Skip to main content
SpringerLink
Log in

Étude du système nerveux autonome par la variabilité de la fréquence cardiaque dans le syndrome clinique d’hyperactivité vésicale idiopathique

Study of autonomic nervous system through heart rate variability in idiopathic vesical hyperactivity syndrome

  • Article Original / Original Article
  • Published:
Pelvi-périnéologie

Résumé

Objectif

Plusieurs études suggèrent un dysfonctionnement du système nerveux autonome (SNA) dans le syndrome clinique d’hyperactivité vésicale idiopathique (SCHV). L’étude de la variabilité de la fréquence cardiaque instantanée (VFc) est une méthode de mesure, non invasive et validée, de l’activité du SNA. Nous avons donc appliqué cette méthode au cours du remplissage vésical dans une population témoin (femmes présentant une incontinence urinaire d’effort pure:IUE) et à des patientes présentant un SCHV idiopathique.

Matériel et méthodes

Sept patientes IUE pure et trois patientes SCHV idiopathique ont été étudiées. L’enregistrement électrocardiographique a été réalisé sur dix minutes au repos, vessie vide, puis au cours du remplissage vésical en cystomanométrie. La VFc est étudiée par des indices fréquentiels: composés de basses fréquences, qui reflètent principalement la modulation sympathique, et de hautes fréquences, qui sont liées au système parasympathique.

Résultats et conclusion

Dans le groupe témoin, nous n’avons observé aucune modification significative des paramètres de la VFc lors du remplissage. En revanche, dans le groupe SCHV, le contrôle neurovégétatif cardiaque est différent des témoins et varie lors du remplissage, passant d’une hypertonie parasympathique vessie vide à une hypertonie sympathique en fin de remplissage. En fin de remplissage, au moment même où la continence vésicale est assurée par le sympathique, nous observons une élévation significative du tonus sympathique (p = 0,001), associée à une baisse du tonus parasympathique cardiaque (p < 0,0001). Ces résultats évoquent un dysfonctionnement de la balance végétative dans le SCHV.

Abstract

Objective

Several studies have suggested a defective automatic nervous system (ANS) in idiopathic vesical hyperactivity syndrome. The study of heart rate variability (HRV) is a non-invasive and validated method for measuring ANS activity. We therefore used this method for vesical filling in a control population (women with stress urinary incontinence: SUI) and in female patients with idiopathic vesical hyperactivity syndrome.

Materials and methods

We included 7 women with pure SUI and 3 with idiopathic vesical hyperactivity syndrome. Continuous ECG recording was performed over 10 minutes with an empty bladder and during artificial bladder filling. Heart rate variations were measured by frequential indices: low frequency, which mainly reflected sympathetic modulation, and high frequency, which is related to the parasympathetic system.

Results

In the control group, no significant changes in heart rate variations during filling were noted. However, in the idiopathic vesical hyperactivity group, cardiac neurovegetative control was different from the control group, and varied during filling, going from empty bladder parasympathetic hypertonia to sympathetic hypertonia at the end of filling. At the end of filling, when vesical continence is ensured by the sympathetic system, we noted a significant increase in sympathetic tone (P = 0.001), associated with a reduction in cardiac parasympathetic tone (P < 0.0001). These results demonstrate vegetative balance dysfunction in idiopathic vesical hyperactivity syndrome.

Conclusion

This preliminary study demonstrates a predominance of parasympathetic activity with an empty bladder and a predominance of sympathetic activity at the end of bladder filling in OAB. The results suggest a defective autonomic nervous system with idiopathic OAB. Further studies in a larger OAB population compared with normal urinary-symptom free patients are necessary to confirm this hypothesis.

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

Références

  1. Abrams P, Cardozo L, Fall M, et al. (2002) Standardisation subcommittee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 21(2): 167–178

    Article  PubMed  Google Scholar 

  2. Mills IW, Greenland JE, McMurray G, et al. (2000) Studies of the pathophysiology of idiopathic detrusor instability: the physiological properties of the detrusor smooth muscle and its pattern of inervation. J Urol 163(2): 646–651

    Article  PubMed  CAS  Google Scholar 

  3. Chapple CR, Artibani W, Cardozo LD, et al. (2005) The role of urinary urgency and its measurement in the overactive bladdersymptom syndrome current concepts and future prospects, BJU Int Vol. 95: 924

    Article  Google Scholar 

  4. Mukerji G, Yiangou Y, Grogono J, et al. (2006) Localization of M2 and M3 muscarinic receptors in human bladder disorders and their clinical correlations. J Urol 176(1): 367–373

