Key result
Delta heart rate during deep breathing detects cardiac autonomic neuropathy in fibromyalgia with ~0.77 AUC.
Why the study?
Fibromyalgia is associated with widespread autonomic dysfunction and sympathetic predominance, but the identification of a simplified test for cardiac autonomic neuropathy in FM patients was needed.
Does the delta heart rate during a deep breathing test accurately identify cardiac autonomic neuropathy in female patients with fibromyalgia?
Cross-Sectional (n=42)
Does the delta heart rate during a deep breathing test accurately identify cardiac autonomic neuropathy in female patients with fibromyalgia?
Delta heart rate during deep breathing provides high sensitivity and negative predictive value for excluding cardiac autonomic neuropathy in women with fibromyalgia.
Answers are grounded in this paper and cite their sources.
Supports potential utility of deep breathing test for ruling out CAN in fibromyalgia; leaves open prospective validation before clinical adoption.
BACKGROUND: Fibromyalgia (FM) is associated with widespread autonomic dysfunction where sympathetic predominance explains associated complaints such as widespread pain, sleep disorders and anxiety. Recent studies indicate a possible neurovascular autonomic interaction in the pathogenesis of FM. OBJECTIVE: Our study paradigm included a modified Ewing's battery of autonomic function tests to find the cardiac autonomic neuropathy (CAN) in FM patients. The battery comprises some tests such as the Valsalva maneuver, which are effort-dependent, so we also aimed to identify a potential simplified test out of the whole battery as an index marker of CAN in FM patients. METHODS: Forty-two female patients with FM were included in this study and were administered sympathetic and parasympathetic reactivity tests to explore the presence of CAN. We compared the results from each sympathetic and parasympathetic reactivity test against CAN. RESULTS: Delta heart rate in the deep breathing test was significantly different in patients with and without CAN. Delta heart rate also exhibited best diagnostic performance (AUC = 0.769, 95% CI: 0.619-0.920, p< 0.001), with 88% sensitivity, 64% specificity, and 89% negative predictive value (NPV). The 30: 15 ratio during the lying to standing test also emerged as a suitable index; however it did not show any difference between CAN and non-CAN patients. CONCLUSION: The delta heart rate has the best diagnostic accuracy, primarily in CAN's exclusion by its very high sensitivity and NPV.
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A 2021 study conducted a cross-sectional in Fibromyalgia (n=42). Delta heart rate in the deep breathing test was evaluated on Diagnostic performance for cardiac autonomic neuropathy (AUC 0.769, 95% CI 0.619-0.920, p=< 0.001). Delta heart rate in the deep breathing test exhibited strong diagnostic performance for cardiac autonomic neuropathy in fibromyalgia patients (AUC 0.769; 95% CI 0.619-0.920; p<0.001).
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