Time- and Frequency-domain Parameters of Heart Rate Variability and Blood Pressure in Parkinson’s disease Patients under Dry Immersion
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1
Petrozavodsk State University, Russia
“Dry” immersion (DI) is used as ground-based analogue of microgravity since it mimics some spaceflight features, such as supportlessness, centralization of body fluids, confinement, immobilization, and hypokinesia (Navasiolava et al., 2011; Watenpaugh, 2016). Besides merely space applications, DI is ever more extensively used in health care. In our earlier study, DI program exerted notable rehabilitation effect in Parkinson’s disease (PD) patients (Meigal et al, 2018). Adaptation of hemodynamics to microgravity is rather complex and its mechanisms are not completely understood. DI is known to strongly affect body fluid distribution and circulation (Watenpaugh, 2016). Though DI less markedly effects on hemodynamics in comparison to other ground-based spaceflight simulations, in older adults or/and patients with chronic diseases one should carefully monitor circulation during DI to prevent its side effects, such as acute hypotension and orthostatic intolerance.
This study was focused on the evaluation of cardiovascular reactions of PD patients during DI using time- and frequency-domain characteristics of heart rate variability (HRV).
Eighteen PD patients (11 m, 7 f) aged 49-66 years, H&Y staged 1-3 volunteered to pass through DI program. Ten young healthy controls (HC, 6 m, 4 f) aged 19-26 years formed the reference group. During DI procedure, subjects were immersed in head-out supine position in thermo-neutral water for 45 min (Meigal A et al, 2018). Blood pressure (BP), heart rate (HR) and ECG in the standard lead II were monitored at rest (after the subject was lying for 15 min before DI procedure), on the 15th, 30th and 40th min of DI. HRV was analyzed on 5-min ECG–samples from subjects without arrhythmias. Intra-group differences were estimated by non-parametric criteria.
The investigated groups had slightly different BP and HR before DI. In HC group systolic and diastolic BP were 101-122 and 56-64 mm Hg, respectively, HR was 58-72 min-1. In PD patients systolic and diastolic BP were 111-132 and 73-82 mm Hg, respectively, HR was 65-79 min-1. During DI in PD patients we observed the decrease of diastolic BP to 62-73 mm Hg (p=0,003), and HR to 60-65 min-1 (p=0,006) in average while in HC these parameters did not significantly change.
Time- and frequency-domain HRV characteristics are presented on figures 1 and 2. In HC group, at rest condition, before DI, the autonomic regulation was characterized by marked variability of HR and prevalence of parasympathetic activity seen as high values of time-domain (SDNN - 39-101 ms, pNN50 - 28-60 %) and frequency-domain (TP 1540-9730 ms2, HF=46%, LF=25%, VLF=29%) parameters of HRV. DI in HC caused notable autonomic response, both parasympathetic and sympathetic. On the 30-40th min of DI we observed the increase of time-domain (SDNN - 58-132 ms, pNN50 - 43-74), and frequency-domain (TP - 2710-13560 ms2, HF=44%, LF=30%, VLF=26%) parameters of HRV. Stress index (SI) before DI was 15-140, and after DI - 10-71.
By contrast, PD patients before DI had low variability of HR (SDNN 17-30 ms2, pNN50 0-1 %), lower TP (310-1200 ms2), HF (36%), LF (25%), and higher VLF (39%). These time- and frequency-domain HRV characteristics correspond with finding that the affection of the autonomic nervous system in PD can be detected at early stages of PD and did not substantially change with disease duration (Maetzler et al., 2015). During DI in this group we observed the increase of time-domain (SDNN -36-58 ms, pNN50 - 1,7-6,6 %) parameters of HRV in respect with the rest condition (p<0,01) as well as frequency-domain (TP - 1010-2160 ms2) parameters of HRV, while the proportion of spectral bands shifted in the direction of lower frequencies (HF=26%, LF=28%, VLF=46%). SI before DI was 236-575, and after DI - 48-167. Thus, during DI parameters of HRV in PD patients tended to converge with the ones of HC group. In both groups, presented HRV parameters before and during DI proved significantly different.
In conclusion, time- and frequency-domain HRV parameters in PD patients, both before and during DI, can be explained by the deficiency of neurogenic (HF, LF) and prevalence of metabolic (VLF) factors in the control of hemodynamics. The tendency of HRV-parameters of PD patients under DI to shift in the direction of HC are in line with our earlier results on the temporary improvement of some motor symptoms and depression signs in PD after the DI program (Meigal et al, 2018). Nonetheless, one should consider the limited adaptation of cardiovascular system in PD patients because of autonomic dysfunction and to carefully monitor BP, ECG and to strictly follow the inclusion criteria in respect with DI. Funding
This study was financially supported by Russian Fund for Basic Research (project 16-07-01289) and by the Ministry of Education and Science of the Russian Federation (project 17.7302.2017/6.7).
References
Maetzler W, Karam M, Berger MF, Heger T, Maetzler C, Ruediger H, et al. (2015). Time- and frequency-domain parameters of heart rate variability and sympathetic skin response in Parkinson's disease. J Neural Transm. 122, 419-422.
Meigal A.Y., Gerasimova-Meigal L.I., Sayenko I.V., Subbotina N.S. (2018). Dry immersion as a novel physical therapeutic intervention for rehabilitation of Parkinson’s disease patients: A feasibility study. Phys. Med. Rehab. Kuror. (in press). DOI: 10.1055/a-0577-5139
Navasiolava N.M, Custaud M.A, Tomilovskaya E.S., Larina I.M., Mano T., Gauquelin-Koch G., et al. (2011). Long-term dry immersion: review and prospects. Eur. J. Appl. Physiol. 111, 1235–1260 Watenpaugh D. E. (2016). Analogs of microgravity: Head-down tilt and water immersion. J. of Appl. Physiol. 120, 904–914.
Keywords:
dry immersion,
Parkinsion's disease (PD),
heart rate variability,
Blood pressure,
heart rate (HR)
Conference:
39th ISGP Meeting & ESA Life Sciences Meeting, Noordwijk, Netherlands, 18 Jun - 22 Jun, 2018.
Presentation Type:
Extended abstract
Topic:
Cardiovascular, Fluid Shift and Respiration
Citation:
Gerasimova-Meigal
L and
Meigal
A
(2019). Time- and Frequency-domain Parameters of Heart Rate Variability and Blood Pressure in Parkinson’s disease Patients under Dry Immersion.
Front. Physiol.
Conference Abstract:
39th ISGP Meeting & ESA Life Sciences Meeting.
doi: 10.3389/conf.fphys.2018.26.00011
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Received:
02 Dec 2018;
Published Online:
16 Jan 2019.
*
Correspondence:
Prof. Liudmila Gerasimova-Meigal, Petrozavodsk State University, Petrozavodsk, Russia, gerasimova@petrsu.ru