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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(07): 689-698
DOI: 10.1055/s-0042-1755225
Original Article

Autonomic and cardiorespiratory responses to the active tilt test in individuals with Parkinson disease: cross-sectional study

Respostas autonômicas e cardiorrespiratórias ao teste ativo de inclinação em indivíduos com doença de Parkinson: estudo transversal
Heloisa Balotari Valente 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Natacha de Lima Gervazoni 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Maria Júlia Lopez Laurino 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Laís Manata Vanzella 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Mileide Cristina Stoco-Oliveira 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Mariana Viana Rodrigues 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Larissa Borba André 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Felipe Ribeiro 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Augusto Cesinando de Carvalho 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
,
Luiz Carlos Marques Vanderlei 
1   Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil.
› Author Affiliations Support The present study was supported by the Programa Institucional de Bolsas de Iniciação Científica - PIBIC/Reitoria/CNPq/UNESP.
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Abstract

Background The Parkinson disease (PD) is frequently associated with autonomic dysfunctions. However, data regarding the influence of PD on the autonomic responses to postural changes is limited.

Objective To analyze and compare the autonomic responses, evaluated through linear and non-linear methods of heart rate variability, and cardiorespiratory parameters in two groups: Parkinson disease (PDG) and control (CG), at rest and during the active tilt test.

Methods A total of 48 participants were analyzed (PDG: n = 25;73.40 ± 7.01 years / CG: n = 23;70.17 ± 8.20 years). The autonomic modulation and cardiorespiratory parameters were evaluated at rest and during the active tilt test. To assess the autonomic modulation the linear indices, at the time (rMSSD, SDNN) and frequency (LF, HF, LF/HF) domains, and the non-linear indices, obtained through the Poincaré plot (SD1, SD2, SD1/SD2), were calculated. The cardiorespiratory parameters evaluated were heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2), and respiratory rate.

Results At rest, the PDG presented significantly lower values of rMSSD, SDNN, LF, HF, SD1, SD2, and DBP, and higher values of SpO2. During test, in the PD group, modifications were observed in HR, and SBP, besides a reduced parasympathetic response, and an increased global modulation. The qualitative analysis of the Poincaré plot showed that the PDG has a lower dispersion of the RR intervals during rest and the active tilt test.

Conclusion Individuals with PD present reduced global variability and parasympathetic modulation at rest, and reduced parasympathetic response and damage in HR regulation when performing the active tilt test, compared with controls.

Resumo

Antecedentes A doença de Parkinson (DP) está frequentemente associada a disfunções autonômicas. Porém, dados sobre a influência da DP nas respostas autonômicas às mudanças posturais são limitados.

Objetivos Analisar e comparar as respostas autonômicas, avaliadas por métodos lineares e não lineares de variabilidade da frequência cardíaca e parâmetros cardiorrespiratórios em dois grupos: DP (GDP) e controle (CG), em repouso e durante o tilt test ativo.

Métodos Foram analisados 48 participantes (GDP: n = 25;73,40 ± 7,01 anos/GC: n = 23; 70,17 ± 8,20 anos). A modulação autonômica e os parâmetros cardiorrespiratórios foram avaliados em repouso e durante o tilt test ativo. Para avaliar a modulação autonômica foram calculados os índices lineares, nos domínios do tempo (rMSSD, SDNN) e frequência (LF, HF, LF/HF), e os índices não lineares, obtidos através do plot de Poincaré (SD1, SD2, SD1/SD2). Os parâmetros cardiorrespiratórios avaliados foram frequência cardíaca (FC), pressão arterial sistólica (PAS), diastólica (PAD), saturação periférica de oxigênio (SpO2) e frequência respiratória.

Resultados Em repouso, o GDP apresentou valores menores de rMSSD, SDNN, LF, HF, SD1, SD2 e PAD, e maiores valores de SpO2. No teste, foram observadas modificações na FC e na PAS, redução da resposta parassimpática e aumento da modulação global no GDP. A análise qualitativa do plot de Poincaré mostrou que o GDP apresentou menor dispersão dos intervalos RR no repouso e no tilt test ativo.

Conclusão Indivíduos com DP apresentam redução da variabilidade global e modulação parassimpática em repouso, redução da resposta parassimpática e prejuízo na regulação da FC ao realizar o tilt test ativo, em comparação aos controles.

Keywords

Arterial Pressure - Autonomic Nervous System Diseases - Heart Rate - Parkinson Disease - Respiratory Rate

Palavras-chave

Pressão Arterial - Doenças do Sistema Nervoso Autônomo - Frequência Cardíaca - Doença de Parkinson - Taxa Respiratória

Authors' Contributions

All authors contributed significantly to this manuscript. HBV, NLG, MJLL, LMV, MCSO, ACC, LCMV: conceptualization; LCMV: project administration; HBV: funding acquisition; ACC: resources; MCSO, HBV, LBA, MVR: investigation; MCSO, HBV, LMV, LCMV: methodology; HBV, LCMV: supervision; MVR, FR: data curation; HBV, LMV: formal analysis; HBV, NLG, MJLL, LBA, MVR: writing-original draft; HBV, NLG, MJLL, LMV, FR, ACC, LCMV: writing-review & editing.




Publication History

Received: 12 August 2021

Accepted: 07 November 2021

Article published online:
29 September 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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