Variation of Autonomic Nervous System Function by Age and Gender in Thai Ischemic Stroke Patients

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Ischemic stroke (n=111). Intervention: Older age (≥60 years) and female sex vs. Younger age (<60 years) and male sex. Primary outcome: Autonomic nervous system modulation assessed via nonlinear heart rate variability parameters (SD1, SD2, SD2/SD1) and pulse transit time (PTT) (r = 0.47 for PNS with SD1; r = -0.47 for PNS with SD2 and SD2/SD1, p=<0.001).

Q: What does this research mean for the field?

In ischemic stroke patients, older age (≥60 years) and female sex are associated with higher parasympathetic tone and distinct nonlinear heart rate variability patterns compared to younger and male patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Warawoot Chuangchai; Wiraporn Pothisiri; Phumdecha Chanbenjapipu

doi:10.3390/brainsci11030380

March 17, 2021Brain SciencesOpen Access

Variation of Autonomic Nervous System Function by Age and Gender in Thai Ischemic Stroke Patients

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Why the study?

The effects of ischemic stroke on the autonomic nervous system via nonlinear heart rate variability and pulse transit time had not been well explored among Thai patients.

Does autonomic nervous system function measured by nonlinear heart rate variability and pulse transit time vary by age and sex in patients with acute ischemic stroke?

Key Points

To assess the relationship between autonomic nervous system function, age, and sex in ischemic stroke patients using nonlinear heart rate variability metrics and pulse transit time.
Enrolled 111 Thai ischemic stroke patients categorized by age (<60 years, n=41; ≥60 years, n=70) and sex (63 males, 48 females) confirmed by hospital examination including MRI.
Collected noninvasive 5-minute daytime recordings of short-term heart rate variability (HRV) parameters, Poincaré plots, and pulse transit time (PTT).
Parasympathetic tone was significantly higher in elderly patients (p = 0.030), with older patients showing higher SD1 (p = 0.024) but lower SD2 (p = 0.023) and SD2/SD1 (p = 0.014) compared to younger patients.
Female patients exhibited higher SD1 (p = 0.026) alongside lower SD2 (p = 0.023) and SD2/SD1 (p = 0.014) than male patients, matching circular and round Poincaré plot patterns.
After controlling for age and sex, parasympathetic response was positively associated with SD1 (r = 0.47, p < 0.001) and PTT (r = 0.29, p = 0.002), and negatively associated with SD2 and SD2/SD1 (r = −0.47, p < 0.001).

Study Design

Type

Cross-Sectional (n=111)

Multicenter

No

Structured PICO

Does autonomic nervous system function measured by nonlinear heart rate variability and pulse transit time vary by age and sex in patients with acute ischemic stroke?

P

Population

111 Thai adults (mean age 61.57 years, 43.2% female) admitted with acute first-ever ischemic stroke and early mobilization within 24 hours, free of valvular heart disease or atrial fibrillation, assessed via 5-minute resting ECG and PPG recordings.

E

Exposure

Short-term (5-minute) resting lead II ECG and fingertip photoplethysmography (PPG) assessment of nonlinear heart rate variability (HRV) and pulse transit time (PTT), stratified by age (≥60 vs <60 years) and sex

C

Comparator

Younger patients (<60 years, n=41) and male patients (n=63)

O

Outcome

Autonomic nervous system (ANS) function (parasympathetic [PNS] and sympathetic [SNS] indices) and its association with nonlinear HRV parameters (SD1, SD2, SD2/SD1, Poincaré plots) and pulse transit time (PTT) during the acute phase of ischemic strokesurrogate

Main Result

Effect estimate: r = 0.47 for PNS with SD1; r = -0.47 for PNS with SD2 and SD2/SD1

p-value: p=<0.001

In Thai patients with acute ischemic stroke, older age (≥60 years) and female sex are associated with predominant parasympathetic modulation as reflected by nonlinear HRV parameters (SD1, SD2, SD2/SD1, Poincaré plots) and pulse transit time.

Limitations

HRV was performed using short-term recordings of 5 minutes rather than the preferred 15-30 minutes or 24-hour recordings.
HRV data represent daytime (6 to 7 am) and may not reflect 24-hour autonomic nervous system activities.
Assessment of cognitive performance was not possible and there was a high level of missing data on NIHSS scores.
Patients with diabetes, sleep apnea, and use of cardio-selective drugs were not excluded.
Personal and lifestyle information such as smoking status, exercise patterns, occupation, or working hours was not collected.
Lack of a non-stroke control group.
Short-term HRV recordings of 5 minutes instead of 15-30 minutes or 24-hour Holter monitoring
Daytime-only recordings (6-7 am) may not reflect 24-hour ANS activity
Lack of cognitive performance assessment and high missingness of NIHSS scores
Did not exclude patients with diabetes, sleep apnea, or cardio-selective drug use
Did not collect lifestyle or sociodemographic factors (smoking, exercise, occupation)
No healthy control group for comparison

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Implication

May warrant age- and sex-adjusted HRV/PTT norms in acute ischemic stroke; hypothesis-generating for outcomes.

Abstract

Background: Ischemic stroke is one of the major causes of disability and mortality. Its effects on the autonomic nervous system (ANS) through nonlinear heart rate variability (HRV) and pulse transit time (PTT) have not been well explored among Thai patients. Objective: This study aims to demonstrate the association between ANS and ischemic stroke through nonlinear HRV and PTT. Methods: In total, 111 patients were enrolled in the study and their short-term HRV and PTT data were collected. Results: Parasympathetic tone was higher in elderly patients (≥60 years). The elderly patients had a higher SD1 but lower SD2 and SD2/SD1 than the younger patients, and a similar pattern was found in the female patients compared to the male patients. These findings were supported by the results of the Poincaré plots. Older and female patients had circular plots and approximately round plots, respectively. Moreover, the parasympathetic nervous system (PNS) response was moderate and positively associated with SD1 (r = 0.47, p < 0.001) and PTT (r = 0.29, p = 0.002), and negatively associated with SD2 and SD2/SD1 (r = −0.47, p < 0.001), after controlling for age and sex. Conclusions: The PNS response was predominant in older and female patients whereas the sympathetic response was lower than in the younger and male patients, which reflected certain characteristics of ANS response to ischemic stroke. Moreover, nonlinear parameters of SD1, SD2, SD2/SD1, and Poincaré plots including PTT are useful and recommended in investigating ANS, particularly in PNS, among ischemic stroke patients.

Discussion

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Cite This Study

Chuangchai et al. (2021) conducted a cross-sectional in Ischemic stroke (n=111). Older age (≥60 years) and female sex vs. Younger age (<60 years) and male sex was evaluated on Autonomic nervous system modulation assessed via nonlinear heart rate variability parameters (SD1, SD2, SD2/SD1) and pulse transit time (PTT) (r = 0.47 for PNS with SD1; r = -0.47 for PNS with SD2 and SD2/SD1, p=<0.001).

synapsesocial.com/papers/6a71c232febe604dd70a44b9 https://doi.org/10.3390/brainsci11030380

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Variation of Autonomic Nervous System Function by Age and Gender in Thai Ischemic Stroke Patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Variation of Autonomic Nervous System Function by Age and Gender in Thai Ischemic Stroke Patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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