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Laboratoire de Physiologie, Faculté de Médecine, 14032 Caen cédex, France
Normand, Hervé, Olivier Etard, and Pierre Denise.
Otolithic and tonic neck receptors control of limb blood flow in humans. J. Appl. Physiol. 82(6):
1734-1738, 1997.
The aim of this study was to evaluate the role
of otolithic receptors and neck mechanoreceptors on the control of the
cardiovascular system. We measured calf (CBF) and forearm blood flow
(FBF) by strain-gauge plethysmography, mean arterial pressure (MAP),
and heart rate (HR) in 12 healthy subjects in two body positions (lying
prone and on the left side) and three head positions (reference,
flexion, and extension). When the subjects were lying prone, CBF and
FBF were lower in head flexion (5.2 ± 0.6 and 3.2 ± 0.4 ml · min
1 · 100 ml
1, respectively) than in
reference position (5.8 ± 0.4 and 3.8 ± 0.3 ml · min
1 · 100 ml
1;
P < 0.05), with no
significant difference in MAP and HR. When the subjects were lying on
the side, changing the head position from reference to flexion
significantly increased FBF (from 3.7 ± 0.2 to. 4.2 ± 0.4 ml · min
1 · 100 ml
1), MAP (from 97.2 ± 3.3 to 102.4 ± 5.8 mmHg), and HR (from 63.7 ± 1.4 to 65.9 ± 2.5 beats/min; P < 0.05). Because otolithic receptors and
neck mechanoreceptors are involved when the subjects are lying prone,
and otolithic receptors are not involved when the subjects are lying on
the side, the results suggest that otolithic and neck mechanoreceptors
exert significant influences over the cardiovascular system.
neck flexion; postural reflexes; orthostatism; peripheral
circulation
THE IMMEDIATE RESPONSE to orthostatism is a generalized
vasoconstriction by To our knowledge, there has been only one study showing a possible
influence of the otolithic system on the cardiovascular system in
humans (8). In subjects lying prone, a complete head flexion from
extension was accompanied by a decrease in limb blood flow (BF). The
change in head position relative to gravity induces not only otolithic
stimulation but also a redistribution of cephalic fluids, which, in
turn, could indirectly stimulate other receptors, e.g., via face
congestion or changes in carotid transmural pressure. However, the
cardiovascular changes observed were not the result of a stimulation of
carotid baroreceptors, cephalic congestion, or increased thoracic
pressure. Thus it was suggested that vestibular stimulation may play a
role (8). If this is the case, the fact that the response was long
lasting precludes a role of semicircular canals, leaving only the
otolithic receptors as possible sensors.
Lower body negative pressure (LBNP) and head-up tilt induce a
deactivation of the cardiopulmonary baroreceptors, which, in turn,
increases sympathetic activity. However, whereas LBNP does not modify
the increase in R-R interval obtained by carotid baroreceptor activation (2, 3, 16), this increase in R-R interval is higher with
subjects in the upright than in the supine position, at least when
sympathetic influences on the sinus node are removed (6). Because LBNP
does not involve otolithic activation, in contrast to a change from the
supine to upright position, a role of the otoliths might explain the
observed difference.
In static conditions, two types of receptors are stimulated by head
flexion on the trunk. The otolithic receptors sense the position of the
head in space, and the neck tonic receptors sense its position in
relation to the trunk. It is known that the two receptors interact, as
shown by a number of studies on the convergence of otolithic and tonic
neck receptor pathways on vestibular nuclei and other brain stem
structures (23). Thus the absence of change in BF observed by Essandoh
et al. (8) during head flexion with subjects lying supine cannot
exclude the possibility of either a role of the tonic neck receptors or
a mechanical effect of the position of the neck because of the possible
interaction of the two receptors. Indeed, tonic neck mechanoreceptor
stimulation in a subject lying supine with the neck flexed is similar
to that seen in a subject in the prone position, whereas stimulation of otolithic receptors is the reverse. In other words, neck
receptors and otolithic responses add up in one case and subtract in
the other. In addition, a cardiovascular response can be induced by neck flexion in patients in a state of cerebral death (thus without vestibular reflexes), whereas the same maneuver does not evoke a
response in patients in a state of coma (12). In the first case, the
response would only be of neck origin, and in the second, it would be
counterbalanced by an otolithic response in the opposite direction.
