Autonomic dysfunction in patients with orthostatic dizziness: Validation of orthostatic grading scale and comparison of Valsalva maneuver and head-up tilt testing results

Kim, Hyun-Ah; Lee, Hyung; Park, Ki-Jong; Lim, Jeong‐Geun

doi:10.1016/j.jns.2012.11.019

Cited by 27 publications

(19 citation statements)

References 13 publications

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“…Impaired dynamic autonomic nervous system responses, as reflected in blunted heart rate responses to acute challenges, is a risk factor for hypertension and cardiovascular disease, as well as other chronic illnesses associated with autonomic dysfunction [45]–[48]. The inability to modify regulation of vascular flow from postural movements can contribute to commonly-observed deficits, such as those found with orthostatic hypotension [18], [49], or the failure to alter blood pressure and heart rate according to respiratory movements (reflected as low heart rate variability, a predictor of sudden death in certain conditions [50], [51]). …”

Section: Discussionmentioning

confidence: 99%

Heart Rate Responses to Autonomic Challenges in Obstructive Sleep Apnea

et al. 2013

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Obstructive sleep apnea (OSA) is accompanied by structural alterations and dysfunction in central autonomic regulatory regions, which may impair dynamic and static cardiovascular regulation, and contribute to other syndrome pathologies. Characterizing cardiovascular responses to autonomic challenges may provide insights into central nervous system impairments, including contributions by sex, since structural alterations are enhanced in OSA females over males. The objective was to assess heart rate responses in OSA versus healthy control subjects to autonomic challenges, and, separately, characterize female and male patterns. We studied 94 subjects, including 37 newly-diagnosed, untreated OSA patients (6 female, age mean±std: 52.1±8.1 years; 31 male aged 54.3±8.4 years), and 57 healthy control subjects (20 female, 50.5±8.1 years; 37 male, 45.6±9.2 years). We measured instantaneous heart rate with pulse oximetry during cold pressor, hand grip, and Valsalva maneuver challenges. All challenges elicited significant heart rate differences between OSA and control groups during and after challenges (repeated measures ANOVA, p<0.05). In post-hoc analyses, OSA females showed greater impairments than OSA males, which included: for cold pressor, lower initial increase (OSA vs. control: 9.5 vs. 7.3 bpm in females, 7.6 vs. 3.7 bpm in males), OSA delay to initial peak (2.5 s females/0.9 s males), slower mid-challenge rate-of-increase (OSA vs. control: −0.11 vs. 0.09 bpm/s in females, 0.03 vs. 0.06 bpm/s in males); for hand grip, lower initial peak (OSA vs. control: 2.6 vs. 4.6 bpm in females, 5.3 vs. 6.0 bpm in males); for Valsalva maneuver, lower Valsalva ratio (OSA vs. control: 1.14 vs. 1.30 in females, 1.29 vs. 1.34 in males), and OSA delay during phase II (0.68 s females/1.31 s males). Heart rate responses showed lower amplitude, delayed onset, and slower rate changes in OSA patients over healthy controls, and impairments may be more pronounced in females. The dysfunctions may reflect central injury in the syndrome, and suggest autonomic deficiencies that may contribute to further tissue and functional pathologies.

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Section: Discussionmentioning

confidence: 99%

Heart Rate Responses to Autonomic Challenges in Obstructive Sleep Apnea

et al. 2013

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“…In addition to BP monitoring using Finometer, BP was obtained at baseline and every minute during the tilt using a manual sphygmomanometer (Tycos, Skaneateles Falls, NY, USA). Before autonomic function tests, all patients were asked to complete the Korean version of the orthostatic grading scale (KOGS), which is a validated tool for screening patients with orthostatic dizziness during daily life in Korea 5 .…”

Section: Methodsmentioning

confidence: 99%

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Lee

Low

Kim

2017

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This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.

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“…Orthostatic dizziness is defined as a non-vertiginous dizziness occurring when patient passes from the supine or seated to the upright position [14]. It is often complained as an impending loss of consciousness or light-headedness [15]. This condition accounts for the 42% of generic dizziness and for the 55% of non-vestibular dizziness and the prevalence increases with the age.…”

Section: Discussionmentioning

confidence: 99%

“…It is common belief that orthostatic dizziness depends on orthostatic hypotension, although they must in fact be considered distinctly [16]. Kim et al [15] demonstrated that only the 51% of the patients with orthostatic dizziness had orthostatic hypotension, mostly the classic or delayed type [5,13]. Jeon et al [17] showed that the second more frequent diagnosis was benign paroxysmal positional vertigo.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

et al. 2018

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Purpose To evaluate the characteristics of patients referred for dizziness to a Syncope Unit. Methods This is a retrospective study. Of 491 patients referred to the Syncope Unit of Careggi Hospital in 2015, 198 (40.3%) who experienced dizziness alone or associated with a history of transient loss of consciousness were enrolled. All the patients underwent an initial evaluation according to the European Society of Cardiology guidelines on syncope. We compared the clinical characteristics and final diagnosis of patients referred for dizziness alone (n = 64) to those of patients with dizziness and history of transient loss of consciousness (n = 134). Results The study population had a mean age of 62 ± 20 years (range 16-96 years) and 101 (51%) were female. A final diagnosis of pre-syncope was made in about the 80% of the patients without a previous history of transient loss of consciousness. In this group, other diagnoses were benign paroxysmal positional vertigo (6.3%), transient ischemic attack (4.7%) or psychogenic dizziness (7.8%). Syncope was diagnosed in the 82.7% of the patients with dizziness and history of transient loss of consciousness. Conclusion Dizziness was the main reason for referral to the Syncope Unit in almost one-third of the patients, in whom presyncope was the most frequent final diagnosis. Otological, neurological and psychiatric disorders should be also considered as differential diagnosis, highlighting the importance of a multidisciplinary approach.

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Autonomic dysfunction in patients with orthostatic dizziness: Validation of orthostatic grading scale and comparison of Valsalva maneuver and head-up tilt testing results

Cited by 27 publications

References 13 publications

Heart Rate Responses to Autonomic Challenges in Obstructive Sleep Apnea

Heart Rate Responses to Autonomic Challenges in Obstructive Sleep Apnea

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

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