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Sympathetic skin response in childhood
66 Sympathetic Skin Response in Childhood Michiko Miyakawa, H i r o t a k a Yamazaki, Hiroko Saito, Syu Miyasaka, Osami O k u b o , Tadayoshi Abe and Masahiko O k u n i
l)epartment qf Pediatrics, Nihon Unicersity School ¢~f" Medicine, Tokyo 173, Japan
Assessment of Autonomic Nervous System with Tilt Test in a Case of Idiopathic Orthostatic Hypotension A t s o n o b u N o m u r a , Hirokazu Saitoh, Takeshi Inn, Hiroyuki Sasaki, Hirotsugu Atarashi, Kazuo M u n a k a t a , T a k a o K a t o h and Hirokazu Hayakawa
kVrst Department of Internal Medicine, Nippon Medical School, 7~kyo 113, Japatt The recording of sympathetic skin response is a new and noninvasire electrophysiological technique for assessing sympathetic function. In the study, sympathetic skin response was m e a s u r e d in 20 normal children (aged between 3 and 2(I) a n d in patients with anorexia nervosa. All tests were p e r f o r m e d with the subject supine and relaxed in a s e m i - d a r k e n e d room. Skin t e m p e r a t u r e was m e a s u r e d and if u n d e r 30°C, the limbs were w a r m e d up. Responses were r e c o r d e d with a s t a n d a r d E E G a p p a r a t u s . The latency was m e a s u r e d from the time of application of the stimulus. Stimuli were administered s e p a r a t e d by irregular intervals of no less than 15 seconds. The following results were obtained. 1) There was no significant difference in sympathetic skin response to electrical stimulation or auditory or visual stimulation. 2) W h e n limb t e m p e r a t u r e was below 30°C, good sympathetic skin response was not obtained. 3) Sympathetic skin responses were always longer in the foot than in the hand, and the latency was shortest in children of about 10.4) The sympathetic skin response of patients with anorexia was absent or markedly r e d u c e d by c o m p a r i s o n with patients in recovery.
A 17-year-old male patient with idiopathic orthostatic hypotension is described. A tilt test (91/° upright) consistently provoked syncopal attacks a c c o m p a n i e d by m a r k e d b r a d y c a r d i a and fall in blood pressure. Pharmacological quantitative analysis of the a u t o n o m i c nervous system ( T a n a k a ' s m e t h o d ) revealed increased beta-sensitivity and decreased beta-secretion. The effects of various pharmacological and mechanical (medical anti-shock trousers) interventions were assessed during tilt tests. Propranolol failed Io prevent the syncopal attack, A t r o p i n e and anti-shock trousers application prevented b r a d y c a r d i a and hypotension syncope but the pulse pressure was decreased. Midodrine showed optimal tolerance and effectively m a i n t a i n e d systolic blood pressure, pulse pressure a n d h e a r t rate. These results suggest thal a disregulation of resistance blood vessels played a key role in the development of orthostatic hypotension in this patient. T h e tilt tests were useful in elucidating the m e c h a n i s m of orthostatic hypotension and in determining the therapeutic a p p r o a c h .
(The A u t o n o m i c Nervous System, 2 7 : 6 0 6 - 6 1 1 , 1990)
(The A u t o n o m i c Nervous System. 2 7 : 6 2 0 626, 1990)
Interaction Between Respiration and Heart Rate in Preterm Infants and Developmental Changes. I. Quiet Sleep Stage Feruyuki Ogawa, Hirotomi Sonoda, Hiroto Sawaguchi, Koichi W a k a y a m a and Kazuya G o t o
Evidence of Increased Sympathetic Nerve Activity in Men with Borderline Hypertension Toshiyoshi Matsukawa, Kazuchika Yoshida * and lchirou K a w a n a
Department of Pediatrics, Medical College of Oita, Oita 879-56. Japan
Second Department of" Internal Medicine, Yokohama City Uni~'ersitv School ¢~f Medicine, Yokahama 230. * Department ~f Internal Medicine, Yokosuka Hokubu Hospital, Yokosuka 237..lapan
We applied spectral analysis through multivariant autoregressivc model fitting (Akaike, 1972) to R R interval a n d respiratory oscillations o b t a i n e d during quiet sleep on the 1st, 3rd a n d 5th days of postnatal life in two groups of p r e t e r m infants: 3 babies at 27 28 weeks gestational age (group l) a n d 3 babies at 3 2 - 3 3 weeks (group It). Power spectra, frequency response and noise contribution ratio between R R interval a n d respiratory oscillations were calculated with a m i n i c o m p u t e r PFU-1200 ( F A C O M ) in o r d e r to determine the structure of the feedback system connecting the two sets of oscillations. We found that 2 0 - 8 0 % of the low frequency (0.5 Hz) c o m p o n e n t in R R interval spectra was caused by respiratory fluctuation. F u r t h e r m o r e , our observations revealed that the critical period of noise contribution ratio of respiratory and R R interval oscillations was at 30 weeks gestational age and that babies in g r o u p I exhibited a significant increase in noisc contribution ratio during the first 5 days of postnatal life, w h e r e a s there was no significant c h a n g e in g r o u p II. It is suggested that the fitting of multivariant autoregressive model provides a very effective m e t h o d for the quantitative analysis of the interaction between R R interval and respiratory oscillations in p r e t e r m infants.
