Changes in Autonomic Nervous System Activity in Children With Spina Bifida: A Case-Control Study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We compared heart rate variability parameters between patients with spina bifida and a control group during urodynamic studies, with the goal of evaluating the autonomic nervous system dysfunction present in spina bifida. Methods: Continuous heart rate variability parameters were recorded during 3 successive periods (P0, the 2 minutes prior to the start of filling; P1, from the start of filling to the first desire to void; and P2, from P1 to the end of filling or the start of voiding). The control group consisted of children with vesicoureteral reflux who had undergone video-urodynamic studies. Our study included 11 patients with spina bifida and 9 control participants. Results: At baseline, patients with spina bifida exhibited lower values for the root mean square of successive differences in NN intervals, the percentage of successive R-R interval differences exceeding 50 msec relative to the total number of intervals, and high frequency (HF). In contrast, the low frequency (LF)/HF ratio was elevated in these patients (5.04±4.75 vs. 0.67±0.42, P=0.014). During bladder filling, LF/HF values increased in the control group (P0, 0.67±0.42; P1, 0.89±0.34; P2, 1.21±0.64; P=0.018), while they declined in patients with spina bifida (P0, 5.04±4.75; P1, 3.96±4.35; P2, 3.26±4.03; P<0.001). The HF values were significantly elevated in children with spina bifida during bladder filling (P=0.002). In the time domain, the standard deviations of all NN intervals were elevated only in the control group during bladder filling. Parasympathetic activity domains were reduced in the children with spina bifida at the initial assessment. Conclusions: During the bladder filling phase, parasympathetic activity increased along with fixed sympathetic activity in the spina bifida group. In contrast, the control group exhibited a shift towards a sympathetic preponderance at the conclusion of bladder filling. These observations may be associated with the pathophysiology of neurogenic bladder in spina bifida.
Abstract
Purpose: We compared heart rate variability parameters between patients with spina bifida and a control group during urodynamic studies, with the goal of evaluating the autonomic nervous system dysfunction present in spina bifida. Methods: Continuous heart rate variability parameters were recorded during 3 successive periods (P0, the 2 minutes prior to the start of filling; P1, from the start of filling to the first desire to void; and P2, from P1 to the end of filling or the start of voiding). The control group consisted of children with vesicoureteral reflux who had undergone video-urodynamic studies. Our study included 11 patients with spina bifida and 9 control participants. Results: At baseline, patients with spina bifida exhibited lower values for the root mean square of successive differences in NN intervals, the percentage of successive R-R interval differences exceeding 50 msec relative to the total number of intervals, and high frequency (HF). In contrast, the low frequency (LF)/HF ratio was elevated in these patients (5.04±4.75 vs. 0.67±0.42, P=0.014). During bladder filling, LF/HF values increased in the control group (P0, 0.67±0.42; P1, 0.89±0.34; P2, 1.21±0.64; P=0.018), while they declined in patients with spina bifida (P0, 5.04±4.75; P1, 3.96±4.35; P2, 3.26±4.03; P<0.001). The HF values were significantly elevated in children with spina bifida during bladder filling (P=0.002). In the time domain, the standard deviations of all NN intervals were elevated only in the control group during bladder filling. Parasympathetic activity domains were reduced in the children with spina bifida at the initial assessment. Conclusions: During the bladder filling phase, parasympathetic activity increased along with fixed sympathetic activity in the spina bifida group. In contrast, the control group exhibited a shift towards a sympathetic preponderance at the conclusion of bladder filling. These observations may be associated with the pathophysiology of neurogenic bladder in spina bifida.
