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Fei N, Li R, Cui H, Hu Y. A Prediction Model for Normal Variation of Somatosensory Evoked Potential During Scoliosis Surgery. Int J Neural Syst 2023; 33:2350005. [PMID: 36581320 DOI: 10.1142/s0129065723500053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Somatosensory evoked potential (SEP) has been commonly used as intraoperative monitoring to detect the presence of neurological deficits during scoliosis surgery. However, SEP usually presents an enormous variation in response to patient-specific factors such as physiological parameters leading to the false warning. This study proposes a prediction model to quantify SEP amplitude variation due to noninjury-related physiological changes of the patient undergoing scoliosis surgery. Based on a hybrid network of attention-based long-short-term memory (LSTM) and convolutional neural networks (CNNs), we develop a deep learning-based framework for predicting the SEP value in response to variation of physiological variables. The training and selection of model parameters were based on a 5-fold cross-validation scheme using mean square error (MSE) as evaluation metrics. The proposed model obtained MSE of 0.027[Formula: see text][Formula: see text] on left cortical SEP, MSE of 0.024[Formula: see text][Formula: see text] on left subcortical SEP, MSE of 0.031[Formula: see text][Formula: see text] on right cortical SEP, and MSE of 0.025[Formula: see text][Formula: see text] on right subcortical SEP based on the test set. The proposed model could quantify the affection from physiological parameters to the SEP amplitude in response to normal variation of physiology during scoliosis surgery. The prediction of SEP amplitude provides a potential varying reference for intraoperative SEP monitoring.
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Affiliation(s)
- Ningbo Fei
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518058, Guangdong, P. R. China.,Department of Orthopeadics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rong Li
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518058, Guangdong, P. R. China.,Department of Orthopeadics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hongyan Cui
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, P. R. China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518058, Guangdong, P. R. China.,Department of Orthopeadics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
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2
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Basaran S, Akıncı E. Screening autonomic functions in patients with restless legs syndrome: A case-control study in a tertiary care hospital. Auton Neurosci 2021; 237:102924. [PMID: 34871924 DOI: 10.1016/j.autneu.2021.102924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/28/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The clinical importance of autonomic involvement in patients with restless legs syndrome (RLS) remains unclear. To our knowledge, no study has explored the relationship between autonomic dysfunction and disease-related variables in patients with RLS. Therefore, this study aimed 1) to determine the presence of autonomic symptoms in drug-naïve patients with RLS in comparison with healthy controls using Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) questionnaire and 2) to evaluate the possible associations of autonomic dysfunction with clinical factors in RLS. METHODS A total of 70 drug-naïve patients with RLS and 85 healthy volunteers were enrolled. The SCOPA-AUT questionnaire and Epworth Sleepiness Scale (ESS) scores were used to determine autonomic functions and sleep propensity, respectively. Moreover, the International Restless Legs Syndrome Study Group rating scale was used to evaluate disease severity in the patient group. RESULTS Compared with the control group, the RLS group had significantly higher subscale scores (gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual [women]) and total scores of the SCOPA-AUT questionnaire (p < 0.05). In the patient group, there was a significant correlation between the total scores and subscale scores (gastrointestinal, cardiovascular, and thermoregulatory subscales) of the SCOPA-AUT questionnaire and disease severity. Moreover, ESS was positively correlated with the total scores and subscale scores (urinary, cardiovascular, and pupillomotor) of the SCOPA-AUT questionnaire. CONCLUSION Disease severity and daytime sleepiness may be related to autonomic dysfunction in RLS. Further studies focusing on autonomic functions in RLS are required to improve management strategies and clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov. NCT04906486; May 28, 2021.
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Affiliation(s)
- Sehnaz Basaran
- Department of Neurology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Erhan Akıncı
- Department of Psychiatry, Canakkale Onsekiz Mart University Medicine Faculty, Canakkale, Turkey.
