Skip to main content
View expanded cover

Clinical Autonomic Dysfunction pp 55–76Cite as

Validation and General Evaluation of Parasympathetic and Sympathetic Monitoring

  • 1671 Accesses

Abstract

Part II provides validations of the P&S monitoring method. This chapter bases P&S validation on comparisons with HRV-alone techniques in response to rest, deep breathing, head-up postural change (stand), clinical examples and in an outcomes study. It ends with a short treatise on past completed validation studies and summarizes how these studies also demonstrate that the methods reduce morbidity and mortality risk, thereby improving patient outcomes.

Keywords

  • Heart Rate Variability
  • Sympathetic Activity
  • Respiratory Sinus Arrhythmia
  • Parasympathetic Activity
  • Deep Breathing

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-07371-2_4
  • Chapter length: 22 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   149.00
Price excludes VAT (USA)
  • ISBN: 978-3-319-07371-2
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   199.00
Price excludes VAT (USA)
Hardcover Book
USD   249.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 4.1
Fig. 4.2
Fig. 4.3
Fig. 4.4
Fig. 4.5
Fig. 4.6
Fig. 4.7
Fig. 4.8
Fig. 4.9
Fig. 4.10

References

  1. Vinik AI, Maser RE, Nakave AA. Diabetic cardiovascular autonomic nerve dysfunction. US Endocr Dis. 2007;2:2–9.

    Google Scholar 

  2. Vinik A, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.

    PubMed  CrossRef  Google Scholar 

  3. DePace NL, Mears JP, Yayac M, Colombo J. Cardiac autonomic testing and diagnosing heart disease. A clinical perspective. In Press, 2014.

    Google Scholar 

  4. DePace NL, Mears JP, Yayac M, Colombo J. Cardiac autonomic testing and treating heart disease. A clinical perspective. In Press, 2014.

    Google Scholar 

  5. Arora RR, Bulgarelli RJ, Ghosh-Dastidar S, Colombo J. Autonomic mechanisms and therapeutic implications of postural diabetic cardiovascular abnormalities. J Diabetes Sci Technol. 2008;2(4):568–71.

    CrossRef  Google Scholar 

  6. Appel ML, Berger RD, Saul JP, Smith JM, Cohen RJ. Beat-to-beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol. 1989;14(5):1139–48.

    CAS  PubMed  CrossRef  Google Scholar 

  7. Akselrod S. Components of heart rate variability: basic studies. In: Malik M, editor. Heart rate variability. Armonk: Futura Publishing Co; 1995. p. 147–63.

    Google Scholar 

  8. Pavri BB, Ingraldi A, Patel H, Zakaria S, Ho RT, Greenspon AJ. Validation of a novel, non-invasive system for autonomic profiling in healthy volunteers. Presented at the North American society for pacing and electrophysiology, scientific sessions, San Diego; 2002.

    Google Scholar 

  9. Berger RD, Akselrod S, Gordon D, Cohen RJ. A efficient algorithm for spectral analysis of heart rate variability. IEEE Trans Biomed Eng. 1986;33:900–4.

    CAS  PubMed  CrossRef  Google Scholar 

  10. Keissar K, Davrath LR, Akselrod S. Coherence analysis between respiration and heart rate variability using continuous wavelet transform. Philos Transact A Math Phys Eng Sci. 2009;367(1892):1393–406.

    CrossRef  Google Scholar 

  11. Peles E, Goldstein DS, Akselrod S, Nitzan H, Azaria M, Almog S, Dolphin D, Halkin H, Modan M. Interrelationships among measures of autonomic activity and cardiovascular risk factors during orthostatic dysfunction and the oral glucose tolerance test. Clin Auton Res. 1995;5(5):271–8.

    CAS  PubMed  CrossRef  Google Scholar 

  12. Toledo E, Akselrod S, Pinhas I, Aravot D. Does synchronization reflect a true interaction in the cardiorespiratory system? Med Eng Phys. 2002;24(1):45–52.

