Mundo LS, Estañol B, Téllez ZJF, Plascencia AN, Vinicio CM, Infante O, García RG

Language: Spanish
References: 30
Page: 115-124
PDF size: 249.52 Kb.

ABSTRACT

Introduction: In the diagnosis of autonomic disturbances, the variability of skin blood flow (SBF) and the sympathetic skin response (SSR) in response to several respiratory maneuvers are not routinely studied. Objective: We sought to standardize the method of SBF variability and SSR in healthy subjects during four respiratory maneuvers: 1) spontaneous breathing (SB); 2) rhythmic breathing at a rate of 6 per minute (RB); 3) sudden deep inspiration (SDI); 4) Valsalva maneuver (VM). Subjects, material and method: We studied 30 healthy subjects with a mean age of 32 years, 60% were men and 40% women. We used a photopletysmograph in the finger pad to measure SBF and surface electrodes on the palms of the hand to register the SSR. We also recorded the ECG and the respiratory movements. The variables were: 1) amplitude of SBF; 2) latency and duration of SSR; 3) percentage of decrease of the SBF during the maneuvers compared with the basal flow. Results: During spontaneous breathing there was no respiratory modulation of the SBF and during RB the SBF was modulated with respiration. With SDI there was a 60% decrease of the SBF. VM induced a larger SBF decrease of 72 per cent. A significant statistical difference was revealed when we compared the decrease of SBF basal breathing with SDI and VM (P ‹ 0.001). The difference was also significant between the SDI and VM (P ‹ 0.001). The SBF decrease recovered more slowly after the SDI (beat 7) than after the VM (veat 6). The SBF decrease was more pronounced in magnitude during the VM. The latency of the SSR appears spontaneously and at random in 57% of subjects during normal breathing but it appeared consistently during RB, SDI, and VM. The latency of SSR was longer during SB (1.7 ± 0.7 s), RB (1.6 ± 0.7 s) than SDI (0.7 ± 0. 5 s) and VM (0.8 ± 0.9 s) (P › 0.050). Duration of the SSR was significantly longer in the SDI (around 7.8 ± 2.4 s) and during the VM (8 ± 2.5 s) as compared to normal breathing (6.3 ± 1.0 s) and RB (6.4 ± 1.5 s) (P ‹ 0.009). Conclusions: SB and RB induce periodic modulation of sympathetic activity to skin blood vessels and sweat glands. SDI and VM produced a much greater activation of sympathetic skin activity than SB and RB. The increased SSR duration and the profound SBF decrease with SDI and VM as compared to SB or RB are consistent with this hypothesis. The latency of the SSR is much shorter with SDI and VM than with SB or RB. The most likely explanation is that the SSR, under these circumstances, results from a central command. The recovery to normal SBF is faster after the VM as compared to SDI. This suggests that the withdrawal of sympathetic responses is faster after the VM. The explanation for this is unknown but suggests that it might be baroreceptor mediated.

REFERENCES

1. Gilliat R: Vasoconstriction in the finger after a deep inspiration. J Physiol (London) 1948; 107: 70-88.

2. Gilliat R: Inspiratory vasoconstriction in patients after spinal injuries. J Physiol (London) 1948; 107: 67-9.

3. Delius W, Hagbarth KE, Hongell A, Wallin BG: Maneuvers affecting sympathetic, outflow in human skin nerves. Acta Physiol Scand 1972c; 84: 82-94.

4. Hagbarth KE, Hallin R, Hongell A, Torebjork HE, Wallin BG: General characteristics of sympathetic activity in human skin nerves. Acta Physiol Scand 1972; 84: 162-5.

5. Benarroch EE, Opfer-Gehrking TL, Low PA: Use of photoplethysmographic technique to analyze the Valsalva maneuver in normal man. Muscle Nerve 1991; 14(12): 1165-72.

6. Aso Y, Inukai T, Takemura Y: Evaluation of skin vasomotor reflex in response to deep inspiration in diabetics patients by laser Doppler flowmetry. Diabetes Care 1997; 20(8): 1324-1330.

7. Low P, Neumann C, Dyck PJ, Fealey RD, Tuck RR: Evaluation of skin vasomotor reflexes by using laser Doppler sppedometer. Mayo Clin Proc 1983; 58(9): 583-90.

8. Bennett T, Hosking DJ, Hampton JR: Vasomotor responses to the Valsalva maneuver in subjects and patients with diabetes mellitus. Br Heart J 1979; 42: 422-8.