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Spektor E, Fietze I, Poluektov MG. Periodic Limb Movements Syndrome in Patients With Cerebral Small Vessel Disease: Protocol for a Prospective Observational Study. Front Neurol 2021; 12:700151. [PMID: 34646228 PMCID: PMC8503532 DOI: 10.3389/fneur.2021.700151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements in sleep (PLMS) are known to be associated with transient changes in heart rate and blood pressure. These changes might influence the course of cerebral small vessel disease (cSVD). Nevertheless, the clinical significance of PLMS, particularly its influence on cardiovascular diseases course, is still controversial and underinvestigated. Methods/design: Patients from 60 to 75 years old diagnosed with cSVD will undergo nocturnal polysomnography. Subjects with apnea/hypopnea index under 5 will be enrolled. Sleep quality and daytime functioning will be assessed at baseline with self-reported questionnaires. Brain MRI and cognitive assessment will be performed at baseline and in the 2-year follow-up. Progression of cSVD markers and cognitive dysfunction will be compared between patients with PLMS index (PLMI) equal to or more than 15 movements per hour of sleep and controls (PLMI <15/h). Discussion: The negative role of PLMS in cSVD progression and related cognitive decline is expected. We suppose that patients with PLMS tend to worsen in cognitive performance more rapidly than age-, gender-, and comorbidity-matched controls. We also expect them to have more rapid white matter hyperintensities and other cSVD marker progression. The limitations of the study protocol are the short follow-up period, the absence of a treatment group, and inability to make a conclusion about causality.
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Affiliation(s)
- Ekaterina Spektor
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ingo Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,The Fourth People's hospital of Guangyuan, Guangyuan City, China.,The Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Mikhail G Poluektov
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Determinants of Nocturnal Cardiovascular Variability and Heart Rate Arousal Response in Restless Legs Syndrome (RLS)/Periodic Limb Movements (PLMS). J Clin Med 2019; 8:jcm8101619. [PMID: 31590229 PMCID: PMC6832401 DOI: 10.3390/jcm8101619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/23/2022] Open
Abstract
Recent studies have suggested that restless legs syndrome is associated with an increased prevalence of cardiovascular diseases mediated by sympathetic activation occurring during periodic limb movements. The aim of this study was to establish which factors affect the degree of sympathetic activation during the basal condition and during periodic limb movements that may contribute to increased vascular risk. Fifty untreated restless legs syndrome patients aged 62.6 ± 11.1 y, free of cardiovascular diseases, were examined. Heart rate variability was calculated during wakefulness and all sleep stages, during periods with and without periodic limb movements. Heart rate changes before and after periodic limb movement onset were analyzed to assess the arousal response to periodic limb movements. Both analyses took into account the effects of age, gender, periodic limb movement duration, periodic limb movement index, periodic limb movement interval and periodicity, and magnitude of muscular activity (electromyogram power). Compared to periods without periodic limb movements, a significant increase in sympathetic activity occurred in periods with periodic limb movements, independent of age, sex and periodic limb movement characteristics. Data obtained from the cardiac arousal response to periodic limb movements showed that electromyogram power is the factor affecting sympathetic tonus. These results suggest that other factors, such as electromyogram power and individual susceptibility, should be considered in the assessment of the vascular risk related to restless legs syndrome.
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Li X, Covassin N, Zhou J, Zhang Y, Ren R, Yang L, Tan L, Li T, Xue P, Tang X. Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability. J Sleep Res 2019; 28:e12861. [PMID: 31131533 DOI: 10.1111/jsr.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/01/2019] [Accepted: 03/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Xiao Li
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Naima Covassin
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota, USA
| | - Junying Zhou
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Linghui Yang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Lu Tan
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Taomei Li
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Pei Xue
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
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Heart rate variability in patients with major depressive disorder and healthy controls during non-REM sleep and REM sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:2312-2315. [PMID: 29060360 DOI: 10.1109/embc.2017.8037318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objectives of this study are to investigate heart rate variability (HRV) in major depressive disorder patients (MDD) and healthy controls during different sleep stages, and to examine the association of HRV during sleep and depression severity. Polysomnography was recorded from 15 depressive patients with a higher beck depression inventory index (BDI > 25, H-BDI-D), 15 depressive patients with a lower BDI index (BDI ≤ 25, L-BDI-D) and 15 healthy controls. HRV was calculated during the first three rapid eye movements (REM) periods and non-REM stages (i.e. sleep stage 2 and 3) with time domain, power spectral and fractal analysis. As a result, H-BDI-D patients showed the highest short-term fractal alpha-1 exponent during first REM period and healthy controls had the lowest values. Our results suggest an association between the depression severity and the autonomic nerve function, especially during the first REM sleep. The pathophysiological analysis for this property should be conducted in future prospective studies.
