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Uncovering the Spectrum of Orthostatic Hypotension in Athletes with Spinal Cord Injury: Implications for Diagnosis,
Mohamed Gomaa Sobeeh1,2, Raza N Malik1,2, Thomas Thordarson1,2
1International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, CANADA.
Insights
Orthostatic hypotension (OH) affects a third of spinal cord injury (SCI) athletes, with delayed OH (DOH) potentially missed. Autonomic testing can reveal these subtypes and inform performance strategies.
Area of Science:
- Sports Medicine
- Neuroscience
- Cardiovascular Physiology
Background:
- Orthostatic hypotension (OH) presents in three subtypes: initial (IOH), classic (COH), and delayed (DOH), each linked to distinct sympathetic nervous system dysfunction.
- OH subtypes remain poorly characterized in athletes with spinal cord injury (SCI), leading to potential underdiagnosis.
- This study investigated the prevalence and autonomic dysfunction severity across OH subtypes in SCI athletes.
Purpose of the Study:
- To determine the prevalence and severity of autonomic impairment in different orthostatic hypotension (OH) subtypes among athletes with spinal cord injury (SCI).
- To characterize the autonomic function using the Valsalva maneuver (VM) and its metrics in SCI athletes with and without OH.
- To examine the distribution of OH subtypes across the International Wheelchair Rugby Federation (IWRF) classifications.
Main Methods:
- Ninety-nine Paralympic athletes with chronic SCI underwent supine and sit-up tests for blood pressure (BP) and heart rate (HR) to classify OH subtypes.
- Autonomic function was assessed via the Valsalva maneuver (VM), measuring Valsalva ratio (VR), total recovery, pressure recovery time (PRT), and overshoot.
- The distribution of OH was analyzed across International Wheelchair Rugby Federation (IWRF) classifications in SCI-rugby athletes.
Main Results:
- 33.3% of SCI athletes experienced OH, with prevalence rates of 10.1% for IOH, 9.1% for COH, and 14.1% for DOH.
- Athletes with OH showed significantly prolonged PRT (p = 0.02) and blunted overshoot (p = 0.006) during VM compared to those without OH.
- OH was present across all IWRF classifications, and altered VM metrics correlated with hemodynamic changes during the sit-up test.
Conclusions:
- SCI athletes exhibit diverse OH subtypes that may impact athletic performance and cognitive function.
- Identifying delayed OH (DOH) is crucial, as this subtype might be overlooked with early termination of orthostatic challenge tests.
- Valsalva maneuver (VM) evaluation can complement orthostatic testing, offering deeper insights into autonomic dysfunction post-SCI and informing performance strategies.
Background:
Orthostatic hypotension (OH) is classified into three subtypes based on when blood pressure drops during an orthostatic challenge: initial (IOH; within <15 s), classic (COH; within 3 min), and delayed (DOH; after 3 min). These subtypes have varying degrees of sympathetic dysfunction. OH subtypes have not been characterized after spinal cord injury (SCI), potentially leaving many undiagnosed. This study determined the prevalence and severity of autonomic impairment across OH subtypes in SCI athletes.
Method:
Ninety-nine Paralympic athletes with chronic SCI underwent blood pressure and heart rate assessments while supine and during a sit-up test to classify OH subtypes. Autonomic functions were assessed using the Valsalva maneuver (VM) and by calculating Valsalva ratio, total recovery, pressure recovery time, and overshoot. Finally, we examined the distribution of OH across the International Wheelchair Rugby Federation (IWRF) Classification in SCI-rugby athletes.
Results:
Notably, 33.3% of the athletes experienced OH, which included 10.1% with IOH, 9.1% with COH, and 14.1% with DOH. Compared with athletes without OH, those with OH exhibited prolonged pressure recovery time ( P = 0.02) and blunted overshoot ( P = 0.006) during VM. The altered VM metrics were associated with hemodynamic changes during the sit-up test. OH presence was distributed throughout all IWRF classifications.
Conclusions:
SCI athletes can experience different subtypes of OH that might interfere with sports performance and cognition. Recognizing athletes with DOH is important since this group may be missed if their orthostatic challenge test is terminated early. Evaluation of VM outcomes could supplement an orthostatic challenge to provide valuable insight into autonomic dysfunctions after SCI. Future research is required to check how the presence of OH throughout IWRF classifications can affect performance.
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