Biomedical subjects

A P Blaber

Publications and source records attributed to A P Blaber.

10 recordsLinked to original sources

PubMed2003

Effect of acute exposure to 3660 m altitude on orthostatic responses and tolerance.

Orthostatic reflexes were examined at 375 m and after 60 min of exposure in a hypobaric chamber at 3660 m using a 20-min 70 degrees head-up tilt (HUT) test. Mean arterial blood pressure, R wave-R wave interval (RRI), and mean cerebral blood flow velocity (MFV) were examined with coarse-graining spectral analysis. Of 14 subjects, 7 at 375 m and 12 at 3660 m were presyncopal. Immediately on arrival to high altitude, breathing frequency and MFV increased, and endtidal PCO2, RRI, RRI complexity, and the parasympathetic nervous system indicator decreased. MFV was similar in HUT at both altitudes. The sympathetic nervous system indicator increased with tilt at 3660 m, whereas parasympathetic nervous system indicator decreased with tilt at both altitudes. Multiple regression analysis of supine variables from either 375 or 3660 m and the time to presyncope at 3660 m indicated that, after 1 h of exposure, increased presyncope at altitude was the result of 1). ineffective peripheral vasoconstriction, despite increased cardiac sympathetic nervous system activity with HUT, and 2). insufficient cerebral perfusion owing to cerebral vasoconstriction as the result of hypoxic hyperventilation-induced hypocapnia.

Adaptation, Physiological↗

PubMed2001

Inspiratory CO2 increases orthostatic tolerance during repeated tilt.

INTRODUCTION: The partial pressure of end tidal CO2 (PetCO2) is known to decrease with head-up tilt. Decreases in arterial CO2 reduce cerebral blood flow (CBF) and may increase the incidence of presyncope. We measured cerebral and central cardiovascular responses to repeated tilt where: 1) PetCO2 was allowed to change with tilt (eucapnic): and 2) PetCO2 was clamped at supine levels (isocapnic). METHODS: In eight healthy subjects breath-by-breath measurements were made of ventilation (VE) and PetCO2 along with beat-by-beat measurements of blood pressure (BP), heart rate (HR) and middle cerebral artery mean flow velocities (MFV). Following 30-min in the supine position, a series of six 10-min 90 degrees head-up tilts were performed, with 30-s of supine between each. Presyncopal subjects were returned immediately to the supine position. RESULTS: Statistical comparisons were made between the supine, and the first and last minute of the first tilt. BP, HR responses were not different between the eu- and isocapnic conditions; however, by the end of the first tilt VE was significantly higher than supine. MFV and BP at brain level decreased and HR increased from supine to tilt. MFV was higher in the isocapnic compared with the eucapnic condition but decreased from the beginning to the end of the first tilt in both conditions (i.e., tilt #1: eucap. 49.4 to 46.7; isocap. 65.0 to 59.6 cm s(-1); p < 0.05) while the BP remained constant. Five subjects were presyncopal in the study. With isocapnic tilt, presyncopal time was not reduced but was extended in four of the five subjects (2.2, 5.5, 6.3 and 31 min) yet at presyncope the values for MFV, BP and HR were the same in both conditions. CONCLUSIONS: Inspiratory CO2 contributed to increased MFV at the beginning of tilt and increased orthostatic tolerance.

Adult↗

PubMed1997

Complexity of middle cerebral artery blood flow velocity: effects of tilt and autonomic failure.

