Eleonora Tobaldini1, Paola Proserpio2, Katrina Sambusida2, Andrea Lanza2, Tiziana Redaelli2, Pamela Frigerio2, Lara Fratticci2, Silvia Rosa3, Karina R Casali4, Virend K Somers5, Lino Nobili2, Nicola Montano6. 1. Department of Internal Medicine, Ca' Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy; Cardiovascular Neuroscience Laboratory, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA. 2. Department of Neuroscience, "Niguarda Ca' Granda" Hospital, Milan, Italy. 3. Neurology Unit, L. Sacco Hospital, Milan, Italy. 4. Department of Science and Technology, Science and Technology Institute, Federal University of São Paulo, São José dos Campos, São Paulo, Brazil. 5. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA. 6. Department of Internal Medicine, Ca' Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy; Cardiovascular Neuroscience Laboratory, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy. Electronic address: nicola.montano@unimi.it.
Abstract
BACKGROUND: Spinal cord injuries (SCI) are associated with altered cardiovascular autonomic control (CAC). Sleep is characterized by modifications of autonomic control across sleep stages; however, no data are available in SCI subjects on CAC during sleep. We aim to assess cardiac autonomic modulation during sleep in subjects with SCI. PATIENTS AND METHODS: 27 participants with a neurological and radiological diagnosis of cervical (Cerv, n = 12, ie, tetraplegic) and thoracic SCI (Thor, n = 15, ie, paraplegic) and healthy subjects (Controls) were enrolled. Overnight polysomnographic (PSG) recordings were obtained in all participants. Electrocardiography and respiration were extracted from PSG, divided into sleep stages [wakefulness (W), non-REM sleep (NREM) and REM] for assessment of CAC, using symbolic analysis (SA) and corrected conditional entropy (CCE). SA identified indices of sympathetic and parasympathetic modulation and CCE evaluated the degree of complexity of the heart period time series. RESULTS: SA revealed a reduction of sympathetic and predominant parasympathetic control during NREM compared to W and REM in SCI patients, independent of the level of the lesion, similar to the Controls. In all three groups, complexity of autonomic regulation was higher in NREM compared to W and REM. CONCLUSIONS: In subjects with SCI, cardiac autonomic control changed across sleep stages, with a reduction of sympathetic and an increase of parasympathetic modulation during NREM compared to W and REM, and a parallel increase of complexity during NREM, which was similar to the Controls. Cardiac autonomic dynamics during sleep are maintained in SCI, independent of the level of the lesion.
BACKGROUND:Spinal cord injuries (SCI) are associated with altered cardiovascular autonomic control (CAC). Sleep is characterized by modifications of autonomic control across sleep stages; however, no data are available in SCI subjects on CAC during sleep. We aim to assess cardiac autonomic modulation during sleep in subjects with SCI. PATIENTS AND METHODS: 27 participants with a neurological and radiological diagnosis of cervical (Cerv, n = 12, ie, tetraplegic) and thoracic SCI (Thor, n = 15, ie, paraplegic) and healthy subjects (Controls) were enrolled. Overnight polysomnographic (PSG) recordings were obtained in all participants. Electrocardiography and respiration were extracted from PSG, divided into sleep stages [wakefulness (W), non-REM sleep (NREM) and REM] for assessment of CAC, using symbolic analysis (SA) and corrected conditional entropy (CCE). SA identified indices of sympathetic and parasympathetic modulation and CCE evaluated the degree of complexity of the heart period time series. RESULTS:SA revealed a reduction of sympathetic and predominant parasympathetic control during NREM compared to W and REM in SCI patients, independent of the level of the lesion, similar to the Controls. In all three groups, complexity of autonomic regulation was higher in NREM compared to W and REM. CONCLUSIONS: In subjects with SCI, cardiac autonomic control changed across sleep stages, with a reduction of sympathetic and an increase of parasympathetic modulation during NREM compared to W and REM, and a parallel increase of complexity during NREM, which was similar to the Controls. Cardiac autonomic dynamics during sleep are maintained in SCI, independent of the level of the lesion.
Authors: Kevin D Beck; Hal X Nguyen; Manuel D Galvan; Desirée L Salazar; Trent M Woodruff; Aileen J Anderson Journal: Brain Date: 2010-01-19 Impact factor: 13.501
Authors: Eleonora Tobaldini; Nicola Montano; Shun-Guang Wei; Zhi-Hua Zhang; Joseph Francis; Robert M Weiss; Karina R Casali; Robert B Felder; Alberto Porta Journal: IEEE Eng Med Biol Mag Date: 2009 Nov-Dec
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