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Barone DA, Ebben MR, DeGrazia M, Mortara D, Krieger AC. Heart rate variability in restless legs syndrome and periodic limb movements of Sleep. ACTA ACUST UNITED AC 2017; 10:80-86. [PMID: 28966745 DOI: 10.5935/1984-0063.20170015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The relationship between the autonomic nervous system and restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) consists of varied and somewhat conflicting reports. In order to further elucidate these complexities, a retrospective analysis of polysomnography (PSG) records and clinical data was performed. METHODS Records from 233 adult subjects were randomly selected and organized into one of four groups ("non-RLS/PLMS" [n=61], "RLS" [n=60], "PLMS" [n=58], and "RLS/PLMS" [n=54]). Heart rate variability (HRV) analysis was based on 5-minute samples of 2-lead electrocardiogram data isolated from PSG recordings during wakefulness and NREM sleep, and included mean RR interval (labeled "NN") and standard deviation of the RR intervals (labeled "SDNN"), and HRV power, very low frequency (VLF), low frequency (LF), and high frequency (HF) spectral bands. RESULTS A significant reduction in the VLF band in the PLMS group as compared to the non-RLS/PLMS group (542±674 vs. 969±1025 ms2, p=0.038) was found in wakefulness. Statistically significant differences were seen in the PLMS group as compared to the non-RLS/PLMS group with a reduction in SDNN (p=0.001) and the HF (p=0.001) band, and an increase in HRV power (p=0.001), and the VLF (p=0.005) and LF (p=0.001) bands in NREM sleep. CONCLUSIONS The PLMS group exhibited reduced basal sympathetic activity in wakefulness, but basal sympathetic predominance during NREM sleep, distinguishing this group from the RLS and RLS/PLMS groups.
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Affiliation(s)
| | | | | | | | - Ana C Krieger
- Weill Cornell Medical College Center for Sleep Medicine
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8
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Autonomic dysfunction in primary sleep disorders. Sleep Med 2016; 19:40-9. [DOI: 10.1016/j.sleep.2015.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/08/2015] [Accepted: 10/12/2015] [Indexed: 11/20/2022]
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9
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Wu MN, Lai CL, Liu CK, Yen CW, Liou LM, Hsieh CF, Tsai MJ, Chen SCJ, Hsu CY. Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea. J Sleep Res 2015; 24:722-9. [PMID: 26118626 DOI: 10.1111/jsr.12314] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/10/2015] [Indexed: 12/01/2022]
Abstract
Because the impact of periodic limb movements in sleep (PLMS) is controversial, no consensus has been reached on the therapeutic strategy for PLMS in obstructive sleep apnea (OSA). To verify the hypothesis that PLMS is related to a negative impact on the cardiovascular system in OSA patients, this study investigated the basal autonomic regulation by heart rate variability (HRV) analysis. Sixty patients with mild-to-moderate OSA who underwent polysomnography (PSG) and completed sleep questionnaires were analysed retrospectively and divided into the PLMS group (n = 30) and the non-PLMS group (n = 30). Epochs without any sleep events or continuous effects were evaluated using HRV analysis. No significant difference was observed in the demographic data, PSG parameters or sleep questionnaires between the PLMS and non-PLMS groups, except for age. Patients in the PLMS group had significantly lower normalized high frequency (n-HF), high frequency (HF), square root of the mean of the sum of the squares of difference between adjacent NN intervals (RMSSD) and standard deviation of all normal to normal intervals index (SDNN-I), but had a higher normalized low frequency (n-LF) and LF/HF ratio. There was no significant difference in the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Short-Form 36 and the Hospital Anxiety and Depression Scale between the two groups. After adjustment for confounding variables, PLMS remained an independent predictor of n-LF (β = 0.0901, P = 0.0081), LF/HF ratio (β = 0.5351, P = 0.0361), RMSSD (β = -20.1620, P = 0.0455) and n-HF (β = -0.0886, P = 0.0134). In conclusion, PLMS is related independently to basal sympathetic predominance and has a potentially negative impact on the cardiovascular system of OSA patients.