To determine w h e t h e r there is an abnormality in sympathetic nerve activity at rest a n d in response to physical a n d psychological stressors, we r e c o r d e d muscle sympathetic nerve activity mic r o n e u r o g r a p h i c a l l y in 12 normolensive and 9 borderline hypertensive a g e - m a t c h e d men. Blood pressure, plasma epinephrine a n d muscle sympathetic nerve activity were m e a s u r e d before anti during a cold pressor test or during a mental arithmetic test. Resting basal muscle muscle sympathetic nerve activity, blood pressure a n d plasma e p i n e p h r i n e were significantly higher in the borderline hypertensive subjects than in the normotensive subjects (p < 0.05). The cold pressor test p r o d u c e d e n h a n c e d pressor responses (p < 0.05) and an increase in nerve activity (p < 0.05) in the hypertensive subjects by c o m p a r i s o n with the normotensive subjects. The mental arithmetic test p r o d u c e d e n h a n c e d pressor responses a n d an increase in plasma e p i n e p h r i n e in hypertensive subjects by c o m p a r i s o n with normotensive subjects (p <0.1/51. Muscle sympathetic nerve activity decreased in the normotensivc subjects during the mental arithmetic test (p < 0.05) but not in the hypertensive subjects. These findings support the hypothesis that in borderline hypertension there is an increase in sympathetic nerve activity.
(The A u t o n o m i c Nervous System, 27: 612-619, 1990l
(The A u t o n o m i c Nervous System, 27: 627-633. 199t))
l)epartment qf Pediatrics, Nihon Unicersity School ¢~f" Medicine, Tokyo 173, Japan
Assessment of Autonomic Nervous System with Tilt Test in a Case of Idiopathic Orthostatic Hypotension A t s o n o b u N o m u r a , Hirokazu Saitoh, Takeshi Inn, Hiroyuki Sasaki, Hirotsugu Atarashi, Kazuo M u n a k a t a , T a k a o K a t o h and Hirokazu Hayakawa
kVrst Department of Internal Medicine, Nippon Medical School, 7~kyo 113, Japatt The recording of sympathetic skin response is a new and noninvasire electrophysiological technique for assessing sympathetic function. In the study, sympathetic skin response was m e a s u r e d in 20 normal children (aged between 3 and 2(I) a n d in patients with anorexia nervosa. All tests were p e r f o r m e d with the subject supine and relaxed in a s e m i - d a r k e n e d room. Skin t e m p e r a t u r e was m e a s u r e d and if u n d e r 30°C, the limbs were w a r m e d up. Responses were r e c o r d e d with a s t a n d a r d E E G a p p a r a t u s . The latency was m e a s u r e d from the time of application of the stimulus. Stimuli were administered s e p a r a t e d by irregular intervals of no less than 15 seconds. The following results were obtained. 1) There was no significant difference in sympathetic skin response to electrical stimulation or auditory or visual stimulation. 2) W h e n limb t e m p e r a t u r e was below 30°C, good sympathetic skin response was not obtained. 3) Sympathetic skin responses were always longer in the foot than in the hand, and the latency was shortest in children of about 10.4) The sympathetic skin response of patients with anorexia was absent or markedly r e d u c e d by c o m p a r i s o n with patients in recovery.