We examined spectral fractal characteristics of middle cerebral artery (MCA) mean blood flow velocity (MFV) and mean arterial blood pressure adjusted to the level of the brain (MAPbrain) during graded tilt (5 min supine, -10 degrees, 10 degrees, 30 degrees, 60 degrees, -10 degrees, supine) in eight autonomic failure patients and age- and sex-matched controls. From supine to 60 degrees, patients had a larger drop in MAPbrain (62 +/- 4.7 vs. 23 +/- 4.5 mmHg, P < 0.001; means +/- SE) and MFV (16.4 +/- 3.8 vs. 7.0 +/- 2.5 cm/s, P < 0.001) than in controls. From supine to 60 degrees, there was a trend toward a decrease in the slope of the fractal component (beta) of MFV (MFV-beta) in both the patients and the controls, but only the patients had a significant decrease in MFV-beta (supine: patient = 2.21 +/- 0.18, control = 1.99 +/- 0.60; 60 degrees: patient = 1.46 +/- 0.24, control = 1.62 +/- 0.19). The beta value of MAPbrain (MAPbrain-beta; 2.19 +/- 0.05) was not significantly different between patients and controls and did not change with tilt. High and low degrees of regulatory complexity are indicated by values of beta close to 1.0 and 2.0, respectively. The increase in fractal complexity of cerebral MFV in the patients with tilt suggests an increase in the degree of autoregulation in the patients. This may be related to the drop in MAPbrain. The different response of MFV-beta compared with that of MAPbrain-beta also indicates that MFV-beta is related to the regulation of cerebral vascular resistance and not systemic blood pressure.

Adult↗

PubMed1997

Cerebrovascular and cardiovascular responses to graded tilt in patients with autonomic failure.

BACKGROUND AND PURPOSE: Patients with autonomic nervous system failure often experience symptoms of orthostatic intolerance while standing. It is not known whether these episodes are caused primarily by a reduced ability to regulate arterial blood pressure or whether changes in cerebral autoregulation may also be implicated. METHODS: Eleven patients and eight healthy age- and sex-matched control subjects were studied during a graded-tilt protocol. Changes in their steady state middle cerebral artery mean flow velocities (MFV), measured by transcranial Doppler, brain-level mean arterial blood pressures (MABPbrain), and the relationship between the two were assessed. RESULTS: Significant differences between patients and control subjects (P < .05) were found in both their MFV and MABPbrain responses to tilt. Patients' MFV dropped from 60 +/- 10.2 cm/s in the supine position to 44 +/- 14.0 cm/s at 60 degrees head-up tilt, whereas MABPbrain fell from 109 +/- 11.7 to 42 +/- 16.9 mm Hg. By comparison, controls' MFV dropped from 54 +/- 7.8 cm/s supine to 51 +/- 8.8 cm/s at 60 degrees, whereas MABPbrain went from 90 +/- 11.2 to 67 +/- 8.2 mm Hg. Linear regression showed no significant difference in the MFV-MABPbrain relationship between patients and control subjects, with slopes of 0.228 +/- 0.09 cm.s-1.mm Hg-1 for patients and 0.136 +/- 0.16 cm.s-1.mm Hg-1 for control subjects. CONCLUSIONS: The present study found significant differences between patients and control subjects in their MFV and MABPbrain responses to tilt but no difference in the autoregulatory MFV-MABPbrain relationship. These results suggest that patients' decreased orthostatic tolerance may primarily be the result of impaired blood pressure regulation rather than a deficiency in cerebral autoregulation.

Adult↗

PubMed1997

Transfer function analysis of cerebral autoregulation dynamics in autonomic failure patients.

