Skip to main content
SpringerLink
Log in

Blunted cutaneous vasoconstriction and increased frequency of presyncope during an orthostatic challenge under moderate heat stress in the morning

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

In normothermia, the tolerance time to presyncope during an orthostatic challenge is shortened during the early morning. Heat stress reduces tolerance to presyncope and the degree of cutaneous vasoconstriction prior to presyncope. However, whether these changes show diurnal variations remains unknown. Therefore, we examined diurnal changes in orthostatic tolerance and cutaneous vascular conductance (CVC) during an orthostatic challenge under moderate heat stress.

Methods

Each lower body negative pressure (LBNP) under normothermia and whole body heat stress was applied for 7 min or until the appearance of presyncopal symptoms in 16 males at both 08:00 (a.m.) and 17:00 hours (p.m.). Measurements included internal and skin temperatures, forearm skin blood flow, arterial pressure, and heart rate. CVC was calculated as skin blood flow/mean arterial pressure, normalized to CVC prior to LBNP and expressed as %CVC.

Results

The average tolerance time in eight subjects exhibiting presyncopal symptoms due to LBNP and moderate heat stress was significantly shorter in the a.m. than in the p.m. (3.7 ± 0.8 versus 6.7 ± 0.3 min, respectively; P = 0.005). Neither %CVC during LBNP in these subjects under moderate heat stress nor normothermia were significantly decreased in the a.m. (P > 0.05, respectively).

Conclusions

These findings indicate an orthostatic challenge even during moderate heat stress that led to an increase in the frequency of presyncope, especially in the morning. The reduction in tolerance was accompanied by blunted cutaneous vasoconstriction prior to presyncope. Hence, diurnal changes in cutaneous vascular responses during combined orthostatic and heat stresses should contribute, at least partly, to heat-induced orthostatic intolerance in the morning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CVC:

Cutaneous vascular conductance

ECG:

Electrocardiogram

HR:

Heart rate

LBNP:

Lower body negative pressure

MAP:

Mean arterial pressure

SkBF:

Skin blood flow

T or :

Sublingual temperature

T sk :

Mean skin temperature

References

  • Aldemir H, Atkinson G, Cable T, Edwards B, Waterhouse J, Reilly T (2000) A comparison of the immediate effects of moderate exercise in the late morning and late afternoon on core temperature and cutaneous thermoregulatory mechanisms. Chronobiol Int 17:197–207

    Article  CAS  PubMed  Google Scholar 

  • Allan JR, Crossley RJ (1972) Effect of controlled elevation of body temperature on human tolerance to +Gz acceleration. J Appl Physiol 33:418–420

    CAS  PubMed  Google Scholar 

  • Aoki K, Kondo N, Shibasaki M, Takano S, Tominaga H, Katsuura T (1997) Circadian variation of sweating responses to passive heat stress. Acta Physiol Scand 161:397–402

    Article  CAS  PubMed  Google Scholar 

  • Aoki K, Stephens DP, Johnson JM (2001) Diurnal variation in cutaneous vasodilator and vasoconstrictor systems during heat stress. Am J Physiol Regul Integr Comp Physiol 281:R591–R595

    CAS  PubMed  Google Scholar 

  • Aoki K, Stephens DP, Saad AR, Johnson JM (2003) Cutaneous vasoconstrictor response to whole body skin cooling is altered by time of day. J Appl Physiol 94:930–934

    PubMed  Google Scholar 

  • Atkinson G, Jones H, Ainslie PN (2010) Circadian variation in the circulatory responses to exercise: relevance to the morning peaks in strokes and cardiac events. Eur J Appl Physiol 108:15–29

    Article  PubMed Central  PubMed  Google Scholar 

  • Crandall CG, Johnson JM, Kosiba WA, Kellogg DL Jr (1996) Baroreceptor control of the cutaneous active vasodilator system. J Appl Physiol 81:2192–2198

    CAS  PubMed  Google Scholar 

  • Crandall CG, Shibasaki M, Wilson TE (2010) Insufficient cutaneous vasoconstriction leading up to and during syncopal symptoms in the heat stressed human. Am J Physiol Heart Circ Physiol 299:H1168–H1173

