Alterations in Baroreflex Sensitivity and Blood Pressure Variability Following Sport-Related Concussion

Ellingson, Chase J.; Singh, Jyotpal; Ellingson, Cody A.; Sirant, Luke W.; Krätzig, Gregory P.; Dorsch, Kim D.; Piskorski, Jarosław; Neary, J. Patrick

doi:10.3390/life12091400

Cited by 9 publications

(12 citation statements)

References 33 publications

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“…Although this analysis focused on the longer-term effect of a history of concussion on autonomic nervous system functionality, there is stronger evidence to suggest that concussion has greater effects on the ANS in the more acute stages. Ellingson et al found SDNN to be depressed after a 5-min ECG recording in collegiate aged athletes 1–5 days post-concussion ( 42 ). Another study on Canadian hockey players found that while standing at rest, the concussed group had lower SDNN and nearly significant lowered RMSSD ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis

Wesolowski,

Ahmed,

Di Pietro

2024

Front. Neurol.

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IntroductionConcussion is a growing concern in worldwide sporting culture. Heart rate variability (HRV) is closely tied with autonomic nervous system (ANS) deficits that arise from a concussion. The objective of this review was to determine if a history of concussion (HOC) can impact HRV values in the time-domain in individuals at rest. This review works to add to the literature surrounding HRV testing and if it can be used to check for brain vulnerabilities beyond the recovery of concussion symptoms.Materials and methodsThe systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. A computer based systematic review scanned articles dating from 1996 to June 2023 through PubMed, Cochrane Library, Google Scholar, and EMBASE databases. A risk of bias assessment was conducted using the ROBINS-E tool. The average difference in time between heartbeats (MeanNN), the standard deviation of the differences (SDNN), and the root mean squared of the successive intervals (RMSSD) were measured.ResultsSix total studies were found that fit the inclusion criteria including a total of 242 participants (133 without HOC, 109 with HOC). The average age of the control group was 23.3 ± 8.2, while the average age of the history of TBI group was 25.4 ± 9.7, with no significant difference between the groups (p = 0.202). Four of the studies reported no significant difference in any of the three measures, while two of the studies reported significant difference for all three measures. The meta-analysis was conducted and found that MeanNN (p = 0.03) and RMSSD (p = 0.04) reached statistical significance, while SDNN did not (p = 0.11).ConclusionThe results of this meta-analysis showed significant difference in two of the three HRV time-domain parameters evaluated. It demonstrates that there can be lowered HRV values that expand beyond the recovery of symptoms, reflecting an extensive period of ANS susceptibility after a concussion. This may be an important variable in determining an athlete’s return to play (RTP). Lack of homogenous study populations and testing methods introduces potential for bias and confounding factors, such as gender or age. Future studies should focus on baseline tests to compare individuals to themselves rather than matched controls.

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Section: Discussionmentioning

confidence: 99%

History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis

Wesolowski,

Ahmed,

Di Pietro

2024

Front. Neurol.

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“…The findings of this current study now highlight the importance of conducting baseline physiological testing at the beginning of a sporting season for any contact sport athletes. Recent research supports the use of baseline physiological testing for standardising pre-participation guidelines so that the medical staff responsible for getting players back-to-play safely, post-concussion, can provide an objective assessment of the players’ physiological status [ 5 , 41 ] to avoid early return-to-play and potential adverse complications.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of research in the concussion literature that has examined the effects of sport-related concussion (SRC) on cerebral physiology has focused on the acute injury phase. This research has documented significant negative effects on brain and cardiac physiology [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The acute physiological effects include altered cerebrovascular reactivity [ 10 , 14 , 15 ], cerebral oxygenation [ 16 ], baroreflex sensitivity [ 5 , 17 ], blood pressure variability [ 5 , 18 ], heart rate variability [ 3 , 19 , 20 , 21 ], dynamic cerebral autoregulation [ 22 , 23 , 24 ], and cardiac mechanics [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…This research has documented significant negative effects on brain and cardiac physiology [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The acute physiological effects include altered cerebrovascular reactivity [ 10 , 14 , 15 ], cerebral oxygenation [ 16 ], baroreflex sensitivity [ 5 , 17 ], blood pressure variability [ 5 , 18 ], heart rate variability [ 3 , 19 , 20 , 21 ], dynamic cerebral autoregulation [ 22 , 23 , 24 ], and cardiac mechanics [ 25 ]. Furthermore, some research has shown that changes in functional connectivity are found in athletes with post-concussion syndrome [ 16 , 26 , 27 , 28 ], but not all research supports this contention [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