    CAS  PubMed  CrossRef  Google Scholar 

  13. Pyetan E, Akselrod S. Do the high-frequency indexes of HRV provide a faithful assessment of cardiac vagal tone? A critical theoretical evaluation. IEEE Trans Biomed Eng. 2003;50(6):777–83.

    PubMed  CrossRef  Google Scholar 

  14. Triedman JK, Perrott MH, Cohen RJ, Saul JP. Respiratory sinus arrhythmia: time domain characterization using autoregressive moving average analysis. Am J Physiol. 1995;268:H2232–8.

    CAS  PubMed  Google Scholar 

  15. Guzzetti S, Piccaluga E, Casati R, Cerutti S, Lombardi F, Pagani M, Malliani A. Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability. J Hypertens. 1988;6:711–7.

    CAS  PubMed  CrossRef  Google Scholar 

  16. Saul JP, Arai Y, Berger RD, Lilly LS, Colucci WS, Cohen RJ. Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol. 1988;61:1292–9.

    CAS  PubMed  CrossRef  Google Scholar 

  17. Baharav A, Mimouni M, Lehrman-Sagie T, Izraeli S, Akselrod S. Spectral analysis of heart rate in vasovagal syncope: the autonomic nervous system in vasovagal syncope. Clin Auton Res. 1993;3(4):261–9.

    CAS  PubMed  CrossRef  Google Scholar 

  18. Karpen J, Ortiz R, Shoemaker WC. Parasympathetic and sympathetic monitoring in pain management. Online publication at Pain.com. 2010.

  19. Appel S, Kuritzky A, Zahavi I, Zigelman M, Akselrod S. Evidence for instability of the autonomic nervous system in patients with migraine headache. Headache. 1992;32(1):10–7.

    CAS  PubMed  CrossRef  Google Scholar 

  20. Zigelman M, Kuritzky A, Appel S, Davidovitch S, Zahavi I, Hering R, Akselrod S. Propranolol in the prophylaxis of migraine–evaluation by spectral analysis of beat-to-beat heart rate fluctuations. Headache. 1992;32(4):169–74.

    CAS  PubMed  CrossRef  Google Scholar 

  21. Zigelman M, Appel S, Davidovitch S, Kuritzky A, Zahavi I, Akselrod S. The effect of verapamil calcium antagonist on autonomic imbalance in migraine: evaluation by spectral analysis of beat-to-beat heart rate fluctuations. Headache. 1994;34(10):569–77.

    CAS  PubMed  CrossRef  Google Scholar 

  22. Baharav A, Kotagal S, Gibbons V, Rubin BK, Pratt G, Karin J, Akselrod S. Fluctuations in autonomic nervous activity during sleep displayed by power spectrum analysis of heart rate variability. Neurology. 1995;45(6):1183–7.

    CAS  PubMed  CrossRef  Google Scholar 

  23. Narkiewicz K, Montano N, Cogliati C, van de Borne PJH, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation. 1998;98:1071–7.

    CAS  PubMed  CrossRef  Google Scholar 

  24. Baharav A, Kotagal S, Rubin BK, Pratt J, Akselrod S. Autonomic cardiovascular control in children with obstructive sleep apnea. Clin Auton Res. 1999;9(6):345–51.

    CAS  PubMed  CrossRef  Google Scholar 

  25. Keselbrener L, Akselrod S, Ahiron A, Eldar M, Barak Y, Rotstein Z. Is fatigue in patients with multiple sclerosis related to autonomic dysfunction? Clin Auton Res. 2000;10(4):169–75.

    CAS  PubMed  CrossRef  Google Scholar 

  26. Garrard CS, Seidler A, McKibben A, McAlpine LE, Gordon D. Spectral analysis of heart rate variability in bronchial asthma. Clin Auton Res. 1992;2(2):105–11.

    CAS  PubMed  CrossRef  Google Scholar 

  27. Chatow U, Davidson S, Reichman BL, Akselrod S. Development and maturation of the autonomic nervous system in premature and full-term infants using spectral analysis of heart rate fluctuations. Pediatr Res. 1995;37(3):294–302.