    Article  CAS  PubMed  Google Scholar 

  • Doering TJ, Brix J, Schneider B, Rimpler M (1996) Cerebral hemodynamics and cerebral metabolism during cold and warm stress. Am J Phys Med Rehab 75:408–415

    Article  CAS  Google Scholar 

  • Durand S, Davis SL, Cui J, Crandall CG (2005) Exogenous nitric oxide inhibits sympathetically mediated vasoconstriction in human skin. J Physiol 562:629–634

    Article  CAS  PubMed  Google Scholar 

  • Elherik K, Khan F, Mclaren M, Kennedy G, Belch JJF (2002) Circadian variation in vascular tone and endothelial cell function in normal males. Clin Sci 102:547–552

    Article  CAS  PubMed  Google Scholar 

  • Ganio MS, Overgaard M, Seifert T, Secher NH, Johansson PI, Meyer MAS, Crandall CG (2012) Effect of heat stress on cardiac output and systemic vascular conductance during simulated hemorrhage to presyncope in young men. Am J Physiol Heart Circ Physiol 302:H1756–H1761

    Article  CAS  PubMed  Google Scholar 

  • Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W (2003) Prevalence and triggers of syncope in medical students. Am J Cardiol 91:1006–1008

    Article  PubMed  Google Scholar 

  • Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, Wieling W, van Dijk N (2006) Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 17:1172–1176

    Article  PubMed  Google Scholar 

  • Greenfield ADM (1963) The circulation through the skin. In: Hamilton WF (ed) Handbook of physiology, circulation. American Physiology Society, Washington, pp 1325–1351

    Google Scholar 

  • Hodges GJ, Kosiba WA, Zhao K, Alvarez GE, Johnson JM (2007) The role of baseline in the cutaneous vasoconstrictor responses during combined local and whole body cooling in humans. Am J Physiol Heart Circ Physiol 293:H3187–H3192

    Article  CAS  PubMed  Google Scholar 

  • Hu K, Scheer FA, Laker M, Smales C, Shea SA (2011) Endogenous circadian rhythm in vasovagal response to head-up tilt. Circulation 123:961–970

    Article  PubMed Central  PubMed  Google Scholar 

  • Johnson JM, Proppe DW (1996) Cardiovascular adjustments to heat stress. In: Fregly MJ, Blatteis CM (eds) Handbook of physiology, environmental physiology. American Physiology Society, Bethesda, pp 215–243

    Google Scholar 

  • Johnson JM, Niederberger M, Rowell LB, Eisman MM, Brengelmann GL (1973) Competition between cutaneous vasodilator and vasoconstrictor reflexes in man. J Appl Physiol 35:798–803

    CAS  PubMed  Google Scholar 

  • Johnson JM, O’Leary DS, Taylor WF, Kosiba WA (1986) Effect of local warming on forearm reactive hyperemia. Clin Physiol 6:337–346

    Article  CAS  PubMed  Google Scholar 

  • Keller DM, Low DA, Wingo JE, Brothers RM, Hastings J, Davis SL, Crandall CG (2009) Acute volume expansion preserves orthostatic tolerance during whole-body heat stress in humans. J Physiol 587:1131–1139

    Article  CAS  PubMed  Google Scholar 

  • Kellogg DL Jr, Johnson JM, Kosiba WA (1990) Baroreflex control of the cutaneous active vasodilator system in humans. Circ Res 66:1420–1426

    Article  PubMed  Google Scholar 

  • Kellogg DL Jr, Crandall CG, Liu Y, Charkoudian N, Johnson JM (1998) Nitric oxide and cutaneous active vasodilation during heat stress in humans. J Appl Physiol 85:824–829

    CAS  PubMed  Google Scholar 

  • Lewis NC, Atkinson G, Lucas SJ, Grant EJ, Jones H, Tzeng YC, Horsman H, Ainslie PN (2010) Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge. Am J Physiol Regul Integr Comp Physiol 299:R55–R61

