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      Synergistic effect of energy drinks and overweight/obesity on cardiac autonomic testing using the Valsalva maneuver in university students

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          Abstract

          BACKGROUND

          Obesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders.

          OBJECTIVES

          To determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks.

          DESIGN

          Cross-sectional, analytical.

          SETTING

          Physiology department at a university in Saudi Arabia.

          SUBJECTS AND METHODS

          University students, 18–22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption.

          MAIN OUTCOME MEASURE(S)

          Autonomic disturbance, hemodynamic changes.

          RESULTS

          In 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes.

          CONCLUSION

          Obesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects.

          LIMITATIONS

          Due to time and resource restraints, only the acute effects of energy drinks were examined.

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          Most cited references50

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          Risk stratification for sudden cardiac death: current status and challenges for the future†

          Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds.
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            Autonomic Function Tests: Some Clinical Applications

            Modern autonomic function tests can non-invasively evaluate the severity and distribution of autonomic failure. They have sufficient sensitivity to detect even subclinical dysautonomia. Standard laboratory testing evaluates cardiovagal, sudomotor and adrenergic autonomic functions. Cardiovagal function is typically evaluated by testing heart rate response to deep breathing at a defined rate and to the Valsalva maneuver. Sudomotor function can be evaluated with the quantitative sudomotor axon reflex test and the thermoregulatory sweat test. Adrenergic function is evaluated by the blood pressure and heart rate responses to the Valsalva maneuver and to head-up tilt. Tests are useful in defining the presence of autonomic failure, their natural history, and response to treatment. They can also define patterns of dysautonomia that are useful in helping the clinician diagnose certain autonomic conditions. For example, the tests are useful in the diagnosis of the autonomic neuropathies and distal small fiber neuropathy. The autonomic neuropathies (such as those due to diabetes or amyloidosis) are characterized by severe generalized autonomic failure. Distal small fiber neuropathy is characterized by an absence of autonomic failure except for distal sudomotor failure. Selective autonomic failure (which only one system is affected) can be diagnosed by autonomic testing. An example is chronic idiopathic anhidrosis, where only sudomotor function is affected. Among the synucleinopathies, autonomic function tests can distinguish Parkinson's disease (PD) from multiple system atrophy (MSA). There is a gradation of autonomic failure. PD is characterized by mild autonomic failure and a length-dependent pattern of sudomotor involvement. MSA and pure autonomic failure have severe generalized autonomic failure while DLB is intermediate.
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              Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation

              Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear.
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                Author and article information

                Journal
                Ann Saudi Med
                Ann Saudi Med
                Annals of Saudi Medicine
                King Faisal Specialist Hospital and Research Centre
                0256-4947
                0975-4466
                May-Jun 2017
                : 37
                : 3
                : 181-188
                Affiliations
                From the Department of Physiology, College of Medicine, University of Dammam, Dammam, Saudi Arabia
                Author notes
                Correspondence: Dr. Farrukh Majeed, Department of Physiology, College of Medicine, University of Dammam, Al-Rakha, Dammam 31451, Saudi Arabia, +966 13 333 5132, fmajeed@ 123456uod.edu.sa , ORCID: http://orcid.org/0000-0002-2987-601X
                Author information
                http://orcid.org/0000-0002-2987-601X
                Article
                asm-37-3-181
                10.5144/0256-4947.2017.181
                6150576
                28578355
                74ca8e24-494b-4ea3-85f1-2d753e2806b2
                © 2017 Annals of Saudi Medicine

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Medicine
                Medicine

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