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1 Hebrew Rehabilitation Center for Aged Research and Training Institute, 2 Beth Israel/Deaconess Medical Center Department of Medicine, and 3 Harvard Medical School, Boston, Massachusetts 02131; and 4 Bikur Cholim Hospital, Jerusalem, 91004 Israel
Received 16 December 1996; accepted in final form 31 March 1997.
Lipsitz, Lewis A., Raymond Morin, Margaret Gagnon, Dan
Kiely, and Aharon Medina. Vasomotor instability preceding
tilt-induced syncope: does respiration play a role? J. Appl. Physiol. 83(2): 383-390, 1997.
This study
aimed to determine whether alterations in cardiovascular dynamics
before syncope are related to changes in spontaneous respiration.
Fifty-two healthy subjects underwent continuous heart rate (HR),
arterial blood pressure (BP), and respiratory measurements during
10-min periods of spontaneous and paced breathing (0.25 Hz) in the
supine and 60° head-up tilt positions. Data were evaluated by power
spectrum and transfer function analyses. During tilt, 27 subjects
developed syncope or presyncope and 25 remained asymptomatic. Subjects
with tilt-induced syncope had significantly greater increases in
low-frequency (0.04-0.15 Hz) systolic BP, diastolic BP, and HR
power during tilt than the asymptomatic subjects
(P 
0.01). This difference was
present during spontaneous but not paced breathing. However, average
tidal volume, respiratory rate, minute ventilation, proportion of
breaths below 0.15 Hz, and low-frequency respiratory power during tilt did not differ between syncopal and nonsyncopal subjects. Transfer magnitudes between low-frequency respiration and BP, and between BP and
interbeat interval, were also similar between groups. Thus vasomotor
instability before syncope is not related to alterations in respiration
or the cardiovagal baroreflex but may reflect oscillating central
sympathetic outflow to the vasculature.
Mayer waves; power spectral analysis; neurally mediated; arterial pressure; heart rate; variability; dynamics
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