Debnath Shubham, Levy Todd J, Bellehsen Mayer, Schwartz Rebecca M, Barnaby Douglas P, Zanos Stavros, Volpe Bruce T, Zanos Theodoros P
Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA.
Bioelectron Med. 2021 Aug 27;7(1):13. doi: 10.1186/s42234-021-00075-7.
The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses.
Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population.
A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions.
These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation.
This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
自主神经系统（ANS）通过副交感神经和交感神经分支维持各器官系统的生理稳态。在常见的弥漫性和局灶性病症中，ANS功能会发生改变，并预示着环境和疾病应激的开始。首先在健康参与者中定义的可靠、敏感且定量的生物标志物，可以区分ANS功能临床上有用的变化。该框架将受控自主测试与生理反应期间的特征提取相结合。
在两周内，对21名个体进行了两次上午和两次下午的测试。每次测试包括五项探测自主神经功能的标准临床测试：深蹲试验、冷加压试验、潜水反射试验、深呼吸和瓦尔萨尔瓦动作。无创传感器记录连续的心电图、血压、呼吸、皮肤电活动和瞳孔直径。提取心率、心率变异性、平均动脉压、皮肤电活动和瞳孔直径对这些刺激的反应，并计算参与者的平均值。一种模板匹配算法计算缩放和拉伸特征，使平均值与个体反应达到最佳拟合。根据测试和模式对这些特征进行分组，以得出该健康人群的交感神经和副交感神经指数。
交感神经振幅反应与体重指数之间存在显著正相关（p = 0.000377）。此外，下午测试时段出现交感神经反应的持续时间更长、幅度更大，副交感神经反应的持续时间也更长；上午时段出现副交感神经反应的幅度更大。
这些结果证明了一种算法方法从标准测试中提取多模式反应的稳健性和敏感性。这种量化ANS功能的新方法可用于早期诊断、疾病进展测量或治疗评估。
本研究已在Clinicaltrials.gov注册，标识符为NCT04100486。于2019年9月24日注册，https://www.clinicaltrials.gov/ct2/show/NCT04100486 。
