Nocturnal cardiac autonomic regulation in Parkinson?s disease

Abstract

Diminished heart rate (HR) variability has been reported in patients with early phase Parkinson's disease (PD) using standardized cardiovascular reflex tests. However, limited data exist on HR variability during sleep; thus the present study was performed to investigate the characteristics of HR variability during different sleep stages. The HR variability of 21 newly diagnosed and untreated PD patients and of 22 control subjects was evaluated by using time domain, frequency domain and non-linear methods and by analyzing HR reactions to body movements during the different sleep stages (non-REM stages S1-4 and the REM stage). The nocturnal cardiac autonomic control was disturbed in PD patients compared to controls both during sleep and waking. HR reactions to body movements were decreased especially during REM sleep referring to defective sympathetic cardiovascular control. High frequency spectral power of HR variability was attenuated in the patients in waking and during non-REM sleep but not during REM sleep suggesting that parasympathetic cardiovascular control is also affected in early PD. However, the variance of R-R intervals during non-REM sleep was significantly increased in PD patients. Especially during this sleep stage the patients also moved more than the controls. HR variability is decreased not only in waking but also during sleep in PD patients. However, the increased variance of HR during non-REM sleep refers that in early phase of PD cardiovascular system is still able to react to changing body circumstances. Furthermore, our findings suggest that the indicators measuring the dominant sympathetic or parasympathetic activity of each given sleep stage are the most sensitive measures in revealing disturbed nocturnal ANS function.

Heart Rate Variability Analyses in Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…HFms 2 . HFms 2 was reported in 24 studies [18,[20][21][22][23][24][26][27][28][29][30]35,36,39,40,45,47,48,[54][55][56]59,63,64]. The mean HFms 2 was 145.2 ± 41.1 ms 2 in PD patients and 219.4 ± 48.8 ms 2 in the healthy control group.…”

“…HFnu. HFnu was reported in 18 studies [21,23,24,26,27,[34][35][36][37]43,44,[49][50][51][52][53][54][55]. The mean HFnu was 34.7 ± 1.8 in PD patients and 33.2 ± 1.9 in the healthy control group.…”

“…In nine studies, both HFms 2 and HFnu were assessed [21,23,24,26,27,35,36,54,55 no significant linear correlation (rp = 0.21, p = 0.583).…”

“…In particular, these are cardiovascular diseases, endocrinological diseases (especially diabetes), peripheral or central neurological disorders (except PD), liver, kidney or lung diseases, and medication known to affect the autonomic nervous system. Eight studies stated that any medical disorder known to affect the autonomic nervous system was excluded [19,21,22,30,36,48,53,58]. Cardiovascular diseases, diabetes, and selected drugs were excluded in 13 studies [19,22,28,[31][32][33][34][35]43,45,55,58,63].…”

Circadian dysregulation in Parkinson's disease

“…Similar to motor function, prominent changes in 24-hour rhythms of heart rate and blood pressure have been repeatedly reported in PD. These studies report reversal of the normal diurnal rhythm of BP with increased diurnal variability of BP and elevations of overnight BP along with loss of diurnal HR variability and a disappearance of the sympathetic morning peak (Haapaniemi et al, 2001, Kallio et al, 2000, Kallio et al, 2004, Mastrocola et al, 1999). Sensory systems, such as retinal function, also appear to be affected in PD.…”