[Valsalva maneuver, Müller maneuver: hemodynamic and reflex mechanisms, relevance]

The time honored ancient reflex tests, the Valsalva and Müller maneuvers are still popular in the everyday clinical practice. These maneuvers are capable of imitating both trivial situations and significant pathological conditions. The Valsalva maneuver is still frequently used for the assessment of autonomic neuropathy. Addition of continuous noninvasive blood pressure monitoring allows assessment of both cardiac vagal and sympathetic driven peripheral vasomotor responses. The Müller maneuver has recently gained renewed popularity in simulating episodes of obstructive sleep apnea (OSA). Continuous monitoring of arterial pressure and muscle sympathetic nerve activity (MSNA) casts light on the close relationship between OSA and circulatory abnormalities.