Dysautonomia: Recommendations from A to Z
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Published
Aug 29, 2024
Abstract
Dysautonomia is an intricate and sometimes misconstrued condition that impacts the autonomic nerve system, which is accountable for controlling involuntary biological functions such as heart rate, blood pressure, and digestion. This detailed analysis explores the diverse facets of dysautonomia, encompassing its etiology, manifestations, diagnostic procedures, therapeutic alternatives, and approaches to lifestyle management. We herein seek to provide a comprehensive overview of dysautonomia by examining recent research advancements and incorporating patient viewpoints. It intends to offer helpful information for persons who are coping with this complex disorder.
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Keywords
Dysautonomia, Etiology, Interventions, Evidence, Outcomes
References
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2. Stewart JM. Common syndromes of orthostatic intol-erance. Pediatrics 2013; 131(5):968-980. DOI: https://doi.org/10.1542/peds.2012-2610
3. Palma JA, Norcliffe-Kaufmann L, Fuente-Mora C, Percival L, Mendoza-Santiesteban C, Kaufmann H. Current treatments in familial dysautonomia. Expert Opin Pharmacother 2014; 15(18):2653-2671. DOI: https://doi.org/10.1517/14656566.2014.970530
4. Dietrich P, Dragatsis I. Familial dysautonomia: Mecha-nisms and models. Genet Mol Biol 2016; 39(4):497-514. DOI: https://doi.org/10.1590/1678-4685-GMB-2015-0335
5. Robb EL, Regina AC, Baker MB. Organophosphate Toxicity. [Updated 2023 Nov 12]. In: StatPearls. Treas-ure Island (FL): StatPearls Publishing; 2024 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470430/
6. Carod-Artal FJ. Infectious diseases causing autonomic dysfunction. Clin Auton Res 2018; 28(1):67-81. DOI: https://doi.org/10.1007/s10286-017-0452-4
7. Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The link between autonomic nervous system and rheumatoid arthritis: From bench to bedside. Front Med (Lausanne) 2020; 7:589079. DOI: https://doi.org/10.3389/fmed.2020.589079
8. Lin HC, Yen CM, Chen WS, Hsu CC, Kung YY, Wu JH, Su YT, Chen KF, Chen HY, Lien CM, Wang MJ, Chang CM. Unveiling the age-related dynamics in Sjögren’s syndrome: Insights from heart rate variability and au-tonomic function. Int J Rheum Dis 2024; 27(3):e15088. DOI: https://doi.org/10.1111/1756-185X.15088
9. Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic dysregulation in multiple sclerosis. Int J Mol Sci 2015; 16(8):16920-16952. DOI: https://doi.org/10.3390/ijms160816920
10. Devigili G, Straccia G, Cereda E, Garavaglia B, Fedeli A, Elia AE, Piacentini SHMJ, Prioni S, Amami P, In-vernizzi F, Andreasi NG, Romito LM, Eleopra R, Cilia R. Unraveling autonomic dysfunction in GBA-related par-kinson’s disease. Mov Disord Clin Pract 2023; 10(11):1620-1638. DOI: https://doi.org/10.1002/mdc3.13892
11. Kumar S, Banerjee A. Quantification of dysautonomia in major depressive disorder using the Composite Au-tonomic Scoring Scale-31 (COMPASS-31). Cureus 2023; 15(10):e48008. DOI: https://doi.org/10.7759/cureus.48008
12. Daniela M, Catalina L, Ilie O, Paula M, Daniel-Andrei I, Ioana B. Effects of exercise training on the autonomic nervous system with a focus on anti-inflammatory and antioxidants effects. Antioxidants (Basel) 2022; 11(2):350. DOI: https://doi.org/10.3390/antiox11020350
13. Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic nervous system dysfunction: JACC focus seminar. J Am Coll Cardiol 2019; 73(10):1189-1206. DOI: https://doi.org/10.1016/j.jacc.2018.12.064
