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Autonomic Dysregulation in Adolescent Concussion Is Sex- and Posture-Dependent
Clinical Journal of Sport Medicine
  • Christopher S. Balestrini, Schulich School of Medicine & Dentistry
  • Marcy Erin Moir, Faculty of Health Sciences
  • Kolten C. Abbott, Faculty of Health Sciences
  • Stephen A. Klassen, Faculty of Health Sciences
  • Lisa K. Fischer, Faculty of Health Sciences
  • Douglas D. Fraser, Faculty of Health Sciences
  • Joel Kevin Shoemaker, Faculty of Health Sciences
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Objective: To study autonomic responses to postural changes in concussed adolescents. The influence of sex was also studied. Design: Longitudinal cohort observational study. Participants: Concussed adolescents (CONC; n = 65; 26 male adolescents; age 15 ± 1 years, range = 12-18 years) and a control (CTRL) group of nonconcussed adolescents of similar age and sport (CTRL; n = 54; 29 male adolescents; age 14 ± 1 years, range = 12-18 years). Interventions: Concussed participants were monitored through 6 weekly visits throughout usual physician care. Control participants underwent 2 visits separated by at least 1 week to account for intrapersonal variation in testing measures. Main Outcome Measures: Heart rate variability as the root mean square of successive differences in R–R intervals (RMSSD), heart rate (HR), and blood pressure [mean arterial pressure (MAP) and diastolic blood pressure (DBP)] were measured in supine, sitting, and standing postures. Results: A mixed analysis of variance revealed a group 3 sex 3 posture interaction (P = 0.04) where seated values of RMSSD were less in concussed female participants versus control female participants (42 ± 4 vs 61 ± 7 ms; P = 0.01; Mann–Whitney rank test). Compared with CTRL, CONC exhibited increased pretesting seated DBP (69 ± 1 vs 74 ± 1 mm Hg; P< 0.01), MAP (83 ± 1 vs 86 ± 1 mm Hg; P = 0.02), and baseline seated HR (72 ± 1 vs 77 ± 2 bpm; P = 0.03). Values of DBP (P = 0.03) and MAP (P, 0.01) improved at clinical discharge, whereas the RMSSD in female participants did not (P > 0.5). Data are mean ± SEM. Conclusions: A modest reduction in female cardiac autonomic regulation was observed during seated postures. Alterations in seated concussed DBP and MAP, but not RMSSD, resolved at clinical discharge (median = 37 days). The results indicate that, in adolescents, concussion may impair cardiovagal function in a sex- and posture-dependent manner. The findings also suggest that BP metrics, but not RMSSD, are associated with clinical concussion recovery.

Citation Information
Christopher S. Balestrini, Marcy Erin Moir, Kolten C. Abbott, Stephen A. Klassen, et al.. "Autonomic Dysregulation in Adolescent Concussion Is Sex- and Posture-Dependent" Clinical Journal of Sport Medicine Vol. 31 Iss. 3 (2021) p. 257 - 265
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