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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(09): 766-773
DOI: 10.1590/0004-282X-ANP-2020-0458
Article

Autonomic modulation at rest and in response to postural change in adolescents with Duchenne muscular dystrophy: a cross-sectional study

Modulação autonômica em repouso e em resposta a mudanças posturais em adolescentes com distrofia muscular de Duchenne: um estudo transversal
Mariana Viana Rodrigues 
1   Universidade Estadual Paulista, Faculdade de Ciências e Tecnologia, Presidente Prudente SP, Brazil.
,
Mileide Cristina Stoco-Oliveira 
1   Universidade Estadual Paulista, Faculdade de Ciências e Tecnologia, Presidente Prudente SP, Brazil.
,
Talita Dias da Silva 
2   Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil.
,
Celso Ferreira 
2   Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil.
,
Heloisa Balotari Valente 
1   Universidade Estadual Paulista, Faculdade de Ciências e Tecnologia, Presidente Prudente SP, Brazil.
,
Laís Manata Vanzella 
1   Universidade Estadual Paulista, Faculdade de Ciências e Tecnologia, Presidente Prudente SP, Brazil.
,
Luiz Carlos Marques Vanderlei 
1   Universidade Estadual Paulista, Faculdade de Ciências e Tecnologia, Presidente Prudente SP, Brazil.
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ABSTRACT

Background: Analysis of autonomic modulation after postural change may inform the prognosis and guide treatment in different populations. However, this has been insufficiently explored among adolescents with Duchenne muscular dystrophy (DMD). Objective: To investigate autonomic modulation at rest and in response to an active sitting test (AST) among adolescents with DMD. Methods: Fifty-nine adolescents were included in the study and divided into two groups: 1) DMD group: adolescents diagnosed with DMD; 2) control group (CG): healthy adolescents. Participants’ weight and height were assessed. Lower limb function, motor limitations and functional abilities of the participants in the DMD group were classified using the Vignos scale, Egen classification and motor function measurement, respectively. The following variables were assessed before, during and after AST: systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (f), oxygen saturation and heart rate (HR). To analyze the autonomic modulation, the HR was recorded beat-by-beat. Heart rate variability (HRV) indices were calculated in the time and frequency domains. Results: Differences in relation to groups were observed for all HRV indices, except LF/HF, oxygen saturation, HR and f (p < 0.05). Differences in relation to time and the interaction effect between group and time were observed for RMSSD, SD1, SD2, SD1/SD2, LFms2 and LFnu, HFun, SBP and DBP (p < 0.05). Differences in relation to time were also observed for the indice SDNN, FC and f (p < 0.05). Conclusions: Performing the AST promoted reduced autonomic modulation and increased SBP, DBP and HR in adolescents with DMD.

Resumo

Antecedentes: A análise da modulação autonômica após mudanças posturais pode gerar informações prognósticas e orientar o tratamento em diferentes populações. Porém, isso não foi suficientemente explorado em adolescentes com DMD. Objetivo: Investigar a modulação autonômica em repouso e em resposta ao teste ativo sentado (TAS) em adolescentes com DMD. Métodos: 59 adolescentes foram incluídos no estudo e divididos em dois grupos: 1) Grupo DMD: adolescentes com diagnóstico de DMD; 2) Grupo controle: adolescentes saudáveis. O peso e a altura dos participantes foram avaliados. No grupo DMD, a funcionalidade de membros superiores, limitações motoras, e habilidades funcionais foram classificadas pela escala de Vignos, Egen Klassification, e motor function measure respectivamente. Pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), frequência respiratória (f), saturação de oxigênio, e frequência cardíaca (FC) foram avaliadas em repouso, durante e após o TAS. Para analisar a modulação autonômica, a FC foi registrada batimento a batimento. Os índices de variabilidade da frequência cardíaca (VFC) foram calculados nos domínios do tempo e da frequência. Resultados: Diferenças entre os grupos foram observadas para todos os índices da VFC, exceto LF/HF, saturação de oxigênio, FC e f (p<0,05). Diferenças em relação ao tempo e interação entre grupo e tempo foram observadas para RMSSD, SD1, SD2, SD1/SD2, LFms2, LFun, HFnu, SBP e DBP (p<0,05). Diferenças em relação ao tempo foram também observadas para o índice SDNN, FC e f (p<0,05). Conclusões: A realização do TAS promoveu redução da modulação autonômica e aumento da PAS, PAD e FC em adolescentes com DMD.

Keywords:

Muscular Dystrophy, Duchenne - Heart Rate - Autonomic Nervous System Diseases - Posture

Palavras-chave:

Distrofia Muscular de Duchenne - Frequência Cardíaca - Doenças do Sistema Nervoso Autônomo - Postura

Authors’ contributions:

All authors contributed to the conception, design and data curation, commented on previous versions of the manuscript, read and approved the final version of this manuscript; MVR, MCSO, HBV: contributed to data collection and methodology; LMV, CF, LCM: contributed to the methodology; LMV, TDS: analysis and interpretation of data; MVR: white the manuscript; LCM: contributed to the investigation, project administration and supervision of the study.




Publication History

Received: 26 September 2020

Accepted: 06 January 2021

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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