Cardiac autonomic neuropathy in fibromyalgia: Revisited.

Journal of Back and Musculoskeletal Rehabilitation
Poorvi KulshreshthaDidhiti Mukherjee

Abstract

Fibromyalgia (FM) is associated with widespread autonomic dysfunction where sympathetic predominance explains associated complaints such as widespread pain, sleep disorders and anxiety. Recent studies indicate a possible neurovascular autonomic interaction in the pathogenesis of FM. Our study paradigm included a modified Ewing's battery of autonomic function tests to find the cardiac autonomic neuropathy (CAN) in FM patients. The battery comprises some tests such as the Valsalva maneuver, which are effort-dependent, so we also aimed to identify a potential simplified test out of the whole battery as an index marker of CAN in FM patients. Forty-two female patients with FM were included in this study and were administered sympathetic and parasympathetic reactivity tests to explore the presence of CAN. We compared the results from each sympathetic and parasympathetic reactivity test against CAN. Delta heart rate in the deep breathing test was significantly different in patients with and without CAN. Delta heart rate also exhibited best diagnostic performance (AUC = 0.769, 95% CI: 0.619-0.920, p< 0.001), with 88% sensitivity, 64% specificity, and 89% negative predictive value (NPV). The 30: 15 ratio during the lying to standing tes...Continue Reading

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