Clinical Autonomic Research

, Volume 18, Issue 6, pp 318–324 | Cite as

Head-up sleeping improves orthostatic tolerance in patients with syncope

  • Victoria L. Cooper
  • Roger HainsworthEmail author



This study was designed to examine the effect of head-up sleeping as a treatment for vasovagal syncope in otherwise healthy patients. Treatment for syncope is difficult. Pharmacological treatments have potential side effects and, although other non-pharmacological treatments such as salt and fluid loading often help, in some cases they may be ineffective or unsuitable. Head-up sleeping may provide an alternative treatment.


Twelve patients had a diagnosis of vasovagal syncope based both on the history and on early pre-syncope during a test of head-up tilting and graded lower body suction. They then underwent a period of 3–4 months of sleeping with the head-end of their bed raised by 10°, after which orthostatic tolerance (time to pre-syncope during tilt test) was reassessed.


Eleven patients (92%) showed a significant improvement in orthostatic tolerance (time to pre-syncope increased by 2 minutes or more). Plasma volume was assessed in eight patients and was found to show a significant increase (P < 0.05, Wilcoxon signed-rank test). There was no significant change in either resting or tilted heart rate or blood pressure after head-up sleeping.


Head-up sleeping is a simple, non-pharmacological treatment which is effective in the majority of patients. However, it may not be tolerated by patients or bed-partners long term and whether the effects continue after cessation of treatment remains to be determined.


syncope head-up sleeping plasma volume blood pressure 


Conflict of interest statement

There are no conflicts of interest.


  1. 1.
    Brignole M, Alboni P, Benditt D et al (2001) Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 22:1256–1306PubMedCrossRefGoogle Scholar
  2. 2.
    Brown CM, Hainsworth R (2000) Forearm vascular responses during orthostatic stress in control subjects and patients with posturally related syncope. Clin Auton Res 10(2):57–61PubMedCrossRefGoogle Scholar
  3. 3.
    Claydon VE, Hainsworth R (2003) Cerebral autoregulation during orthostatic stress in healthy controls and in patients with posturally related syncope. Clin Auton Res 13(5):321–329PubMedCrossRefGoogle Scholar
  4. 4.
    Claydon VE, Hainsworth R (2004) Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension 43(4):809–813PubMedCrossRefGoogle Scholar
  5. 5.
    Claydon VE, Hainsworth R (2005) Increased postural sway in control subjects with poor orthostatic tolerance. J Am Coll Cardiol 46(7):1309–1313PubMedCrossRefGoogle Scholar
  6. 6.
    Claydon VE, Hainsworth R (2006) Postural sway in patients with syncope and poor orthostatic tolerance. Heart 92(11):1688–1689PubMedCrossRefGoogle Scholar
  7. 7.
    Colman N, Nahm K, Ganzeboom KS et al (2004) Epidemiology of reflex syncope. Clin Auton Res 14:I9–I17CrossRefGoogle Scholar
  8. 8.
    Cooper VL, Fuentealba P, Hainsworth R, McIntosh SJ (2006) Is simple advice all that is needed to manage patients with syncope? Clin Auton Res 16:341 (abstr)Google Scholar
  9. 9.
    Cooper VL, Hainsworth R (2002) Effects of head-up tilting on baroreceptor control in subjects with different tolerances to orthostatic stress. Clin Sci (Lond) 103(3):221–226Google Scholar
  10. 10.
    Cooper VL, Hainsworth R (2002) Effects of dietary salt on orthostatic tolerance, blood pressure and baroreceptor sensitivity in patients with syncope. Clin Auton Res 12(4):236–241PubMedCrossRefGoogle Scholar
  11. 11.
    El-Bedawi KM, Hainsworth R (1994) Combined head-up tilt and lower body suction: a test of orthostatic tolerance. Clin Auton Res 4(1–2):41–47PubMedCrossRefGoogle Scholar
  12. 12.
    El-Sayed H, Goodall SR, Hainsworth R (1995) Re-evaluation of Evans blue dye dilution method of plasma volume measurement. Clin Lab Haematol 17(2):189–194PubMedGoogle Scholar
  13. 13.
    El-Sayed H, Hainsworth R (1996) Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75(2):134–140PubMedCrossRefGoogle Scholar
  14. 14.
    Gilbert CA, Stevens PM (1996) Forearm vascular responses to lower body negative pressure and orthostasis. J App Physiol 21:1265–1272Google Scholar
  15. 15.
    Hainsworth R, El-Bedawi KM (2004) Orthostatic tolerance in patients with unexplained syncope. Clin Auton Res 4(5):239–244CrossRefGoogle Scholar
  16. 16.
    Kapoor WN (2000) Syncope. N Engl J Med 343:1826–1856CrossRefGoogle Scholar
  17. 17.
    Lassen NA (1959) Cerebral blood flow and oxygen consumption in man. Physiol Rev 39:183–238PubMedGoogle Scholar
  18. 18.
    Mtinangi BL, Hainsworth R (1998) Increased orthostatic tolerance following moderate exercise training in patients with unexplained syncope. Heart 80(6):596–600PubMedGoogle Scholar
  19. 19.
    Mtinangi BL, Hainsworth R (1998) Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope. Clin Auton Res (4):231–235Google Scholar
  20. 20.
    Mtinangi BL, Hainsworth R (1999) Effects of moderate exercise training on plasma volume, baroreceptor sensitivity and orthostatic tolerance in healthy subjects. Exp Physiol 84(1):121–130PubMedGoogle Scholar
  21. 21.
    Olsen H, Lanne T (1998) Reduced venous compliance in lower limbs of ageing humans and its importance for capacitance function. Am J Physiol 275:H878–H886PubMedGoogle Scholar
  22. 22.
    Pathak A, Raoul V, Montastruc JL, Senard JM (2005) Adverse drug reactions related to drugs used in orthostatic hypotension: a prospective and systematic pharmacovigilance study in France. Eur J Clin Pharmacol 61(5–6):471–474PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Cardiorespiratory UnitSt James’s University HospitalLeedsUK
  2. 2.Institute for Cardiovascular ResearchUniversity of LeedsLeedsUK

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