14. Bello-Lujan LM, Serrano-Sanchez JA, Gonzalez-Henriquez JJ. Stable gender gap and similar gender trend in chronic morbidities between 1997-2015 in adult canary population. Int J Environ Res Public Health 2022; 19(15):9404. DOI: https://doi.org/10.3390/ijerph19159404
15. Reichgott MJ. Clinical Evidence of Dysautonomia. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Ex-aminations. 3rd edition. Boston: Butterworths; 1990. Chapter 76. Available at: https://www.ncbi.nlm.nih.gov/books/NBK400/
16. Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. [Updated 2023 Aug 7]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541074/
17. Kornum DS, Terkelsen AJ, Bertoli D, Klinge MW, Høyer KL, Kufaishi HHA, Borghammer P, Drewes AM, Brock C, Krogh K. Assessment of gastrointestinal autonomic dysfunction: Present and future perspectives. J Clin Med 2021; 10(7):1392. DOI: https://doi.org/10.3390/jcm10071392
18. Lewsey SC, Weiss K, Schär M, Zhang Y, Bottomley PA, Samuel TJ, Xue QL, Steinberg A, Walston JD, Ger-stenblith G, Weiss RG. Exercise intolerance and rapid skeletal muscle energetic decline in human age-associated frailty. JCI Insight 2020; 5(20):e141246. DOI: https://doi.org/10.1172/jci.insight.141246
19. Cheshire WP Jr. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196:91-104. DOI: https://doi.org/10.1016/j.autneu.2016.01.001
20. Kim H, Jung HR, Kim JB, Kim DJ. Autonomic dys-function in sleep disorders: From neurobiological basis to potential therapeutic approaches. J Clin Neurol 2022; 18(2):140-151. DOI: https://doi.org/10.3988/jcn.2022.18.2.140
21. Ray JC, Cheema S, Foster E, Gunasekera L, Mehta D, Corcoran SJ, Matharu MS, Hutton EJ. Autonomic symptoms in migraine: Results of a prospective longi-tudinal study. Front Neurol 2022; 13:1036798. DOI: https://doi.org/10.3389/fneur.2022.1036798
22. Ratajska AM, Etheridge CB, Lopez FV, Kenney LE, Rodriguez K, Schade RN, Gertler J, Bowers D. The relationship between autonomic dysfunction and mood symptoms in de novo Parkinson’s disease patients over time. J Geriatr Psychiatry Neurol 2024; 37(3):242-252. DOI: https://doi.org/10.1177/08919887231204542
23. Cheshire WP Jr, Goldstein DS. Autonomic uprising: The tilt table test in autonomic medicine. Clin Auton Res 2019; 29(2):215-230. DOI: https://doi.org/10.1007/s10286-019-00598-9
24. Low PA, Tomalia VA, Park KJ. Autonomic function tests: Some clinical applications. J Clin Neurol 2013; 9(1):1-8. DOI: https://doi.org/10.3988/jcn.2013.9.1.1
25. Feigofsky S, Fedorowski A. Defining cardiac dysau-tonomia - Different types, overlap syndromes; case-based presentations. J Atr Fibrillation 2020; 13(1):2403. DOI: https://doi.org/10.4022/jafib.2403
26. Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ 2004; 329(7461):336-341. DOI: https://doi.org/10.1136/bmj.329.7461.336
27. Goh YY, Saunders E, Pavey S, Rushton E, Quinn N, Houlden H, Chelban V. Multiple system atrophy. Pract Neurol 2023; 23(3):208-221. DOI: https://doi.org/10.1136/pn-2020-002797
28. Coon EA, Singer W, Low PA. Pure autonomic failure. Mayo Clin Proc 2019; 94(10):2087-2098. DOI: https://doi.org/10.1016/j.mayocp.2019.03.009
29. Bar-Aluma BE. Familial Dysautonomia. 2003 Jan 21 [Updated 2021 Nov 4]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews®. Seattle (WA): University of Washington, Seattle; 1993-2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK1180/
30. Nakane S, Koike H, Hayashi T, Nakatsuji Y. Autoim-mune autonomic neuropathy: From pathogenesis to diagnosis. Int J Mol Sci 2024; 25(4):2296. DOI: https://doi.org/10.3390/ijms25042296