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History of Brain Injury Alters Cerebral Haemodynamic Oscillations with Cardiac Influence

et al. 2022

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(1) Background: Cerebral autoregulation is altered during acute mild traumatic brain injury, or concussion. However, it is unknown how a history of concussion can impact cerebral haemodynamic activity during a task that elicits an autoregulatory response. (2) Methods: We assessed cerebral haemodynamic activity in those with a history of three or more concussions. The study included 44 retired athletes with concussion history and 25 control participants. We recorded participants’ relative changes in right and left pre-frontal cortex oxygenation collected by near-infrared spectroscopy and continuous beat-to-beat blood pressure measured by finger photoplethysmography. Participants completed a 5-min seated rest followed by a 5-min repeated squat (10-s) stand (10-s) maneuver (0.05 Hz) to elicit a cerebral autoregulatory response. Wavelet transformation was applied to the collected signals, allowing separation into cardiac interval I (0.6 to 2 Hz), respiratory interval II (0.145 to 0.6 Hz), and smooth muscle cell interval III (0.052 to 0.145 Hz). (3) Results: Significant increases at cardiac interval I were found for the wavelet amplitude of oxy-haemoglobin and haemoglobin difference at the right pre-frontal cortex. No significant difference was found at the left pre-frontal cortex or the blood pressure wavelet amplitudes. (4) Conclusion: Contributions from cardiac activity to the pre-frontal cortex oxygenation are elevated when eliciting dynamic cerebral autoregulation in those with a history of three or more concussions.

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“…In response to blood pressure changes, the baroreflex shifts sympathetic tone through a negative feedback loop by adjusting HR. Baroreflex sensitivity (BRS) is the change in the interbeat interval when blood pressure changes [ 11 ] and is measured by regression of the R-R interval and systolic blood pressure [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in Heart Rate Variability and Baroreflex Sensitivity between Male and Female Athletes

Shafiq

Ellingson

Krätzig

et al. 2023

JCM

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Heart rate variability (HRV), systolic blood pressure variability (BPV), and spontaneous baroreflex sensitivity (BRS) are indirect and approximate measures of autonomic regulation of the cardiovascular system. Studies have shown differences in HRV and BRS between males and females; however, no study has observed differences in BPV, HRV, or BRS between male and female athletes. One hundred males (age 21.2 ± 2.1 y; BMI 27.4 ± 4.5 kg/m2) and sixty-five females (age: 19.7 ± 1.6 y; BMI 22.7 ± 2.2 kg/m2) were assessed during the pre-season baseline. We collected resting beat-to-beat blood pressure and R-R intervals using finger photoplethysmography and a 3-lead electrocardiogram, respectively. Participants underwent a controlled slow breathing protocol (six breaths/minute: 5 s inhale, 5 s exhale) for 5 min. Spectral and linear analysis was conducted on blood pressure and ECG data. Regression curves were fitted to the blood pressure and R-R signals, with the slopes providing the BRS parameters. Male athletes had significantly (p < 0.05) lower mean heart rate, RR interval SD2/SD1, HRV % low-frequency, and higher BP high-frequency power during controlled respiration. No differences were found in any BRS parameters. HRV and BPV responses to a slow breathing protocol differed between male and female athletes; however, BRS responses did not.

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Alterations in Baroreflex Sensitivity and Blood Pressure Variability Following Sport-Related Concussion

Cited by 9 publications

References 33 publications

History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis

History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis

History of Brain Injury Alters Cerebral Haemodynamic Oscillations with Cardiac Influence

Differences in Heart Rate Variability and Baroreflex Sensitivity between Male and Female Athletes

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