Cardiovascular Autonomic Response to Orthostatic Stress Under Hypoxia in Patients with Spinal Cord Injury

Huang, Shu-Chun, Kuo-Cheng Liu, Alice M.K. Wong, Shih-Chieh Chang, and Jong-Shyan Wang. Cardiovascular autonomic response to orthostatic stress under hypoxia in patients with spinal cord injury. High Alt Med Biol. 00:000-000, 2018. Aims: Determining whether systemic hypoxia aggravates the severity of autonomic cardiovascular dysfunction in orthostatic stress among patients with spinal cord injuries (SCIs). Methods: Twenty-four male patients with chronic SCI whose neurological levels were above T6 were recruited. Twenty-five healthy men were enrolled in the control group. Five-minute supine rest (SR) and head-up tilt (HUT) at 60 degrees were performed in normoxia and after 1 hour, 13.5% fraction of inspired O-2 exposure. A noninvasive cardiac output (CO) monitor was used to measure stroke volume (SV), CO, total peripheral resistance (TPR), and blood pressure (BP), whereas heart rate variability (HRV) was performed to determine cardiac autonomic activity. Digital volume pulse analysis was applied to measure arteriolar tone. Results: In normoxia from SR to HUT, systolic and diastolic BPs declined, SV decreased, and heart rate increased, whereas CO and TPR showed a declining trend in the SCI group. Sympathetic activation and vagal withdrawal were also disclosed in the HRV analysis. In hypoxia, the change of these cardiovascular responses from SR to HUT exhibited no difference to normoxia in the SCI group. No significant difference in arterial desaturation was observed between the two groups (82.9% vs. 80.4%). Conclusions: Cardiovascular adaptation to orthostatic stress is not affected by subacute steady-state hypoxia in chronic SCI patients with neurological levels higher than T6.