Furman J M, Jacob R G, Redfern M S
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
J Vestib Res. 1998 Jan-Feb;8(1):27-34.
The vestibular system, including both the peripheral vestibular system, that is, the labyrinth, and the central vestibular system, is known to influence autonomic function in several ways that have clinical implications. This paper discusses evidence for vestibular influences on autonomic control from normal human subjects, evidence for vestibular influences on autonomic control from patients, clinical implications of vestibulo-autonomic regulation, and speculations regarding possible clinical implications of vestibulo-autonomic control. Situations that provoke vestibular-induced autonomic responses in normal subjects include vestibular laboratory testing, vehicular motion, simulators, and, possibly, exposure to microgravity. Patients with peripheral and central vestibular abnormalities manifest both symptoms and signs of autonomic dysfunction presumably via vestibulo-autonomic connections. Vestibulo-autonomic regulation impacts vestibular diagnostic testing, clinical diagnosis of balance disorders, and treatment of balance disorders. In addition to well-recognized peripheral and central vestibular disorders, anxiety disorders have recently been linked to vestibular dysfunction in a subset of patients. In particular, vestibular dysfunction has been linked to panic disorder and agoraphobia. Vestibular-autonomic connections may form a basis for an association between vestibular dysfunction and panic attacks. The importance of vestibulo-autonomic regulation in the clinical arena is not fully known. Two speculative areas discussed in this paper include vestibular-induced orthostatic intolerance and the role of vestibular-respiratory pathways on sleep apnea.
前庭系统，包括外周前庭系统（即内耳迷路）和中枢前庭系统，已知其可通过多种具有临床意义的方式影响自主神经功能。本文讨论了正常人类受试者前庭对自主神经控制影响的证据、患者前庭对自主神经控制影响的证据、前庭 - 自主神经调节的临床意义，以及关于前庭 - 自主神经控制可能的临床意义的推测。在正常受试者中引发前庭诱导自主神经反应的情况包括前庭实验室测试、车辆运动、模拟器，以及可能的微重力暴露。外周和中枢前庭异常的患者可能通过前庭 - 自主神经连接表现出自主神经功能障碍的症状和体征。前庭 - 自主神经调节影响前庭诊断测试、平衡障碍的临床诊断以及平衡障碍的治疗。除了公认的外周和中枢前庭疾病外，焦虑症最近在一部分患者中与前庭功能障碍有关。特别是，前庭功能障碍与惊恐障碍和广场恐惧症有关。前庭 - 自主神经连接可能构成前庭功能障碍与惊恐发作之间关联的基础。前庭 - 自主神经调节在临床领域的重要性尚未完全明确。本文讨论的两个推测领域包括前庭诱导的直立性不耐受以及前庭 - 呼吸途径在睡眠呼吸暂停中的作用。
