Comparison of Autonomic Reactions during Urodynamic Examination in Patients with Spinal Cord Injuries and Able-Bodied Subjects

• Published in: PloS one Vol. 11; no. 8; p. e0161976
• Main Authors: Huang, Yu-Hui, Chang, Hsiao-Yun, Tsai, Sen-Wei, Chou, Li-Wei, Chen, Sung-Lang, Lin, Yu-Hao
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.08.2016; Public Library of Science (PLoS)
• Subjects: Adult; Autonomic nervous system; Autonomic Nervous System - physiopathology; Biology and Life Sciences; Bladder; Blood pressure; Blood Pressure - physiology; Care and treatment; Case-Control Studies; Complications and side effects; Diagnosis; Distension; EKG; Electrocardiography; Female; Heart - physiology; Heart Rate; Hospitals; Humans; Injuries; Insertion; Male; Medical instruments; Medicine; Medicine and Health Sciences; Middle Aged; Paralysis; Paraplegia; Patients; Physical therapy; Physiological aspects; Prospective Studies; Rehabilitation; Rodents; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - physiopathology; Urinary bladder; Urodynamics; Urogenital system; Urology; Young Adult; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0161976

This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls. Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV. Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls. Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.