Best Parameters of Heart Rate Variability for Assessing Autonomic Responses to Brief Rectal Distention in Patients with Irritable Bowel Syndrome.
Best Parameters of Heart Rate Variability for Assessing Autonomic Responses to Brief Rectal Distention in Patients with Irritable Bowel Syndrome.
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DOI：
10.3390/s23198128
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发表时间：
2023-09-28
期刊：
影响因子：
--
通讯作者：
Chen JDZ
中科院分区：
文献类型：
--
作者：
Ali MK;Gong S;Nojkov B;Burnett C;Chen JDZ
心率变异性（HRV）已被用于无创测量自主神经系统（ANS）的活动。本研究的目的是确定肠易激综合征（IBS）患者短暂直肠膨胀（RD）时ANS活性最合适的HRV参数。肠易激综合征患者参加了一项为期五个阶段的研究。在每次访问期间，记录15分钟的心电图基线值和直肠膨胀期间。对于直肠膨胀，在直肠内充气一个球囊，以5毫米汞柱的速度增加压力30秒；每次扩张后，球囊完全放气（0 mmHg），休息30 s，直到每位患者的最大耐受性达到或高达60 mmHg。计算时域、频域和非线性HRV参数来评估ANS的活动。每个HRV参数的值在基线和RD之间进行比较，每次访问以及所有五次访问的总和。并对每个HRV参数的灵敏度和稳健性/重复性进行了评估。参数包括交感神经指数（SI）；连续差的均方根；高频功率（HF）；低频电源；归一化高频功率；归一化LF功率；低频/高频;呼吸性窦性心律失常；庞加莱图的SD1、SD2及其比值；pNN50、SDSD、SDNN和SDNN指数。分析并比较了17例患者的基线和FD以及5个疗程的数据。在检测ANS对RD的反应时，SI被发现是最敏感和最稳健的HRV参数。在9个副交感神经参数中，只有SDNN和SDNN指数足够敏感，可以在第一次就诊时检测副交感神经对RD的调节。频域参数未显示对RD的反应有任何变化。还观察到，IBS患者的重复RD由于习惯化导致自主反应减少，因为HRV参数的变化量在第一次就诊时最高，但在随后的就诊中减少。总之，SI和SDNN/SDNN指数在评估直肠膨胀的自主神经反应时最敏感。对直肠膨胀的自主神经反应在重复的疗程中减弱，证明了重复试验随机化的必要性。
Heart rate variability (HRV) has been used to measure autonomic nervous system (ANS) activity noninvasively. The purpose of this study was to identify the most suitable HRV parameters for ANS activity in response to brief rectal distension (RD) in patients with Irritable Bowel Syndrome (IBS). IBS patients participated in a five-session study. During each visit, an ECG was recorded for 15 min for baseline values and during rectal distension. For rectal distension, a balloon was inflated in the rectum and the pressure was increased in steps of 5 mmHg for 30 s; each distension was followed by a 30 s rest period when the balloon was fully deflated (0 mmHg) until either the maximum tolerance of each patient was reached or up to 60 mmHg. The time-domain, frequency-domain and nonlinear HRV parameters were calculated to assess the ANS activity. The values of each HRV parameter were compared between baseline and RD for each of the five visits as well as for all five visits combined. The sensitivity and robustness/reproducibility of each HRV parameter were also assessed. The parameters included the Sympathetic Index (SI); Root Mean Square of Successive Differences (RMSSD); High-Frequency Power (HF); Low-Frequency Power (LF); Normalized HF Power (HFn); Normalized LF Power (LFn); LF/HF; Respiratory Sinus Arrhythmia (RSA); the Poincare Plot’s SD1, SD2 and their ratio; and the pNN50, SDSD, SDNN and SDNN Index. Data from 17 patients were analyzed and compared between baseline and FD and among five sessions. The SI was found to be the most sensitive and robust HRV parameter in detecting the ANS response to RD. Out of nine parasympathetic parameters, only the SDNN and SDNN Index were sensitive enough to detect the parasympathetic modulation to RD during the first visit. The frequency-domain parameters did not show any change in response to RD. It was also observed that the repetitive RD in IBS patients resulted in a decreased autonomic response due to habituation because the amount of change in the HRV parameters was the highest during the first visit but diminished during subsequent visits. In conclusion, the SI and SDNN/SDNN Index are most sensitive at assessing the autonomic response to rectal distention. The autonomic response to rectal distention diminishes in repetitive sessions, demonstrating the necessity of randomization for repetitive tests.
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