A 17-year-old male patient with idiopathic orthostatic hypotension is described. A tilt test (91/° upright) consistently provoked syncopal attacks a c c o m p a n i e d by m a r k e d b r a d y c a r d i a and fall in blood pressure. Pharmacological quantitative analysis of the a u t o n o m i c nervous system ( T a n a k a ' s m e t h o d ) revealed increased beta-sensitivity and decreased beta-secretion. The effects of various pharmacological and mechanical (medical anti-shock trousers) interventions were assessed during tilt tests. Propranolol failed Io prevent the syncopal attack, A t r o p i n e and anti-shock trousers application prevented b r a d y c a r d i a and hypotension syncope but the pulse pressure was decreased. Midodrine showed optimal tolerance and effectively m a i n t a i n e d systolic blood pressure, pulse pressure a n d h e a r t rate. These results suggest thal a disregulation of resistance blood vessels played a key role in the development of orthostatic hypotension in this patient. T h e tilt tests were useful in elucidating the m e c h a n i s m of orthostatic hypotension and in determining the therapeutic a p p r o a c h .
(The A u t o n o m i c Nervous System, 2 7 : 6 0 6 - 6 1 1 , 1990)
(The A u t o n o m i c Nervous System. 2 7 : 6 2 0 626, 1990)
Interaction Between Respiration and Heart Rate in Preterm Infants and Developmental Changes. I. Quiet Sleep Stage Feruyuki Ogawa, Hirotomi Sonoda, Hiroto Sawaguchi, Koichi W a k a y a m a and Kazuya G o t o
Evidence of Increased Sympathetic Nerve Activity in Men with Borderline Hypertension Toshiyoshi Matsukawa, Kazuchika Yoshida * and lchirou K a w a n a
Department of Pediatrics, Medical College of Oita, Oita 879-56. Japan
Second Department of" Internal Medicine, Yokohama City Uni~'ersitv School ¢~f Medicine, Yokahama 230. * Department ~f Internal Medicine, Yokosuka Hokubu Hospital, Yokosuka 237..lapan
We applied spectral analysis through multivariant autoregressivc model fitting (Akaike, 1972) to R R interval a n d respiratory oscillations o b t a i n e d during quiet sleep on the 1st, 3rd a n d 5th days of postnatal life in two groups of p r e t e r m infants: 3 babies at 27 28 weeks gestational age (group l) a n d 3 babies at 3 2 - 3 3 weeks (group It). Power spectra, frequency response and noise contribution ratio between R R interval a n d respiratory oscillations were calculated with a m i n i c o m p u t e r PFU-1200 ( F A C O M ) in o r d e r to determine the structure of the feedback system connecting the two sets of oscillations. We found that 2 0 - 8 0 % of the low frequency (0.5 Hz) c o m p o n e n t in R R interval spectra was caused by respiratory fluctuation. F u r t h e r m o r e , our observations revealed that the critical period of noise contribution ratio of respiratory and R R interval oscillations was at 30 weeks gestational age and that babies in g r o u p I exhibited a significant increase in noisc contribution ratio during the first 5 days of postnatal life, w h e r e a s there was no significant c h a n g e in g r o u p II. It is suggested that the fitting of multivariant autoregressive model provides a very effective m e t h o d for the quantitative analysis of the interaction between R R interval and respiratory oscillations in p r e t e r m infants.
To determine w h e t h e r there is an abnormality in sympathetic nerve activity at rest a n d in response to physical a n d psychological stressors, we r e c o r d e d muscle sympathetic nerve activity mic r o n e u r o g r a p h i c a l l y in 12 normolensive and 9 borderline hypertensive a g e - m a t c h e d men. Blood pressure, plasma epinephrine a n d muscle sympathetic nerve activity were m e a s u r e d before anti during a cold pressor test or during a mental arithmetic test. Resting basal muscle muscle sympathetic nerve activity, blood pressure a n d plasma e p i n e p h r i n e were significantly higher in the borderline hypertensive subjects than in the normotensive subjects (p < 0.05). The cold pressor test p r o d u c e d e n h a n c e d pressor responses (p < 0.05) and an increase in nerve activity (p < 0.05) in the hypertensive subjects by c o m p a r i s o n with the normotensive subjects. The mental arithmetic test p r o d u c e d e n h a n c e d pressor responses a n d an increase in plasma e p i n e p h r i n e in hypertensive subjects by c o m p a r i s o n with normotensive subjects (p <0.1/51. Muscle sympathetic nerve activity decreased in the normotensivc subjects during the mental arithmetic test (p < 0.05) but not in the hypertensive subjects. These findings support the hypothesis that in borderline hypertension there is an increase in sympathetic nerve activity.
(The A u t o n o m i c Nervous System, 27: 612-619, 1990l
(The A u t o n o m i c Nervous System, 27: 627-633. 199t))