Key result
MS patients display attenuated BP and autonomic responses during orthostatic challenge compared to healthy controls.
Why the study?
The relationship between daytime sleepiness, fatigue, and autonomic hemodynamic responses during head-up tilt test in multiple sclerosis patients was unclear.
Do multiple sclerosis patients exhibit altered hemodynamic and autonomic responses during a head-up tilt test compared to healthy controls, and are these associated with fatigue and sleepiness?
Observational (n=88)
Do multiple sclerosis patients exhibit altered hemodynamic and autonomic responses during a head-up tilt test compared to healthy controls, and are these associated with fatigue and sleepiness?
p-value: p=0.021
Multiple sclerosis patients exhibit blunted autonomic and hemodynamic responses to orthostatic stress, which correlate with subjective symptoms of fatigue and daytime sleepiness.
Attenuated orthostatic responses in MS correlate with fatigue; hypothesis-generating and should not yet change practice.
We aimed to assess dynamic changes in hemodynamic and autonomic function in response to the head-up tilt test (HUTT) in patients with multiple sclerosis (MS) compared to healthy controls (HCs) and evaluate its relationship with the patients’ reported daytime sleepiness and fatigue symptoms. A total of 58 MS patients and 30 HCs were included in the analysis. Fatigue and sleepiness were evaluated using the Chalder Fatigue Scale (CFQ) and the Epworth Sleepiness Scale (ESS), respectively. Hemodynamic response, baroreflex sensitivity, heart rate variability, and systolic and diastolic blood pressure (BP) variability (SBPV, DBPV) parameters were calculated at rest, and in response to the HUTT. The MS patients displayed attenuated BP responses coupled with a more pronounced decrease in cardiac index as well as a reduced increase in the low frequency (LFnu) of DBPV (p = 0.021) and the sympathovagal ratio (p = 0.031) in the latter-phase orthostatic challenge compared to HCs. In MS patients, the ESS score showed no correlation with CFQ or clinical disease outcomes, but exhibited a moderate correlation with LFnu of BPVrest. Fatigue and disease variants predicted blood pressure response to HUTT. These findings underscore the importance of subjective daytime sleepiness and fatigue symptoms and their role in blood pressure regulation in MS patients.
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Zawadka‐Kunikowska et al. (2023) conducted an observational in Multiple Sclerosis (n=88). Multiple sclerosis vs. Healthy controls was evaluated on Hemodynamic and autonomic function in response to the head-up tilt test (p=0.021). MS patients displayed attenuated blood pressure responses and reduced increases in LFnu of DBPV (p=0.021) and sympathovagal ratio (p=0.031) during orthostatic challenge compared to healthy controls.
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