The aim of this study was to assess separately the effect of otolithic
receptor and neck mechanoreceptor stimulation on the cardiovascular
system. We quantified the effect of head movements in subjects lying on
the side, compared with prone. With subjects lying on the side, only
the neck mechanoreceptors are stimulated because there is no otolithic
reorientation relative to gravity, whereas otoliths are stimulated with
the subjects lying prone. We will refer to the first
situation as neck stimulation and the second as neck + otolith
stimulation. In our experimental conditions, we could not stimulate the
otoliths independently of the neck. However, the difference between the
effects of neck + otolith stimulation and neck stimulation allowed us
to approximate the effect of a stimulation of the otoliths alone.
-adrenergic stimulation, linked to a
deactivation of cardiopulmonary receptors and a decrease in arterial
baroreceptor activity when arterial pressure drops (4). The respective
importance of the two types of receptors and their interaction in the
control of vascular resistances (VRs) is still debated (11, 15, 17), and it is also possible that other receptors may participate in orthostatic reflexes. In animals, the vestibular system can modulate the sympathetic activity (24, 25), and it was shown that bilateral vestibular nerve section in cat impairs the orthostatic reflexes (5).
Subjects.
Twelve male subjects (age 22-31 yr) without previous
cardiovascular, cochlear, vestibular, or neurological pathological
conditions participated in this study. They were informed of the
protocol and familiarized with the instruments and recording procedures before giving their written consent.
At each body position, five measurement sequences were done based on head position, with each extension or flexion measurement sequence preceded and followed by a measurement sequence in the reference position. During each sequence, FBF and CBF were measured four times, namely, 90, 135, 180, and 225 s after the new head position was taken. All four values of BF were identical in each sequence and thus were averaged. MAP and HR were averaged from the overall sequence of measurements. It has been shown that in the prone position, BF in limbs decreases with time (1). To control for this variable, the order in which the effects of body and head position were studied was randomized. Effect of otolithic stimulation. For each subject, the effect of otolithic stimulation alone was calculated by subtracting, at each head position, the value obtained with the subject lying on the side from that obtained with the subject lying prone. Differences obtained in head flexion are referred to as head-down values and those in head extension as head-up values. Statistical analysis. The overall calculations were carried out by using the statistical software SAS 6.08. Values are expressed as means ± SE. For each body position (prone, on left side, and prone minus on left side), the data were compared by two-way analysis of variance, testing for head position (flexion, extension, reference) and subject variability. The Dunnett's test was used to compare head positions.
Baseline data at each body and head position are given in Table 1. Results in Fig. 3 are presented in terms of differences relative to the reference position.
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With the subjects lying prone (neck + otolith stimulation), MAP and HR
did not change with head position, whereas CBF was affected
(P < 0.01). It was lower when the head was in
flexion compared with the reference position (5.2 ± 0.6 ml · min
1 · 100 ml
1; reference 5.8 ± 0.4 ml · min
1 · 100 ml
1;
P < 0.05) and
tended to increase when the head was in extension (P < 0.1). FBF was
less affected by head position (P = 0.07), and this only occurred in head flexion compared with the
reference position (3.2 ± 0.4 ml · min
1 · 100 ml
1; reference 3.8 ± 0.3 ml · min
1 · 100 ml
1;
P < 0.05). CVR was significantly
increased in head flexion and decreased in head extension, whereas FVR
was not affected by head position.
With the subjects lying on the side (neck stimulation), MAP, HR, and
FBF were significantly higher when the head was in flexion (MAP: 102.4 ± 5.8 mmHg; reference 97.2 ± 3.3 mmHg; HR: 65.9 ± 2.5 beats/min; reference 63.7 ± 1.4 beats/min; FBF: 4.2 ± 0.4 ml · min
1 · 100 ml
1; reference 3.7 ± 0.2 ml · min
1 · 100 ml
1;
P < 0.05), whereas
CBF, FVR, and CVR did not change. Head extension had no
effect on any of the cardiovascular parameters.
Head-down otolithic stimulation significantly decreased MAP (P < 0.05) and FBF (P < 0.01). It tended to decrease CBF (P < 0.1) and increase FVR (P < 0.1). Head-up otolithic stimulation had no significant effect on cardiovascular parameters.
We are most grateful to Dr. Odile Mathieu-Costello for helpful comments and help with the preparation of the manuscript.
Address for reprint requests: H. Normand, Laboratoire de Physiologie, Faculté de Médecine, 14032 Caen Cedex, France (E-mail: physiochu{at}mail.cpod.fr).
Received 7 December 1995; accepted in final form 15 January 1997.
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