BACKGROUND AND PURPOSE: Autonomic nervous system diseases affect systemic blood pressure regulation. Patients with autonomic nervous system diseases have consistently larger drops in blood pressure associated with standing than the normal population. Autonomic dysfunction and/or these changes in blood pressure may affect dynamic cerebral autoregulation. METHODS: Heart rate, mean blood flow velocity (MBFV) of the middle cerebral artery via transcranial Doppler ultrasound, mean arterial blood pressure adjusted to brain level (MABPbrain) via Finapres, and end tidal CO2 were measured continuously during graded tilt (after 5 minutes in supine position as baseline, -10 degrees, +10 degrees, +30 degrees, +60 degrees, -10 degrees, and supine recovery) in autonomic failure patients and their age- and sex-matched control subjects. The dynamic response of MBFV to spontaneous variations in MABPbrain was investigated by cross-spectral analysis. The transfer gain and phase relationships between MBFV and MABPbrain were determined from the final 256 beats of each 5-minute-tilt segment. The transfer gain was normalized to mean MABPbrain and MBFV and then converted to decibels (dB). RESULTS: MBFV variation (0.03 to 0.14 Hz) preceded MABPbrain by similar phase angles in patients and control subjects and in all tilt conditions (patients: 31 +/- 5 degrees; control subjects: 30 +/- 5 degrees; mean +/- SEM). Patients had a higher supine gain than control subjects (P < .05). Both patients and control subjects showed a significant decrease in gain with tilt and by 60 degrees the patients were not different from the control subjects (supine to 60 degrees: patients = 5.23 +/- 0.77 to -1.65 +/- 0.89 dB; control subjects = 1.74 +/- 0.82 to -1.80 +/- 0.62 dB). CONCLUSIONS: These data indicate an altered, yet present, autoregulatory response with autonomic failure.

Autonomic Nervous System Diseases↗

PubMed1996

Coarse graining spectral analysis of HR and BP variability in patients with autonomic failure.

We examined heart rate and blood pressure variability (HRV and BPV) during graded tilt (5 min in each position: supine, -10 degrees, 10 degrees, 30 degrees, 60 degrees, -10 degrees, supine) in autonomic failure patients and age-matched controls. Heart rate was not different between patients and controls and increased with tilt (P < 0.001). Total HRV was reduced in patients (P < 0.03). Patients had reduced low-frequency (0-0.15 Hz) HRV and BPV (P < 0.005). With tilt, low-frequency BPV increased in controls, whereas high-frequency (> 0.15 Hz) BPV increased in patients. The slope of the fractal component (beta) for HRV and BPV was not different between patients and controls. HRV-beta increased (1.5-1.9, P < 0.01) with tilt, but BPV-beta (approximately 1.8) was unaffected. Values of beta close to 1 indicate high signal regulatory complexity, and values of beta close to 2 indicate low complexity. HRV and BPV provide clear evidence of impaired sympathetic and parasympathetic autonomic nervous system response to tilt with autonomic failure. The similarity in signal complexity with reduced fractal and harmonic spectral power, in patients compared with controls, suggests unchanged cardiovascular neural input and integration with reduced output in autonomic failure.

Adult↗

PubMed1996

Cardiorespiratory interactions during fixed-pace resistive breathing.

We tested the hypothesis that the arterial baroreflex was important in the origin of respiratory sinus arrhythmia (RSA) under conditions of normal and resistive breathing. That is, mechanical effects of breathing [indicated by instantaneous lung volume (ILV)] would directly influence left ventricular stroke volume (LVSV), which in turn would influence systolic arterial blood pressure (SABP), causing variation in R-R interval through the baroreflex. Eight healthy young subjects (four men and four women) were monitored in the supine position while breathing with a fixed frequency (0.2 Hz) and tidal volume for 15 min through each of three resistances (R0, R1, and R2) producing inspiratory (-) and expiratory (+) pressures of +/- 1.6, +/- 5.4, and +/- 16.6 cmH2O, respectively. LVSV was estimated by stroke distance [(SDist); by Doppler ultrasound]. There were no differences across R0, R1, and R2 for the mean values of R-R interval, SDist, or SABP. Cross-spectral analysis showed that, at R0, each value of R-R interval, SDist, and SABP lagged ILV by approximately 80 degrees. At R1 and R2, phase was reduced from ILV to SDist and R-R interval, and the transfer magnitude for SDist (R2 only), SABP, and R-R interval increased. The transfer magnitude from SDist to SABP significantly increased as a function of resistance breathing, whereas that from SABP to R-R interval significantly decreased. There were no changes in phase relationships from SDist to SABP to R-R interval. Thus the magnitude of RSA (ILV to R-R interval) was increased, but the transfer through the arterial baroreflex (SABP to R-R interval) was reduced. Although factors other than the arterial baroreflex are probably involved in the genesis of RSA, the constant phase relationship across the levels of breathing resistance among SDist, SABP, and R-R interval suggests an important functional link caused by mechanical effects of breathing.