    CAS  PubMed  CrossRef  Google Scholar 

  28. Gordon D, Cohen RJ, Kelly D, Akselrod S, Shannon DC. Sudden infant death syndrome: abnormalities in short term fluctuations in heart rate and respiratory activity. Pediatr Res. 1984;18(10):921–6.

    CAS  PubMed  Google Scholar 

  29. Maayan C, Axelrod FB, Akselrod S, Carley DW, Shannon DC. Evaluation of autonomic dysfunction in familial dysautonomia by power spectral analysis. J Auton Nerv Syst. 1987;21(1):51–8. Erratum in: J Auton Nerv Syst 1988;22(2):174. Shannon CD [corrected to Shannon DC].

    CAS  PubMed  CrossRef  Google Scholar 

  30. Barak Y, David D, Keselbrener L, Akselrod S. Autonomic response to hypobaric hypoxia assessed by time-dependent frequency decomposition of heart rate. Aviat Space Environ Med. 2001;72(11):992–1000.

    CAS  PubMed  Google Scholar 

  31. Gordon D, Herrera VL, McAlpine L, Cohen RJ, Akselrod S, Lang P, Norwood WI. Heart-rate spectral analysis: a noninvasive probe of cardiovascular regulation in critically ill children with heart disease. Pediatr Cardiol. 1988;9(2):69–77.

    CAS  PubMed  CrossRef  Google Scholar 

  32. Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ, et al. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol. 1985;248(1 pt 2):H151–3.

    CAS  PubMed  Google Scholar 

  33. Saul JP. Beat-to-beat variations of heart rate reflect modulation of cardiac outflow. News Physiol Sci. 1990;5:32–7.

    Google Scholar 

  34. Toledo E, Pinhas I, Aravot D, Almog Y, Akselrod S. Functional restitution of cardiac control in heart transplant patients. Am J Physiol Regul Integr Comp Physiol. 2002;282(3):R900–8.

    CAS  PubMed  Google Scholar 

  35. Sadeh D, Shannon DC, Abboud S, Saul JP, Akselrod S, Cohen RJ. Altered cardiac repolarization in some victims of sudden infant death syndrome. N Engl J Med. 1987;317(24):1501–5.

    CAS  PubMed  CrossRef  Google Scholar 

  36. Shannon DC, Kelly DH, Akselrod S, Kilborn KM. Increased respiratory frequency and variability in high risk babies who die of sudden infant death syndrome. Pediatr Res. 1987;22(2):158–62.

    CAS  PubMed  CrossRef  Google Scholar 

  37. Davidson S, Reina N, Shefi O, Hai-Tov U, Akselrod S. Spectral analysis of heart rate fluctuations and optimum thermal management for low birth weight infants. Med Biol Eng Comput. 1997;35(6):619–25.

    CAS  PubMed  CrossRef  Google Scholar 

  38. Shefi O, Davidson S, Maayan A, Akselrod S. The effect of thermal stimulation on the heart-rate variability in neonates. Early Hum Dev. 1998;52(1):49–66.

    CAS  PubMed  CrossRef  Google Scholar 

  39. Malik M. The task force of the European society of cardiology and the North American society of pacing and electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65.

    CrossRef  Google Scholar 

  40. Malik M. The task force of the European society of cardiology and the North American society of pacing and electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354–81.

    CrossRef  Google Scholar 

  41. Aysin B, Aysin E. Effect of respiration in heart rate variability (HRV) analysis. Conf Proc IEEE Eng Med Biol Soc. 2006;1:1776–9. PubMed: 17946068.

    PubMed  CrossRef  Google Scholar 

  42. Akselrod S, Gordon S, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuations: a quantitative probe of beat-to- beat cardiovascular control. Science. 1981;213:213–20.

    CrossRef  Google Scholar 

  43. Aysin B, Aysin E, Colombo J. Comparison of HRV analysis methods during orthostatic challenge: HRV with respiration or without? IEEE engineering in medicine and biology conference. France: Lyons; 2007.

    Google Scholar 

  44. Bloomfield DM, Kaufman ES, Bigger Jr JT, Fleiss J, Rolnitzky L, Steinman R. Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. Am Heart J. 1997;134(2 Pt 1):316–20.

