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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Physiol. | doi: 10.3389/fphys.2019.01104

Autonomic abnormalities in patients with primary Sjogren’s syndrome – preliminary results

Enrico Brunetta1,  Dana Shiffer1,  Pietro Mandelli2,  Sara Achenza1, Marco Folci1, Aurora Zumbo1, Maura Minonzio1,  Beatrice Cairo3,  Giris Jacob4, Laura Boccassini5, Piercarlo Sarzi Puttini5,  Alberto Porta3, 6 and  Raffaello Furlan1, 7*
  • 1Humanitas Clinical and Research Center, Milan University, Italy
  • 2Department of Pathophysiology and Transplantation, Faculty of Medicine and Surgery, University of Milan, Italy
  • 3Department of Biomedical Sciences For Health, Faculty of Medicine and Surgery, University of Milan, Italy
  • 4Tel Aviv Sourasky Medical Center, Israel
  • 5Luigi Sacco Hospital, Italy
  • 6Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, San Donato Polyclinic (IRCCS), Italy
  • 7Department of Biomedical Sciences, Humanitas University, Italy

Primary Sjögren's syndrome (pSS) is an autoimmune disease affecting exocrine glands and extra-glandular organs. There are conflicting reports on the presence of autonomic dysfunction in pSS and no data are available on the functional status of sympathetic outflow to the vessels and baroreceptor (BRS) control mechanisms. We investigated the cardiac (cBRS) and sympathetic (sBRS) baroreceptor modulation in both time and frequency domains and the cardiovascular autonomic profile in pSS patients compared to healthy controls. Autonomic symptoms were quantified by the COMPASS31 3-item questionnaire. The ESSPRI questionnaire evaluated the magnitude of pSS clinical symptoms, i.e. fatigue, pain and sicca symptoms.
ECG, beat-by-beat arterial pressure and respiratory activity were continuously recorded in 17 pSS patients and 16 healthy controls, while supine and during 75° head-up tilt. In 7 patients and 7 controls, muscle sympathetic nerve activity (MSNA) was measured. Spectrum analysis of RR variability provided markers of cardiac vagal modulation (HFRR n.u.) and sympatho-vagal balance (LF/HF). The power of low frequency (LF,0.1Hz) oscillations of systolic arterial pressure (SAP) variability (LFSAP) evaluated the vasomotor response to sympathetic stimulation.
Compared to controls, pSS patients scored higher in total COMPASS31 (p<0.0001) and all ESSPRI subdomains (fatigue, p=0.005; pain, p=0.0057; dryness, p<0.0001). Abnormal scialometry (<1.5 ml/15 min) and Shirmer tests (< 5 mm/5 min) were found in pSS patients and salivary flow rate was negatively associated with ESSPRI dryness (p=0.0014). While supine, pSS patients had lower SEQcBRS index of cardiac baroreceptor sensitivity, higher HFRR nu (p=0.021), lower LF/HF (p=0.007) and greater MSNA (p=0.038) than controls. No differences were observed in LFSAP between groups. During orthostatic challenge, although LFSAP increased similarly in both groups, MSNA was greater in pSS patients (p=0.003).
At rest pSS patients showed lower cardiac baroreflex control and greater parasympathetic modulation. Furthermore, greater sympathetic nerve activity was observed in pSS patients while supine and in response to gravitational challenge. We hypothesized that such enhanced sympathetic vasoconstrictor activity might reflect an attempt to maintain blood pressure in a setting of likely reduced vascular responsiveness.

Keywords: primary Sjogren’s syndrome, Baroreceptor activity, power spectrum analysis, Heart rate variability, muscle sympathetic nerve activity

Received: 10 Jan 2019; Accepted: 08 Aug 2019.

Copyright: © 2019 Brunetta, Shiffer, Mandelli, Achenza, Folci, Zumbo, Minonzio, Cairo, Jacob, Boccassini, Sarzi Puttini, Porta and Furlan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Raffaello Furlan, Humanitas Clinical and Research Center, Milan University, Rozzano, Italy,