Adult↗

PubMed1995

Methodology of spontaneous baroreflex relationship assessed by surrogate data analysis.

We tested the hypothesis that the spontaneous beat-by-beat interactions of systolic blood pressure (SBP) and R-R interval reflected true baroreflex events rather than chance interactions. Original data sets of 1,024 heartbeats obtained in seated rest from six healthy subjects [R-R interval = 953 +/- 94 (+/- SE) ms] were compared with isospectral [generated by a windowed (inverse) Fourier transform with phase randomization] and isodistribution (data points randomly shuffled) surrogate data sets. The isospectral data set was used to test for random phase relationships, and the isodistribution data set was used for effects of white noise between SBP and R-R interval. Spontaneous baroreflex sequences were defined as three or more beats in which SBP and the R-R interval of the same (lag 0), next (lag 1), or next following (lag 2) beat changed in the same direction. The total number of baroreflex sequences in the original data was significantly greater than the surrogates (P < 0.001). In the original data, there were significantly (P < 0.001) more lag 0 than lag 1 or lag 2 baroreflex sequences. Therefore, these results indicated that spontaneous baroreflex sequences represented physiological rather than chance interactions and that baroreflex responses can occur within the same beat.

Adult↗

PubMed1995

Change in phase relationship between SBP and R-R interval during lower body negative pressure.

We have investigated the hypothesis that beat-by-beat interaction of systolic blood pressure (SBP) to R-R interval (the spontaneous baroreflex) is dependent on the length of the R-R interval. Data were collected from eight healthy men while heart rate was slow (R-R interval 1,043 +/- 34 ms) and accelerated (R-R interval 804 +/- 18 ms) by application of lower body negative pressure (LBNP greater than or equal to -40 mmHg). Time series data of SBP and R-R interval were searched for spontaneous baroreflex sequences in which R-R interval changed in the same (lag 0), next (lag 1), or next following (lag 2) beat as SBP. This phase relationship was also quantified by cross-spectral analysis. At rest, 85% of all spontaneous baroreflex sequences occurred with no lag (lag 0). With LBNP, there was a significant reduction in the number of lag 0 sequences (26%), whereas lag 1 and lag 2 sequences increased (10-26% and 5-29%, respectively). Cross-spectral phase also changed significantly from -2.3 +/- 6.3 degrees at rest to 70.5 +/- 7.4 degrees during LBNP. These data supported the hypothesis that the lag of a baroreflex event was dependent on the prevailing R-R interval.

Adult↗

PubMed1994

Effect of 28-day head-down bed rest with countermeasures on heart rate variability during LBNP.

The effect of exercise and LBNP countermeasures on the cardiovascular deconditioning response have been evaluated by the study of heart rate variability during progressive LBNP tests before, during (day 15), and after 28 d continuous 6 degrees head-down tilt bed rest. Twelve healthy men (age 27-42 years) were studied in two groups. Six were assigned to a countermeasure regime (CM) consisting of strenuous short-term resistance exercise once per day, 6 days per week from day 7 to day 28, combined with lower body negative pressure (LBNP, -28 mm Hg) for 15 min on days 16, 18, 20, and 22-28. Results were compared with data from six subjects, matched on the basis of maximum oxygen uptake, who received no countermeasures (No-CM). The main effects of bed rest were seen in reductions in RR-interval, and in total spectral power. The results of spectral analysis showed a significant reduction in an index of parasympathetic activity with a nonsignificant increase in a sympathetic indicator. The fractal component of heart rate variability was reduced also, suggesting a change in cardiovascular control mechanisms. Although there were significant differences between CM and No-CM for a number of variables, there were no bed rest by countermeasure interaction effects in the statistical analysis. These results suggested that this particular series of countermeasures was ineffective in preventing at least certain changes indicative of cardiovascular deconditioning with 28 d head-down tilt bed rest.

Adult↗