    Article  PubMed  CAS  Google Scholar 

  5. Choi JB, Kim YB (2005) Analysis of heart rate variability in female patients with overactive bladder. Urology 65(6): 1109–1112

    Article  PubMed  Google Scholar 

  6. Blanc F, Pichot V, Roche F, et al. (2001) Activity of the autonomous nervous system measured based on the variability of heart rate in female urinary incontinence. Prog Urol 11(3): 492–497

    PubMed  CAS  Google Scholar 

  7. Penaz J, Roukenz J, Van der Waal HJ (1968) Spectral Analysisof Some Spontaneous Rhythms in the Circulation. In: Drischel H, Tiedt N, (eds.) Leipzig, Germany: Biokybernetik, Karl Marx University: 233–241

    Google Scholar 

  8. Luczak H, Lauring WJ (1973) An analysis of heart rate variability. Ergonomics 16(1): 85–97

    Article  PubMed  CAS  Google Scholar 

  9. Hirsh JA, Bishop B (1981) Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am J Physiol 241(4): 620–629

    Google Scholar 

  10. Unalacak M, Aydin M, Ermis B, et al. (2004) Assessment of cardiac autonomic regulation in children with monosymptomatic nocturnal enuresis by analysis of heart rate variability. Tohoku J Exp Med 204(1): 63–69

    Article  PubMed  Google Scholar 

  11. Fujiwara J, Kimura S, Tsukayama H, et al. (2001) Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis; power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms. Scand J Urol Nephrol 35(5): 350–356

    Article  PubMed  CAS  Google Scholar 

  12. Akselrod S, Gordon D, Ubel FA, et al. (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science 213: 220–222

    Article  PubMed  CAS  Google Scholar 

  13. Schafer W, Abrams P, Liao L, et al. (2002) International Continence Society. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21(3): 261–274

    Article  PubMed  Google Scholar 

  14. Karemaker J (1997) Analysis of blood pressure and heart rate variability. Clinical autonomic disorders, 2nd edition PA Low (Ed), Lippincott-Raven Publishers, Philadelphia 309–322

    Google Scholar 

  15. Task force of the European society of cardiology and the North American society of pacing and electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93(5): 1043–1065

    Google Scholar 

  16. Fitzgerald MP, Thom DH, Wassel-Fyr C, et al. (2006) Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol 175(3 Pt 1): 989–993

    Article  PubMed  Google Scholar 

  17. Terui N, Koizumi K (1984) Responses of cardiac vagus and sympathetic nerves to excitation of somatic and visceral nerves. J Auton Nerv Syst 10(2): 73–91

    Article  PubMed  CAS  Google Scholar 

  18. Griffiths D, Drebyshire S, Stenger A, Resnick N (2005) Brain control of normal and overactive bladder. J Urol 174(5): 1862–1867

    Article  PubMed  Google Scholar 

  19. Oppenheimer SM, Cechetto DF (1990) Cardiac chronotropic organization of the rat insular cortex. Brain Res 533(1): 66–72

    Article  PubMed  CAS  Google Scholar 

  20. Amarenco G, Raibaut P, Ismael SS, et al. (2006) Evidence of occult dysautonomia in Fowler’s syndrome: alteration of cardiovascular autonomic function tests in female patients presenting with urinary retention. BJU Int 97(2): 288–291

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UMR S 731, faculté de médecine, université Pierre-et-Marie-Curie-Paris-VI, F-75013, Paris, France

    K. Hubeaux, X. Deffieux & G. Amarenco

  2. Service de rééducation neurologique et d’explorations périnéales, groupe hospitalier universitaire Est, hôpital Rothschild, APHP, F-75012, Paris, France

    K. Hubeaux, X. Deffieux, S. S. Ismael, P. Raibaut & G. Amarenco

  3. Inserm, U731, F-75651, Paris, France

    K. Hubeaux, X. Deffieux & G. Amarenco

Authors
  1. K. Hubeaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. X. Deffieux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. S. Ismael
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Raibaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Amarenco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Hubeaux.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hubeaux, K., Deffieux, X., Ismael, S.S. et al. Étude du système nerveux autonome par la variabilité de la fréquence cardiaque dans le syndrome clinique d’hyperactivité vésicale idiopathique. Pelv Perineol 2, 295–300 (2007). https://doi.org/10.1007/s11608-007-0162-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11608-007-0162-9

Mots clés

Keywords

Search

Navigation