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Affiliation(s)
- Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiou-Lian Lai
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Kuan Liu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Wen Yen
- Department of Mechanical and Electro-mechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Li-Min Liou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sharon C-J Chen
- Department of Medical Imaging and Radiation Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Niemeijer ND, Corssmit EPM, Reijntjes RHAM, Lammers GJ, van Dijk JG, Thijs RD. Sleep-mediated heart rate variability after bilateral carotid body tumor resection. Sleep 2015; 38:633-9. [PMID: 25325476 DOI: 10.5665/sleep.4586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/14/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The carotid bodies are thought to play an important role in sleep-dependent autonomic changes. Patients who underwent resection of bilateral carotid body tumors have chronically attenuated baroreflex sensitivity. These subjects provide a unique opportunity to investigate the role of the baroreflex during sleep. DESIGN One-night ambulatory polysomnography (PSG) recording. SETTING Participants' homes. PARTICIPANTS Nine patients with bilateral carotid body tumor resection (bCBR) (four women, mean age 50.4 ± 7.2 years) and nine controls matched for age, gender, and body mass index. INTERVENTIONS N/A. MEASUREMENTS Sleep parameters were obtained from PSG. Heart rate (HR) and its variability were calculated using 30-s epochs. RESULTS In bCBR patients, HR was slightly but not significantly increased during wake and all sleep stages. The effect of sleep on HR was similar for patients and controls. Low frequency (LF) power of the heart rate variability spectrum was significantly lower in bCBR patients in active wakefulness, sleep stage 1 and REM sleep. No differences were found between patients and controls for high frequency (HF) power and the LF/HF ratio. CONCLUSIONS Bilateral carotid body tumor resection (bCBR) is associated with decreased low frequency power during sleep, suggesting impaired baroreflex function. Despite this, sleep-related heart rate changes were similar between bCBR patients and controls. These findings suggest that the effects of sleep on heart rate are predominantly generated through central, non-baroreflex mediated pathways.
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Affiliation(s)
- Nicolasine D Niemeijer
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN, Heemstede, The Netherlands
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,SEIN, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
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Izzi F, Placidi F, Romigi A, Lauretti B, Marfia GA, Mercuri NB, Marciani MG, Rocchi C. Is autonomic nervous system involved in restless legs syndrome during wakefulness? Sleep Med 2014; 15:1392-7. [PMID: 25266501 DOI: 10.1016/j.sleep.2014.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate cardiovascular autonomic function in patients with restless leg syndrome (RLS) by means of cardiovascular reflexes and heart rate variability (HRV) during wakefulness. METHODS Twelve RLS patients and 14 controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. HRV analysis was performed in the frequency domain using both autoregressive (AR) and fast Fourier transform algorithms in rest supine condition and during HUTT. RESULTS There was a significant increase in systolic blood pressure values in supine rest condition and a trend toward a lower Valsalva ratio in RLS patients with respect to controls. The significant and physiological changes of HRV at HUTT detected in healthy subjects were not found in RLS patients. CONCLUSION RLS patients exhibit a tendency toward hypertension, reduced amplitude of both sympathetic and parasympathetic responses at HUTT, as well as blunted parasympathetic drive to blood pressure changes. These findings, if confirmed by more controlled studies, might support the hypothesis of autonomic nervous system involvement during wakefulness and consequently an enhanced cardiovascular risk in RLS.
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Affiliation(s)
- Francesca Izzi
- Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Fabio Placidi
- Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Andrea Romigi
- Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Benedetta Lauretti
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Girolama A Marfia
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Nicola B Mercuri
- Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Maria G Marciani
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Camilla Rocchi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
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