31. Słomko J, Estévez-López F, Kujawski S, Zawad-ka-Kunikowska M, Tafil-Klawe M, Klawe JJ, Morten KJ, Szrajda J, Murovska M, Newton JL, Zalewski P. Au-tonomic phenotypes in chronic fatigue syndrome (CFS) are associated with illness severity: A cluster analysis. J Clin Med 2020; 9(8):2531. DOI: https://doi.org/10.3390/jcm9082531
32. Nakane S. [Autoimmune Autonomic Ganglionopathy and Acute Autonomic Sensory Neuropathy]. Brain Nerve 2024; 76(5):562-568. Japanese. DOI: https://doi.org/10.11477/mf.1416202644
33. Ueno T, Hasegawa Y, Hagiwara R, Kon T, Nunomura JI, Tomiyama M. Integrated treatment for autonomic paraneoplastic syndrome improves performance status in a patient with small lung cell carcinoma: A case report. BMC Neurol 2018; 18(1):189. DOI: https://doi.org/10.1186/s12883-018-1192-3
34. Y Lei L, S Chew D, K Sandhu R, S Sheldon R, R Raj S. Non-pharmacological and pharmacological manage-ment of cardiac dysautonomia syndromes. J Atr Fi-brillation 2020; 13(1):2395. DOI: https://doi.org/10.4022/jafib.2395
35. Nachawati D, Patel JB. Alpha-Blockers. [Updated 2023 Jul 3]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK556066/
36. Singh D, Saadabadi A. Venlafaxine. [Updated 2024 Feb 26]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535363/
37. Mar PL, Raj V, Black BK, Biaggioni I, Shibao CA, Paranjape SY, Dupont WD, Robertson D, Raj SR. Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: A randomized, crossover trial. J Psychopharmacol 2014; 28(2):155-161. DOI: https://doi.org/10.1177/0269881113512911
38. Veazie S, Peterson K, Ansari Y, Chung KA, Gibbons CH, Raj SR, Helfand M. Fludrocortisone for orthostatic hypotension. Cochrane Database Syst Rev 2021; 5(5):CD012868. DOI: https://doi.org/10.1002/14651858.CD012868.pub2
39. Rahman M, Anjum F. Fludrocortisone. [Updated 2024 Mar 21]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK564331/
40. Snapper H, Cheshire WP. Oral and intravenous hydra-tion in the treatment of orthostatic hypotension and postural tachycardia syndrome. Auton Neurosci. 2022; 238:102951. DOI: https://doi.org/10.1016/j.autneu.2022.102951
41. Do T, Diamond S, Green C, Warren M. Nutritional im-plications of patients with dysautonomia and hypermo-bility syndromes. Curr Nutr Rep 2021; 10(4):324-333. DOI: https://doi.org/10.1007/s13668-021-00373-1
42. Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci 2018; 215:20-27. DOI: https://doi.org/10.1016/j.autneu.2018.07.001
43. Luyer MD, Habes Q, van Hak R, Buurman W. Nutri-tional stimulation of the autonomic nervous system. World J Gastroenterol 2011; 17(34):3859-3863. DOI: https://doi.org/10.3748/wjg.v17.i34.3859
44. Bagai K, Song Y, Ling JF, Malow B, Black BK, Biaggioni I, Robertson D, Raj SR. Sleep disturbances and di-minished quality of life in postural tachycardia syn-drome. J Clin Sleep Med 2011; 7(2):204-210.
45. Gurel NZ, Hadaya J, Ardell JL. Stress-related dysau-tonomias and neurocardiology-based treatment ap-proaches. Auton Neurosci 2022; 239:102944. DOI: https://doi.org/10.1016/j.autneu.2022.102944
46. Li QQ, Shi GX, Xu Q, Wang J, Liu CZ, Wang LP. Acu-puncture effect and central autonomic regulation. Evid Based Complement Alternat Med 2013; 2013:267959. DOI: https://doi.org/10.1155/2013/267959
47. Corrado J, Iftekhar N, Halpin S, Li M, Tarrant R, Gri-maldi J, Simms A, O’Connor RJ, Casson A, Sivan M. HEART rate variability biofeedback for Long COVID dysautonomia (HEARTLOC): Results of a feasibility study. Adv Rehabil Sci Pract 2024; 13:27536351241227261. DOI: https://doi.org/10.1177/27536351241227261
48. Jia S, Lu W, Hang M, Zhang C, Ma Z, Xue K, Lu Y, Zhang S, Guo Y, Zhang J, Zhang X, Wang Y, Zhao H. Study on the effect of acupuncture treatment on au-tonomic nerve dysfunction in convalescent period of stroke based on heart rate variability assessment technique. Medicine (Baltimore) 2022; 101(50):e32355. DOI: https://doi.org/10.1097/MD.0000000000032355