    Article  CAS  PubMed  Google Scholar 

  • Lewis NC, Ainslie PN, Atkinson G, Jones H, Grant EJ, Lucas SJ (2012) The effect of time-of-day and sympathetic α1-blockade on orthostatic tolerance. Choronobiol Int 29:882–890

    Article  CAS  Google Scholar 

  • Lind AR, Leithead CS, McNicol GW (1968) Cardiovascular changes during syncope induced by tilting men in the heat. J Appl Physiol 25:268–276

    CAS  PubMed  Google Scholar 

  • Lucas RA, Ganio MS, Pearson J, Crandall CG (2013) Sweat loss during heat stress contributes to subsequent reductions in lower-body negative pressure tolerance. Exp Physiol 98:473–480

    Article  PubMed  Google Scholar 

  • Mineda Y, Sumiyoshi M, Takano T, Yasuda M, Nakazato K, Nakazato Y, Nakata Y, Yamaguchi H (2000) Circadian variation of vasovagal syncope. J Cardiovasc Electrophysiol 11:1078–1080

    Article  CAS  PubMed  Google Scholar 

  • Nakazato T, Shikama T, Toma S, Nakajima Y, Masuda Y (1998) Nocturnal variation in human sympathetic baroreflex sensitivity. J Auton Nerv Syst 70:32–37

    Article  CAS  PubMed  Google Scholar 

  • Panza JA, Epstein SE, Quyyumi AA (1991) Circadian variation in vascular tone and its relation to α-sympathetic vasoconstrictor activity. N Eng J Med 325:986–990

    Article  CAS  Google Scholar 

  • Parati G, Di Rienzo M, Bertinieri G, Pomidossi G, Casadei R, Groppelli A, Pedotti A, Zanchetti A, Manica G (1988) Evaluation of the baroreceptor-heart rate reflex by 24-hour intra-arterial blood pressure monitoring in humans. Hypertension 12:214–222

    Article  CAS  PubMed  Google Scholar 

  • Parati G, Frattola A, Di Rienzo M, Castiglioni P, Pedotti A, Manica G (1995) Effects of aging on 24-h dynamic baroreceptor control of heart rate in ambulant subjects. Am J Physiol 268:H1606–H1612

    CAS  PubMed  Google Scholar 

  • Pearson J, Lucas RA, Crandall CG (2013) Elevated local skin temperature impairs cutaneous vasoconstrictor responses to a simulated haemorrhagic challenge while heat stressed. Exp Physiol 98:444–450

    Article  CAS  PubMed  Google Scholar 

  • Peters JK, Nishiyasu T, Mack GW (2000) Reflex control of the cutaneous circulation during passive body core heating in humans. J Appl Physiol 88:1756–1764

    Article  CAS  PubMed  Google Scholar 

  • Rowell LB (1977) Reflex control of the cutaneous vasculature. J Invest Dermatol 69:154–166

    Article  CAS  PubMed  Google Scholar 

  • Rowell LB (1986) Human circulation regulation during physical stress. Oxford University Press, New York

    Google Scholar 

  • Rowell LB, Brengelmann GL, Murray JA (1969) Cardiovascular responses to sustained high skin temperature in resting man. J Appl Physiol 27:673–680

    CAS  PubMed  Google Scholar 

  • Schroeder C, Bush VE, Norcliffe LJ, Luft FC, Tank J, Jordan J, Hainsworth R (2002) Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation 106:2806–2811

    Article  PubMed  Google Scholar 

  • Shastry S, Dietz NM, Halliwill JR, Reed AS, Joyner MJ (1998) Effects of nitric oxide synthase inhibition on cutaneous vasodilation during body heating in humans. J Appl Physiol 84:830–834

    Google Scholar 

  • Shibasaki M, Davis SL, Cui J, Low DA, Keller DM, Durand S, Crandall CG (2006) Neurally mediated vasoconstriction is capable of decreasing skin blood flow during orthostasis in the heat-stressed human. J Physiol 575:953–959