    CAS  PubMed  CrossRef  Google Scholar 

  45. Heldt T, Oefinger MB, Hoshiyama M, Mark RG. Circulatory response to passive and active changes in posture. Comput Cardiol. 2003;30:263–6.

    Google Scholar 

  46. Nanavati SH, Bulgarelli RJ, Vazquez-Tanus J, Ghosh-Dastidar S, Colombo J, Arora RR. Altered autonomic activity with atrial fibrillation as demonstrated by non-invasive autonomic monitoring. US Cardiol. 2010;7(1):47–50.

    Google Scholar 

  47. Vinik AI, Aysin B, Colombo J. Enhanced frequency domain analysis replaces older heart rate variability methods. Fourth annual diabetes technology meeting. Philadelphia; 28–30 Oct 2004.

    Google Scholar 

  48. Vinik AI, Arora RR, Colombo J. Age matched attenuation of both autonomic branches in chronic disease: II. Diabetes mellitus. Cleveland clinic heart-brain summit, Cleveland clinic Lou Ruvo center for brain health. Las Vegas; 23–24 Sep 2010.

    Google Scholar 

  49. Colombo J, Shoemaker WC. Non-invasive autonomic nervous system monitoring in critical care. In: Shoemaker WC et al., editors. Procedures and monitoring for the critically ill. Philadelphia: W.B. Saunders Co; 2000. p. 211–24.

    Google Scholar 

  50. Adiraju RK, Gessman LJ, Colombo J. Preliminary applications of the ANS-R1000. MESPE J. 2001;3(1):33–45.

    Google Scholar 

  51. Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectra analysis. Am J Physiol. 1985;249:H867–75.

    CAS  PubMed  Google Scholar 

  52. Low PA, editor. Clinical autonomic disorders: evaluation and management. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  53. Stoupakis G, Colombo J, Rendas-Baum R, Budhwani N, Arora R. Postural drop of low frequency component of heart rate variability in diagnosis of orthostatic dysfunction. Presented at Scientific Sessions of the American Heart Association. Chicago; 2002.

    Google Scholar 

  54. Tobias H, Vinitsky A, Bulgarelli RJ, Ghosh-Dastidar S, Colombo J. Autonomic nervous system monitoring of patients with excess parasympathetic responses to sympathetic challenges – clinical observations. US Neurol. 2010;5(2):62–6.

    Google Scholar 

  55. Akselrod S, Eliash S, Oz O, Cohen S. Hemodynamic regulation in SHR: investigation by spectral analysis. Am J Physiol. 1987;253:H176–83.

    CAS  PubMed  Google Scholar 

  56. Malik M, editor. Clinical guide to cardiac autonomic tests. Dordrecht: Kluwer Academic Publishers; 1998.

    Google Scholar 

  57. Akselrod S. Spectral analysis of fluctuations in cardiovascular parameters: a quantitative tool for the investigation of autonomic control. Trends Pharmacol Sci. 1988;9:6–9.

    CAS  PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Autonomic Laboratory Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA

    Joseph Colombo PhD

  2. ANSAR Medical Technologies, Inc., Philadelphia, PA, USA

    Joseph Colombo PhD

  3. Department of Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  4. Department of Cardiology, The Chicago Medical School, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  5. Department of Cardiology, Hahnemann Hospital Drexel University College of Medicine, Philadelphia, PA, USA

    Nicholas L. DePace MD, FACC

  6. Department of Medicine, Eastern Virginia Medical School Strelitz Diabetes Research Center, Norfolk, VA, USA

    Aaron I. Vinik MD, PhD, FCP, MACP

Authors
  1. Joseph Colombo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rohit Arora MD, FACC, FAHA, FACP, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas L. DePace MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron I. Vinik MD, PhD, FCP, MACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Validation and General Evaluation of Parasympathetic and Sympathetic Monitoring. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07371-2_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07370-5

  • Online ISBN: 978-3-319-07371-2

  • eBook Packages: MedicineMedicine (R0)