9. Vissing SF, Scherrer U, Victor RG: Increase of sympathetic discharge to skeletal muscle but not to skin during mild lower body negative pressure in humans. J Physiol 1994; 481(Pt 1): 233-41.

10. Vissing SF: Differential activation of sympathetic discharge to skin and skeletal muscle in humans. Acta Physiol Scand 1997; 639: 1-32.

11. Vissing SF, Secher NH, Victor RG: Mechanism of cutaneous vasoconstriction during upright posture. Acta Physiol Scand 1997; 159(2): 131-8.

12. McLeod JG: Evaluation of the Autonomic Nervous System. In: Electrodiagnosis in clinical Neurology. Aminoff MJ. 3a. Edition New York, Churchill Livingstone Inc. 1992, pp 421-32.

13. Guyton AC, Hall JE: Tratado de Fisiología Médica. New York McGraw-Hill 1997.

14. Gómez Pérez FJ, García Ramos G, García Alcalá H, Rull JA: Neuropatía Diabética. En: Tratado de Diabetología. Gómez Pérez FJ, Rull JA. INCMNSZ. 1a. Edición México D.F. 1997, pp 763-82.

15. Shahani B, Halperin J, Boulu P, Cohen J: Sympathetic skin response-a method of study of unmyelinated axon dysfunction in peripheral neuropathies. J Neurol Neurosurg Psychiatry 1984; 47: 536-42.

16. Tanja B, Herman K: Quantitative assessment and correlation of sympathetic, parasympathetic, and afferent small fiber function in peripheral neuropathy. J Neurol 2000; 247: 267-72.

17. Cacciatori V, Dellera A, Bellavere F, Bongiovanni LG, Tetini F, Gemma ML, Muggeo M: Comparative assessment of peripheral sympathetic function by postural vasoconstriction arteriolar reflex and sympathetic skin response in NIDDM patients. Am J Med 1997; 102(4): 365-70.

18. Suárez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA: The Autonomic Symptom Profile: a new instrument to asses autonomic symptoms. Neurology 1999; 52(3): 523-8.

19. Infante O, Sánchez-Torrez G, Martínez-Memije R, Flores-Chávez P, Sánchez-Miranda G: Sistema para la medición no invasiva de la velocidad de pulso arterial en diferentes territorios vasculares. Arch Inst Cardiol Méx 1999; 69: 330-7.

20. Drory V, Korcsyn A: Sympathetic skin response: age effect. Neurology 1993; 43: 1818-20.

21. Elie B, Guiheneuc P: Sympathetic skin response: normal result in different experimental condition. Clin Neurophysiol 1990; 76: 258-267.

22. 22. Stewart J: Autonomic Nervous System dysfunction in Adolescents with postural Orthostatic tachicardy Syndrome and chronic fatigue Syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion. Ped Res 2000; 48: 218-26.

23. Vissing SF, Scherrer U, Victor RG: Stimulation of skin sympathetic nerve discharge by central command. Differential control of sympathetic outflow to skin and skeletal muscle during static exercise. Circ Res 1991; 69(1): 228-38.

24. Vissing SF, Hjortso EM: Central motor command activates sympathetic outflow to the cutaneous circulation in humans. J Physiol 1996; 492(Pt 3): 931-9.

25. Victor RG, Secher NH, Lyson T, Mitchell JH: Central command increases muscle sympathetic nerve activity during intense intermittent isometric exercise in humans. Circ Res 1995; 76: 127-31.

26. Silber DH, Sinoway LI, Leuenberger UA, Amassian VE: Magnetic stimulation of the human motor cortex evokes skin sympathetic nerve activity. J Appl Physiol 2000; 88: 126-34.

27. Saito M: Transient response of heart rate, skin and muscle sympathetic nerve activity before and after anticipatory muscle contraction. Ann Physiol Anthropol 1992; 11(3): 231-9.

28. Cooke W, Cox JF, Diedrich AM, Taylor JA, Beightol LA, Ames JE, et al: Controlled breathing protocols probe human autonomic cardiovascular rhythms. Am J Physiol 1998; 274: H709-18.

29. Badra LJ, Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, et al: Respiratory modulation of human autonomic rhythms. Am J Physiol Heart Circ Physiol 2001; 280(6): H-2674-88.

30. Seidel H, Herzel H, Eckberg DL: Phase dependencies of the human barorreceptor reflex. Am J Physiol 1997; 272: H2040-53.