참고문헌 (27)
- Zerah M, "Spinal cord malformations", Handb Clin Neurol, 112, pp.975~991 (2013)
- Phillips LA, "Spina bifida management", Curr Probl Pediatr Adolesc Health Care, 47, pp.173~177 (2017)
- de Groat WC, "Neural control of the lower urinary tract", Compr Physiol, 5, pp.327~396 (2015)
- Mehnert U, "Heart rate variability : an objective measure of autonomic activity and bladder sensations during urodynamics", Neurourol Urodyn, 28, pp.313~319 (2009)
- Ben-Dror I, "Alterations of heart rate variability in women with overactive bladder syndrome", Int Urogynecol J, 23, pp.1081~1086 (2012)
- Pumprla J, "Functional assessment of heart rate variability : physiological basis and practical applications", Int J Cardiol, 84, pp.1~14 (2002)
- 심강희, "Changes in autonomic nervous system activity after treatment with alpha-blocker in men with lower urinary tract symptoms", Investigative and Clinical Urology, 59(1), pp.49~54 (2018), 대한비뇨의학회[DOI]
- Cho DS, "Heart rate variability in assessment of autonomic dysfunction in patients with chronic prostatitis", chronic pelvic pain syndrome, 2011, pp.78, 1369~1372
- Austin PF, "The standardization of terminology of lower urinary tract function in children and adolescents : update report from the standardization committee of the International Children’s Continence Society", Neurourol Urodyn, 35, pp.471~481 (2016)
- Drzewiecki BA, "Urodynamic testing in children: indications, technique, interpretation and significance", J Urol, 186, pp.1190~1197 (2011)
- Plews DJ, "Comparison of heart-rate-variability recording with smartphone photoplethysmography, Polar H7 Chest Strap, and electrocardiography", Int J Sports Physiol Perform, 12, pp.1324~1328 (2017)
- Task Force of the European Society of Cardiology, "Heart rate variability. Standards of measurement, physiological interpretation, and clinical use", Eur Heart J, 17, pp.354~381 (1996)
- Taskinen S, "Effect of spinal cord abnormalities on the function of the lower urinary tract in patients with anorectal abnormalities", J Urol, 168, pp.1147~1149 (2002)
- Boemers TM, "Urodynamic evaluation of children with the caudal regression syndrome(caudal dysplasia sequence)", J Urol, 151, pp.1038~1040 (1994)
- Stone AR, "Neurourologic evaluation and urologic management of spinal dysraphism", Neurosurg Clin N Am, 6, pp.269~277 (1995)
- Hon EH, "Electronic evaluation of the fetal heart rate. VIII. Patterns preceding fetal death, further observations", Am J Obstet Gynecol, 87, pp.814~826 (1963)
- Hubeaux K, "Autonomic nervous system activity during bladder filling assessed by heart rate variability analysis in women with idiopathic overactive bladder syndrome or stress urinary incontinence", J Urol, 178, pp.2483~2487 (2007)
- Choi JB, "Analysis of heart rate variability in female patients with overactive bladder", Urology, 65, pp.1109~1112 (2005)
- Fazeli MS, "Cardiac autonomic nervous system activity in children with bladder and bowel dysfunction", J Urol, 195, pp.1245~1249 (2016)
- Floyd K, "The influence of visceral mechanoreceptors on sympathetic efferent discharge in the cat", J Physiol, 323, pp.65~75 (1982)
- den Braber-Ymker M, "The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury", Virchows Arch, 470, pp.175~184 (2017)
- Leonardi-Figueiredo MM, "Damaged cardiovascular autonomic control in wheelchair-using children and adolescents with myelomeningocele : a case-control study", Braz J Phys Ther, 23, pp.27~32 (2019)
- Claydon VE, "Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury", Am J Physiol Heart Circ Physiol, 294, pp.H668~78 (2008)
- Inoue K, "Assessment of autonomic function in traumatic quadriplegic and paraplegic patients by spectral analysis of heart rate variability", J Auton Nerv Syst, 54, pp.225~234 (1995)
- Jacobs PL, "Hypokinetic circulation in persons with paraplegia", Med Sci Sports Exerc, 34, pp.1401~1407 (2002)
- Boot CR, "Arterial vascular properties in individuals with spina bifida", Spinal Cord, 41, pp.242~246 (2003)
- Li KHC, "The current state of mobile phone apps for monitoring heart rate, heart rate variability, and atrial fibrillation : narrative review", JMIR Mhealth Uhealth, 7, pp.e11606~ (2019)