Explore the vast range of titles available.

Cardiovascular autonomic neuropathy (CAN) predicts clinical diabetic nephropathy (DN). We investigated the relationship between DN structural lesions and CAN. Sixty three Pima Indians with type 2 diabetes underwent kidney biopsies following a 6-year clinical trial testing the renoprotective efficacy of losartan vs. placebo. CAN was assessed a median 9.2years later. CAN variables included expiration/inspiration ratio (E/I), standard deviation of the normal R-R interval (sdNN), and low and high frequency signal power and their ratio (LF, HF, LF/HF); lower values reflect more severe neuropathy. Associations of CAN with renal structural variables were assessed by linear regression adjusted for age, sex, diabetes duration, blood pressure, HbA1c, glomerular filtration rate, and treatment assignment during the trial. Global glomerular sclerosis was negatively associated with sdNN (partial r=−0.35, p=0.01) and LF (r=−0.32, p=0.02); glomerular basement membrane width was negatively associated with all measures of CAN except for LF/HF (r=−0.28 to −0.42, p<0.05); filtration surface density was positively associated with sdNN, LF, and HF (r=0.31 to 0.38, p<0.05); and cortical interstitial fractional volume was negatively associated with HF (r=−0.27, p=0.04). CAN associates with DN lesions.

The Primer on the Autonomic Nervous System presents, in a readable and accessible format, key information about how the autonomic nervous system controls the body, particularly in response to stress.It represents the largest collection of world-wide autonomic nervous system authorities ever assembled in one book.

The central autonomic nervous system (ANS) is essential for maintaining cardiovascular and respiratory homeostasis in the newborn and has a critical role in supporting higher cortical functions. At birth, the central ANS is maturing and is vulnerable to adverse environmental and physiologic influences. Critical connections are formed early in development between the ANS and limbic system to integrate psychological and body responses. The Polyvagal Theory, developed by Stephen Porges, describes how modulation of the autonomic vagal impulse controls social responses and that a broad range of neuropsychiatric disorders may be due to impaired vagal balance, with either deficient vagal tone or excessive vagal reactivity. Under additional circumstances of prematurity, growth restriction, and environmental stress in the fetus and newborn, the immature ANS may undergo “dysmaturation”. Maternal stress and health as well as the intrauterine environment are also quite important and have been implicated in causing ANS changes in the infant and neuropsychiatric diseases in children. This review will cover the aspects of ANS development and maturation that have been associated with neuropsychiatric disorders in children.

Diabetic cardiac neuropathy, which is characterized by reduced heart rate variability (HRV), frequently coexists with peripheral neuropathy. Gabapentin has been used for the treatment of diabetic neuropathy. We aimed to evaluate the possible effect of gabapentin treatment on autonomic function in patients with type 2 diabetes via HRV. Thirty patients with type 2 diabetes mellitus and peripheral neuropathy and 28 age- and sex-matched healthy controls were consecutively registered. Each patient underwent HRV measurements, and diabetic patients were administered gabapentin. After 3 months of gabapentin therapy, HRV parameters were measured again. Baseline HRV parameters were blunted in patients with diabetes mellitus according to the controls [standard deviation of all NN intervals (SDNN, ms): 106.3±29.9 vs. 148.8±36.5, P=.001; power spectrum of the high-frequency band (HF, ms 2): 133.6±98.3 to 231.4±197.6, P=.02; power spectrum of the low-frequency band (LF, ms 2): 341.8±247.8 to 511.5±409.4, P=.048; LF/HF ratio: 3.3±2.4 to 2.6±1.5, P=.33]. After 3 months of treatment with gabapentin, some HRV parameters showed some improvement. SDNN (106.2±29.8 to 119.4 ± 25, P=.016) and HF (133.6±98.3 to 167.6±118.3, P=.021) increased significantly. LF/HF ratio decreased (from 3.3±2.4 to 2.3±1.9, P=.039) and LF remained unchanged (341.8±247.8 to 352.3±228.9, P=.88). Therapeutic doses of gabapentin not only alleviate neuropathic symptoms but also improve cardiac autonomic function in diabetic patients with peripheral neuropathy.

