Origins of Pupillary Hippus in the Autonomic Nervous System

Turnbull, Philip; Irani, Nouzar; Lim, Nicky; Phillips, J. R.

doi:10.1167/iovs.16-20785

Cited by 58 publications

(50 citation statements)

References 38 publications

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“…This is in line with the idea that sleepiness induces slow rhythmic changes of pupil size that are also referred to as pupillary hippus or fatigue waves Loewenfeld, 1952, 1962;Hornung, 1968;Bouma and Baghuis, 1971). Recent research demonstrated that these pupillary oscillations are associated primarily by parasympathetic influence (Turnbull et al, 2017).…”

Section: Discussionsupporting

confidence: 81%

Sympathetic and Parasympathetic Modulation of Pupillary Unrest

et al. 2020

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Pupillary unrest is an established indicator of drowsiness or sleepiness. How sympathetic and parasympathetic activity contribute to pupillary unrest is not entirely unclear. In this study, we investigated 83 young healthy volunteers to assess the relationship of pupillary unrest to other markers of the autonomic nervous system. Sample entropy (SE) and the established pupillary unrest index (PUI) were calculated to characterize pupil size variability. Autonomic indices were derived from heart rate, blood pressure, respiration, and skin conductance. Additionally, we assessed individual levels of calmness, vigilance, and mood. In an independent sample of 26 healthy participants, we stimulated the cardiovagal system by a deep breathing test. PUI was related to parasympathetic cardiac indices and sleepiness. A linear combination of vagal heart rate variability [root mean square of heart beat interval differences (RMSSD)] and skin conductance fluctuations (SCFs) was suited best to explain interindividual variance of PUI. Complexity of pupil diameter (PD) variations correlated to indices of sympathetic skin conductance. Furthermore, we found that spontaneous fluctuations of skin conductance are accompanied by increases of pupil size. In an independent sample, we were able to corroborate the relation of PUI with RMSSD and skin conductance. A slow breathing test enhanced RMSSD and PUI proportionally to each other, while complexity of PD dynamics decreased. Our data suggest that the slow PD oscillations (f < 0.15 Hz) quantified by PUI are related to the parasympathetic modulation. Sympathetic arousal as detected by SCFs is associated to transient pupil size increases that increase non-linear pupillary dynamics.

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Section: Discussionsupporting

confidence: 81%

Sympathetic and Parasympathetic Modulation of Pupillary Unrest

et al. 2020

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“…The pupil can also undergo periods of spontaneous, oscillating constrictions, and dilations that occur independently of changes in illumination or of eye movements. These changes are termed pupillary “hippus” and are thought to result primarily from parasympathetic nervous system activity (Turnbull et al, 2017 ). Pupillary hippus is reduced in periods of wakefulness and, like dilation, may be a useful measurement of behavioral state (Lüdtke et al, 1998 ; Prasad et al, 2011 ).…”

Section: Mechanisms Controlling Pupil Diameter and The Effects Of Lummentioning

confidence: 99%

Neuromodulatory Correlates of Pupil Dilation

Larsen

Waters

2018

Front. Neural Circuits

225

180

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Pupillometry has long been used as a measure of brain state. Changes in pupil diameter are thought to coincide with the activity of neuromodulators, including noradrenaline and acetylcholine, producing alterations in the brain state and corresponding changes in behavior. Here we review mechanisms underlying the control of pupil diameter and how these mechanisms are correlated with changes in cortical activity and the recruitment of neuromodulatory circuits.

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“…Activation of the parasympathetic nervous system (PNS) results in contraction of the circular muscles of the pupil causing miosis. Some authors have suggested that PH could stem from a continuous sympathetic-parasympathetic antagonism [2]. Nevertheless, Turnbull and colleagues [2] have recently proposed that PH originates from central PNS activity, and not from SNS activity, or oscillations in the input from the PNS and SNS.…”

Section: Clinical Casementioning

confidence: 99%

“…Some authors have suggested that PH could stem from a continuous sympathetic-parasympathetic antagonism [2]. Nevertheless, Turnbull and colleagues [2] have recently proposed that PH originates from central PNS activity, and not from SNS activity, or oscillations in the input from the PNS and SNS. They studied 36 normal subjects without central nervous system pathology.…”

Section: Clinical Casementioning

confidence: 99%

“…Pupillary hippus (PH) refers to spontaneous bilateral synchronous rhythmic constriction and dilatation of the pupils [1]. This rare phenomenon is spasmodic, cyclic and bilaterally in phase, and is usually considered benign [2]. However, this clinical sign can rarely be the main manifestation of refractory epilepsy and nonconvulsive status epilepticus (NCSE) in critically ill patients [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

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