    Article  CAS  PubMed  Google Scholar 

  • Shibasaki M, Durand S, Davis SL, Cui J, Low DA, Keller DM, Crandall CG (2007) Endogenous nitric oxide attenuates neutrally mediated cutaneous vasoconstriction. J Physiol 585:627–634

    Article  CAS  PubMed  Google Scholar 

  • Shibasaki M, Low DA, Davis SL, Crandall CG (2008) Nitric oxide inhibits cutaneous vasoconstriction to exogenous norepinephrine. J Appl Physiol 105:1504–1508

    Article  CAS  PubMed  Google Scholar 

  • Shvartz E, Meyerstein N (1970) Effect of heat and natural acclimatization to heat on tilt tolerance of men and women. J Appl Physiol 28:428–432

    CAS  PubMed  Google Scholar 

  • Taylor WF, Johnson JM, O’Leary DS, Park MK (1984) Effects of high local temperature on reflex cutaneous vasodilation. J Appl Physiol 57:191–196

    CAS  PubMed  Google Scholar 

  • Taylor WF, Johnson JM, Kosiba WA, Kwan CM (1989) Cutaneous vascular responses to isometric handgrip exercise. J Appl Physiol 66:1586–1592

    CAS  PubMed  Google Scholar 

  • Taylor CE, Atkinson G, Willie CK, Jones H, Ainslie PN, Tzeng YC (2011) Diurnal variation in the mechanical and neural components of the baroreflex. Hypertension 58:51–56

    Article  CAS  PubMed  Google Scholar 

  • Tham TCK, Guy S, Riddell JG, Shanks RG, Harron DWG (1996) Circadian variation of α1-adrenoceptor-mediated pressor response to phenylephrine in man. J Pharm Pharmacol 48:526–528

    Article  CAS  PubMed  Google Scholar 

  • Torii M, Nakayama H, Sasaki T (1995) Thermoregulation of exercising men in the morning rise and evening fall phases of internal temperature. Br J Sports Med 29:113–120

    Article  CAS  PubMed  Google Scholar 

  • van Dijk N, Boer MC, De Santo T, Grovale N, Aerts AJ, Boersma L, Wieling W (2007) Daily, weekly, monthly, and seasonal patterns in the occurrence of vasovagal syncope in an older population. Europace 9:823–828

    Article  PubMed  Google Scholar 

  • Wilson TE, Cui J, Zhang R, Witkowski S, Crandall CG (2002) Skin cooling maintains cerebral blood flow velocity and orthostatic tolerance during tilting in heated humans. J Appl Physiol 93:85–91

    PubMed  Google Scholar 

  • Wilson TE, Cui J, Zhang R, Crandall CG (2006) Heat stress reduces cerebral blood velocity and markedly impairs orthostatic tolerance in humans. Am J Physiol Regul Integr Comp Physiol 291:R1443–R1448

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Yamazaki F, Sone R (2001) Thermal stress modulates arterial pressure variability and arterial baroreflex response of heart rate during head-up tilt in humans. Eur J Appl Physiol 84:350–357

    Article  CAS  PubMed  Google Scholar 

  • Zoghi M, Duygu H, Gungor H, Nalbantgil S, Ozerkan F, Akilli A, Akin M (2008) Circadian and infradian rhythms of vasovagal syncope in young and middle-aged subjects. Pacing Clin Electrophysiol 31:1581–1584

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to the volunteers who participated in the study. This work was supported by JSPS KAKENHI Grant Number 18700537.

Conflict of interest

There is no financial or other relationship that may be perceived as leading to a conflict of interest.

Author information

Authors and Affiliations

  1. Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Ken Aoki, Yojiro Ogawa & Ken-ichi Iwasaki

Authors
  1. Ken Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yojiro Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken-ichi Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ken Aoki.

Additional information

Communicated by Massimo Pagani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aoki, K., Ogawa, Y. & Iwasaki, Ki. Blunted cutaneous vasoconstriction and increased frequency of presyncope during an orthostatic challenge under moderate heat stress in the morning. Eur J Appl Physiol 114, 629–638 (2014). https://doi.org/10.1007/s00421-013-2795-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-013-2795-4

Keywords

Search

Navigation