Heart rate variability (HRV) indicates brain-body interaction and has been associated with a variety of mental and physical health indicators. Transient reductions in HRV, independent of bodily movement (so-called additional HRV reduction [AddHRVr]), may reflect moments of psychophysiological vulnerability. This metric is quantified by regressing bodily movement on the root mean square of successive differences and identifying reductions <0.5 SD of the predicted value in real time in everyday life. We aimed to apply this measure using wearables in everyday life to trigger low-threshold, 1-minute just-in-time adaptive interventions (JITAIs) to stabilize autonomic function and relieve perceived stress and ruminative thoughts. Thus, we compared moments of AddHRVr with random points in time with respect to the effects of brief JITAIs. In 2 preregistered microrandomized trials, participants underwent a 1-day calibration period to derive individualized trigger settings and then received AddHRVr-triggered and random prompts throughout the following 3 days, asking for perceived stress and rumination. In study 1, participants (N=60) underwent a slow breathing intervention (0.1 Hz slow-paced breathing) following each prompt, and in study 2, participants (N=50) were microrandomized to both an external attention (ie, focusing attention on a nonliving object) and a mindful breathing intervention. HRV was assessed before, during, and following each intervention by means of the root mean squares of successive differences, SD of normal-to-normal beats, and high- and low-frequency HRV. Participants also reported on perceived stress and ruminative thoughts before and after the interventions. Following interventions in both studies, perceived stress and ruminative thoughts significantly declined irrespective of the kind of prompt and intervention (study 1-perceived stress: b=-0.12; P<.001 and ruminative thoughts: b=-0.11; P<.001 and study 2-perceived stress: b=-0.07; P=.01 and ruminative thoughts: b=-0.10; P=.002). AddHRVr-triggered prompts resulted in a stronger increase in HRV during the slow-paced breathing (b=0.08; P=.02) and mindful breathing interventions (b=0.10; P=.03), and elevated HRV metrics in a time frame of 10 minutes following the interventions in contrast to random prompts (study 1: b=0.12; P<.001 and study 2: b=0.10; P=.03). Both studies show, for the first time, that transient, nonmetabolic reductions in HRV (AddHRVr) can be used to trigger brief JITAIs in real time by wearables to stabilize autonomic function, thus potentially promoting cardiac health. The findings suggest that although psychological benefits emerged independent of the cardiac autonomic state, slow-paced breathing or directing attention for 1 minute to either the own body or nonliving objects seemed to boost autonomic flexibility when HRV was compromised. German Clinical Trial Register DRKS00035684; https://www.drks.de/search/de/trial/DRKS00035684 and DRKS00035685; https://www.drks.de/search/de/trial/DRKS00035685.

Background: The modulation of the autonomic nervous system’s activity, particularly increasing its parasympathetic tone, is of significant interest in clinical physiotherapy due to its potential benefits for stress-related conditions and recovery processes. This study evaluated the effectiveness of the addition of neurodynamics in enhancing parasympathetic activation in subjects with chronic stress. Methods: A clinical trial randomly assigned participants to a group with neurodynamics (6 bpm breathing protocol + manual therapy + neurodynamic technique) or a group without neurodynamics (6 bpm breathing protocol + manual therapy only). Metrics of heart rate variability (HRV), including the Mean Heart Rate (Mean HR), standard deviation of intervals between consecutive heartbeats (SDNN), Heart Rate Difference (Diff. HR), Root Mean Square of Successive Differences (RMSSD), number of intervals differing by more than 50 ms (NN50), percentage of consecutive NN intervals that differed by more than 50 ms (pNN50), and the high-frequency component measured in standardized units (HF), were assessed before, during, and after the intervention. Results: During the intervention, the group with neurodynamics showed significant changes in all variables except in the pNN50 and HF while the group without neurodynamics only showed improvements in the Mean HR, SDNN, and RMSSD. In the post-intervention phase, the group with neurodynamics maintained an increase in HRV while the group without neurodynamics experienced a decrease, suggesting an increase in sympathetic activity. Conclusions: Vagal nerve neurodynamics appear to represent an effective method for enhancing parasympathetic activation in patients with chronic stress. The results highlight the importance of a more comprehensive analysis of HRV variables in order to obtain a correct picture of the impact of interventions on the complex and multifaceted functioning of the autonomic nervous system.

This study investigates the effects of various acupuncture techniques, specific acupuncture points, and their combinations on symptom improvement in chronic fatigue syndrome (CFS) patients as well as their influence on heart rate variability (HRV) indicators. We recruited 35 healthy subjects as a healthy control group (Group A) and 175 patients with CFS, who were randomly divided into a fake acupuncture group (Group B), an acupuncture group targeting the Zusanli (ST36) point (Group C), an acupuncture group targeting the Guanyuan (CV4) point (Group D), a dual-acupoint acupuncture group (Group E), and a moxibustion group (Group F), with 35 patients in each group. Group B received fake acupuncture at both the bilateral Zusanli and Guanyuan points simultaneously. Group C received acupuncture at the bilateral Zusanli points along with fake acupuncture at the Guanyuan point. Group D received acupuncture at the Guanyuan point along with fake acupuncture at the bilateral Zusanli points. Group E received acupuncture at both the bilateral Zusanli and Guanyuan points simultaneously, and Group F received moxibustion at both the bilateral Zusanli and Guanyuan points simultaneously. Each group received a total of 10 treatments, administered every other day. Before treatment, the Qi-deficiency Syndrome Score, CFS Score, and SF36 Score were assessed for all subjects. HRV was measured before treatment, after the first treatment, after the fourth treatment, and at the end of treatment. The results showed that both acupuncture and moxibustion can effectively alleviate fatigue symptoms in patients suffering from CFS, with combined acupuncture and moxibustion demonstrating greater effectiveness. Acupuncture excelled in regulating the immediate effects of HRV, while moxibustion excelled in regulating long-term effects. Acupuncture targeting both the Zusanli and Guanyuan points proved more effective than acupuncture targeting a single point, with this difference reflected in the distinct regulatory effects on the sympathetic and parasympathetic nervous systems. The intervention mechanism of Zusanli may involve the parasympathetic nervous system, whereas Guanyuan may operate through the sympathetic nervous system. Approved by the Medical Ethics Committee of Hubei Provincial Hospital of Traditional Chinese Medicine (Approval number: HBZY2016-C24-01), and registered with the North American Clinical Trials Data Center (Clinical Trials.gov) (05/10/2016) (registration number: NCT02924831). •Acupuncture has significant therapeutic effect on CFS.•Different acupuncture techniques have varying effects on CFS.•The different effects may be influenced by activation of different autonomic nerve circuits (sympathetic or parasympathetic nerves).•Acupuncture has good immediate effect, while moxibustion has better long-term effect.

