Optimizing Autonomic Function Analysis via Heart Rate Variability Associated With Motor Activity of the Human Colon

M Khawar Ali, Lijun Liu, Ji-Hong Chen, Jan D Huizinga, M Khawar Ali, Lijun Liu, Ji-Hong Chen, Jan D Huizinga

Abstract

The parameters of heart rate variability (HRV) can non-invasively assess some autonomic activities, and HRV is influenced by many bodily actions. Although parasympathetic activity is the primary driver of colonic propulsive activity, and sympathetic activity a major inhibitor of colonic motility, they are rarely measured and almost play no role in diagnosis of colon motor dysfunction or in standard treatments. Here we set out to optimize HRV analysis of autonomic nervous system changes related to human colon motility. The electrocardiogram and impedance were recorded in synchrony with colonic motor patterns by high-resolution manometry. Respiratory sinus arrhythmia (RSA), root mean square of successive differences of beat-to-beat intervals (RMSSD), the Baevsky Index or Sympathetic Index (SI), and the ratios of SI/RSA and SI/RMSSD were shown to indicate a marked increase in parasympathetic and withdrawal of sympathetic activity during the high-amplitude propagating pressure waves (HAPWs). Strong associations were seen with HAPWs evoked by a meal and rectal bisacodyl indicating a marked increase in parasympathetic and withdrawal of sympathetic activity during the gastrocolic reflex and the defecation reflex. When HAPWs occurred in quick succession, parasympathetic activation (RSA and RMSSD) occurred in a rhythmic fashion. Hence, during propulsive motor patterns, an overall shift in autonomic activity toward increased parasympathetic control was shown to be reflected in HRV. HRV assessment may therefore be valuable in the assessment of autonomic dysfunction related to colonic dysmotility.

Keywords: Baevsky’s Stress Index; RMSSD; RSA; autonomic nervous system; colonic motility; high-amplitude propagating pressure waves.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Ali, Liu, Chen and Huizinga.

Figures

FIGURE 1
FIGURE 1
HRV parameters associated with a single HAPW. (A) 2-min before, during, and 2-min after HAPW recorded by HRCM. (B) HF power/RSA band of HRV signal time matched with HRCM recording. (C) RMSSD time matched with HRCM. (D) SI time matched with HRCM. Distance at 0 cm is positioned at the proximal colon, distance at 80 cm is just proximal to the anal sphincter.
FIGURE 2
FIGURE 2
HRV parameters associated with two consecutive HAPWs. (A) Before-During and After a Motor Complex. (B) Time matched HF Power/RSA band of the HRV signal before-during and after MC. (C) RMSSD time matched with HRCM. (D) SI time matched with HRCM.
FIGURE 3
FIGURE 3
HRV parameters associated with a complex of multiple HAPWs (a motor complex). (A) HRCM recording with a motor complex containing long overlapping HAPWs. (B) HF power/RSA band of HRV signal. (C) RMSSD. (D) SI. (E) HF/RSA power band in 3D.
FIGURE 4
FIGURE 4
The RSA band in baseline and with HAPWs. (A) Baseline HRCM recording without any colonic motor pattern. (B) HF power/RSA band during the baseline. (C) HRCM recording with Motor Complex. (D) HF power/RSA band during the Motor Complex.

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