Heart rate variability in individuals with thoracic spinal cord injury

Serra-Añó, Pilar; Montesinos, Lluisa; Morales, J.; Bueno, Laura López; Bataller, María Querol; García‐Massó, Xavier; Moreno, Luís Millán González

doi:10.1038/sc.2014.207

Cited by 32 publications

(41 citation statements)

References 26 publications

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“…3 In lesions around the T5 level and below, there is increased likelihood of problems such as uncontrolled hypertension and tachycardia. 3,5 Increased cardiovascular risks in lower level lesions may be due to increased compensatory sympathetic activity. 5 The mechanisms for ANS dysfunction are complex and require further investigation.…”

Section: Introductionmentioning

confidence: 99%

“…3,5 Increased cardiovascular risks in lower level lesions may be due to increased compensatory sympathetic activity. 5 The mechanisms for ANS dysfunction are complex and require further investigation. [1][2][3][4][5] Physical inactivity, metabolic syndrome and being overweight or obese increase cardiovascular risks, 2,5 and arguably these problems are likely to be associated with chronic fatigue.…”

Section: Introductionmentioning

confidence: 99%

“…5 The mechanisms for ANS dysfunction are complex and require further investigation. [1][2][3][4][5] Physical inactivity, metabolic syndrome and being overweight or obese increase cardiovascular risks, 2,5 and arguably these problems are likely to be associated with chronic fatigue. Fatigue has been defined as a state of excessive chronic tiredness involving pervasive feelings of exhaustion and negative emotions such as anxiety and poor mood.…”

Section: Introductionmentioning

confidence: 99%

“…2 Generally, dysregulation is likely to be more severe the higher and more complete the lesion, 1,3,4 although inactivity associated with being wheelchair dependent may result in disordered cardiac control in lesions as low as T10. 5 In cervical and high thoracic lesions, disruption of sympathetic nervous system (SNS) pathways to the heart is associated with bradycardia, orthostatic hypotension, reduced blood pressure, as well as autonomic dysreflexia and a reduced capacity to thermoregulate. 3 In lesions around the T5 level and below, there is increased likelihood of problems such as uncontrolled hypertension and tachycardia.…”

Section: Introductionmentioning

confidence: 99%

“…14,15 In comparison with AB controls, reduced sympathetic activity was found in adults with SCI, with no differences found for parasympathetic activity. 3,5,16 Grim et al 3 studied the influence of the neurological level with small samples of adults with tetraplegia (n = 10 with complete lesions; n = 10 with incomplete lesions) and adults with paraplegia (n = 10) on sympathovagal balance with comparisons with a small sample of AB controls (n = 10). They employed tilt, cold pressor and isometric tests to investigate the ANS function.…”

Section: Introductionmentioning

confidence: 99%

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Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

et al. 2015

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Study design: Group cohort design. Objectives: To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. Setting: SCI rehabilitation outpatient and community settings in New South Wales, Australia. Methods: Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. Results: Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function--that is, reduced sympathetic activity. Conclusions: Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

et al. 2015

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Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration

Solinsky

Schleifer

Draghici

et al. 2022

PM&R

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Background Heart rate variability is a measure of autonomic activity that is growing in popularity as a research outcome. However, despite its increased use, the known effects of respiration on heart rate variability measures are rarely accounted for in rehabilitation medicine research, leading to potential misinterpretation. Objective To describe the effect that unpaced and paced breathing introduces to heart rate variability measures in a rehabilitation medicine relevant example of individuals with spinal cord injury. Design Cross‐sectional comparison of heart rate variability during unpaced and paced breathing (0.25 Hz, 15 breaths per minute) within the same individuals during the same lab session. Setting Academic autonomic physiology laboratory. Interventions Not applicable. Main Outcome Measures Mean low frequency (LF) and high frequency (HF) heart rate variability power, percentage of total power derived from the LF spectrum, LF:HF ratio. Results Fifty‐nine individuals with spinal cord injury completed laboratory assessments using standardized protocols (NCT02139436). In repeated measures within individuals, mean LF power was significantly higher in unpaced breathing compared to paced breathing (1292 vs. 573 ms2, p < .001). A Bland‐Altman plot demonstrated significant positive proportional bias for LF power when comparing unpaced and paced breathing conditions (R2 = 0.39). Mean HF power was similar between unpaced and paced breathing conditions, although there were wide positive and negative differences between measures, leading to notable uncertainty when respiratory confounders were not accounted for. The percentages of total power derived from the LF spectrum and the mean LF:HF ratio were both significantly higher for unpaced breathing compared to paced breathing (64 vs. 42%, p < .001; and 3.2 vs. 1.1, p < .001, respectively). Conclusion Respiration has a significant effect on heart rate variability following spinal cord injury, and not accounting for this has serious consequences for accurate interpretation of unpaced data. Future studies of heart rate variability in rehabilitation medicine should accordingly consider paced breathing.

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