Glycemic control decreases the incidence and progression of diabetic complications but increases the incidence of hypoglycemia. Hypoglycemia can impair hormonal and autonomic responses to subsequent hypoglycemia. Intensive glycemic control may increase mortality in individuals with type 2 diabetes at high risk for cardiovascular complications. We tested the hypothesis that prior exposure to hypoglycemia leads to impaired cardiovascular autonomic function. Twenty healthy subjects (age 28 +/- 2 years; 10 men) participated in two 3-day inpatient visits, separated by 1-3 months. Autonomic testing was performed on days 1 and 3 to measure sympathetic, parasympathetic, and baroreflex function. A 2-h hyperinsulinemic [hypoglycemic (2.8 mmol/l) or euglycemic (5.0 mmol/l)] clamp was performed in the morning and in the afternoon of day 2. Comparison of the day 3 autonomic measurements demonstrated that antecedent hypoglycemia leads to 1) reduced baroreflex sensitivity (16.7 +/- 1.8 vs. 13.8 +/- 1.4 ms/mmHg, P = 0.03); 2) decreased muscle sympathetic nerve activity response to transient nitroprusside-induced hypotension (53.3 +/- 3.7 vs. 40.1 +/- 2.7 bursts/min, P < 0.01); and 3) reduced (P < 0.001) plasma norepinephrine response to lower body negative pressure (3.0 +/- 0.3 vs. 2.0 +/- 0.2 nmol/l at -40 mmHg). Baroreflex sensitivity and the sympathetic response to hypotensive stress are attenuated after antecedent hypoglycemia. Because impaired autonomic function, including decreased cardiac vagal baroreflex sensitivity, may contribute directly to mortality in diabetes and cardiovascular disease, our findings raise new concerns regarding the consequences of hypoglycemia.

Cardiovascular autonomic neuropathy (CAN) is an under-recognised yet highly prevalent microvascular complication of diabetes. CAN affects approximately 20% of people with diabetes, with recent studies highlighting the presence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose), indicating early involvement of the autonomic nervous system. Understanding of the pathophysiology of CAN continues to evolve, with emerging evidence supporting a potential link between lipid metabolites, mitochondrial dysfunction and genetics. Recent advancements, such as streamlining CAN detection through wearable devices and monitoring of heart rate variability, present simplified and cost-effective approaches for early CAN detection. Further research on the optimal use of the extensive data provided by such devices is required. Despite the lack of specific pharmacological interventions targeting the underlying pathophysiology of autonomic neuropathy, several studies have suggested a favourable impact of newer glucose-lowering agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, where there is a wealth of clinical trial data on the prevention of cardiovascular events. This review delves into recent developments in the area of CAN, with emphasis on practical guidance to recognise and manage this underdiagnosed condition, which significantly increases the risk of cardiovascular events and mortality in diabetes. Graphical Abstract

BackgroundDue to the lack of long-term studies, this research aimed to explore the changes and predictors of autonomic dysfunction (AD) in people with multiple sclerosis (pwMS) over a 6-year period from disease onset.MethodsAmong the 121 pwMS cohort, 75 underwent autonomic function tests at baseline and year 6. Autonomic symptoms were assessed using the Composite Autonomic System Score-31 (COMPASS-31), while the results of autonomic tests were recorded using the Composite Autonomic Scoring Scale (CASS) at baseline and biennially over 6 years. Symptomatic dysautonomia was identified by a COMPASS-31 score greater than 7.913 and a CASS score greater than 0.ResultsNo significant changes were noted in the COMPASS-31 and CASS scores from baseline to year 6. However, there was a significant decline in the cardiovagal index (p=0.001) and the sudomotor index (p=0.036 and p=0.001, respectively) at years 4 and 6, compared with baseline. The number of participants with symptomatic dysautonomia increased significantly from year 0 to 6 (14 (20.9%) vs 29 (39.2%), respectively; p=0.049). Multivariable logistic regression analysis revealed that experiencing a relapse during the 6 years increased the likelihood of symptomatic dysautonomia (Exp(B) 3.886, 95% CI 1.019 to 14.825, p=0.047). Conversely, transitioning to high-efficacy disease-modifying therapy (HET) reduced the probability of having a CASS score greater than 0 at year 6 (Exp(B) 0.221, 95% CI 0.067 to 0.734, p=0.014).ConclusionsDysfunction of the cardiovagal and sudomotor systems progresses alongside disease duration in pwMS. The early initiation of HET may help mitigate the risk of developing AD.