals after a period of bed rest (26) or after prolonged endurance exercise (27).Data from recent epidemiological studies have revealed a distinct increase in the frequency of neurally mediat...

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Section: R57 Orthostatic Intolerance In the Morningmentioning

confidence: 64%

Section: Perspectives and Significancementioning

confidence: 99%

mentioning

confidence: 99%

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Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge

Lewis

Atkinson

Lucas

et al. 2010

American Journal of Physiology-Regulatory, Integrative and Comp

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“…High salt intake, endurance exercise and head-up sleeping increase plasma volume and increase orthostatic tolerance [37]. A clear diurnal variation in the frequency of syncopal episodes with a striking peak in the morning also strongly suggests that orthostatic tolerance is diminished in the morning hours [15,31].…”

Section: Sleep With Head-up Tilt: Past and Presentmentioning

confidence: 99%

Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

2009

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“…Orthostatic hypotension has been reported to be an independent risk factor for cardiovascular mortality (16). Thus, the mechanism(s) responsible for orthostatic hypotension is important.It has been demonstrated that there is a diurnal variation associated with orthostatic tolerance (14,18,38,45). Inability to maintain blood pressure upon standing can be related to a failure of cardiac output and/or systemic peripheral resistance to increase appropriately.…”

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confidence: 99%

Is there diurnal variation of the vestibulosympathetic reflex: implications for orthostatic hypotension

Ray

Sauder

Chin-Sang

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Incidences of adverse cardiac events and orthostatic hypotension are associated with diurnal variations. The primary purpose of the present study was to determine if the vestibulosympathetic reflex (VSR) follows a diurnal variation in humans. We hypothesized that the VSR would be attenuated at night based on the relation between melatonin and the VSR. Arterial blood pressure, heart rate, calf blood flow, and muscle sympathetic nerve activity (MSNA) were measured in nine healthy subjects (28 ± 1 yr, 5 men and 4 women) at rest and during head-down rotation. Each subject was tested during the day at 11:34 ± 13 and again at night 22:10 ± 5. MSNA was significantly decreased at night compared with day (8 ± 1 vs. 11 ± 2 bursts/min, respectively, P < 0.02). Heart rate and arterial blood pressure at rest were significantly increased at night compared with day (heart rate: 70 ± 4 vs. 66 ± 4 beats/min and mean arterial blood pressure: 91 ± 2 vs. 87 ± 1 mmHg, respectively). MSNA and hemodynamic responses to head-down rotation were not significantly altered at night compared with day (changes of 3 ± 1 bursts/min and 25 ± 6% for MSNA and calf blood flow, respectively). The data indicate that MSNA at rest decreases during the late evening hours and exhibits a diurnal variation, whereas the VSR does not. In summary, diurnal variation of orthostatic hypotension in humans does not appear to be associated with changes in the VSR and MSNA at rest.

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Daily, weekly, monthly, and seasonal patterns in the occurrence of vasovagal syncope in an older population

Abstract: A circadian pattern in the frequency of vasovagal episodes exists, with a peak in the morning. This is in accordance with reports of diurnal variations in blood pressure and heart rate. No difference was observed in syncope distribution between days of the week, months, or seasons.

Cited by 28 publications

References 33 publications

Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge

Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge

Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

Is there diurnal variation of the vestibulosympathetic reflex: implications for orthostatic hypotension

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