49. Prados G, Miró E, Martínez MP, Sánchez AI, Pichot V, Medina-Casado M, Chouchou F. Effect of cogni-tive-behavioral therapy on nocturnal autonomic activity in patients with fibromyalgia: A preliminary study. Brain Sci 2022; 12(7):947. DOI: https://doi.org/10.3390/brainsci12070947
50. Mustafa HI, Fessel JP, Barwise J, Shannon JR, Raj SR, Diedrich A, Biaggioni I, Robertson D. Dysautonomia: Perioperative implications. Anesthesiology 2012; 116(1):205-215. DOI: https://doi.org/10.1097/ALN.0b013e31823db712
2. Stewart JM. Common syndromes of orthostatic intol-erance. Pediatrics 2013; 131(5):968-980. DOI: https://doi.org/10.1542/peds.2012-2610
3. Palma JA, Norcliffe-Kaufmann L, Fuente-Mora C, Percival L, Mendoza-Santiesteban C, Kaufmann H. Current treatments in familial dysautonomia. Expert Opin Pharmacother 2014; 15(18):2653-2671. DOI: https://doi.org/10.1517/14656566.2014.970530
4. Dietrich P, Dragatsis I. Familial dysautonomia: Mecha-nisms and models. Genet Mol Biol 2016; 39(4):497-514. DOI: https://doi.org/10.1590/1678-4685-GMB-2015-0335
5. Robb EL, Regina AC, Baker MB. Organophosphate Toxicity. [Updated 2023 Nov 12]. In: StatPearls. Treas-ure Island (FL): StatPearls Publishing; 2024 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470430/
6. Carod-Artal FJ. Infectious diseases causing autonomic dysfunction. Clin Auton Res 2018; 28(1):67-81. DOI: https://doi.org/10.1007/s10286-017-0452-4
7. Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The link between autonomic nervous system and rheumatoid arthritis: From bench to bedside. Front Med (Lausanne) 2020; 7:589079. DOI: https://doi.org/10.3389/fmed.2020.589079
8. Lin HC, Yen CM, Chen WS, Hsu CC, Kung YY, Wu JH, Su YT, Chen KF, Chen HY, Lien CM, Wang MJ, Chang CM. Unveiling the age-related dynamics in Sjögren’s syndrome: Insights from heart rate variability and au-tonomic function. Int J Rheum Dis 2024; 27(3):e15088. DOI: https://doi.org/10.1111/1756-185X.15088
9. Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic dysregulation in multiple sclerosis. Int J Mol Sci 2015; 16(8):16920-16952. DOI: https://doi.org/10.3390/ijms160816920
10. Devigili G, Straccia G, Cereda E, Garavaglia B, Fedeli A, Elia AE, Piacentini SHMJ, Prioni S, Amami P, In-vernizzi F, Andreasi NG, Romito LM, Eleopra R, Cilia R. Unraveling autonomic dysfunction in GBA-related par-kinson’s disease. Mov Disord Clin Pract 2023; 10(11):1620-1638. DOI: https://doi.org/10.1002/mdc3.13892
11. Kumar S, Banerjee A. Quantification of dysautonomia in major depressive disorder using the Composite Au-tonomic Scoring Scale-31 (COMPASS-31). Cureus 2023; 15(10):e48008. DOI: https://doi.org/10.7759/cureus.48008
12. Daniela M, Catalina L, Ilie O, Paula M, Daniel-Andrei I, Ioana B. Effects of exercise training on the autonomic nervous system with a focus on anti-inflammatory and antioxidants effects. Antioxidants (Basel) 2022; 11(2):350. DOI: https://doi.org/10.3390/antiox11020350
13. Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic nervous system dysfunction: JACC focus seminar. J Am Coll Cardiol 2019; 73(10):1189-1206. DOI: https://doi.org/10.1016/j.jacc.2018.12.064
14. Bello-Lujan LM, Serrano-Sanchez JA, Gonzalez-Henriquez JJ. Stable gender gap and similar gender trend in chronic morbidities between 1997-2015 in adult canary population. Int J Environ Res Public Health 2022; 19(15):9404. DOI: https://doi.org/10.3390/ijerph19159404
15. Reichgott MJ. Clinical Evidence of Dysautonomia. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Ex-aminations. 3rd edition. Boston: Butterworths; 1990. Chapter 76. Available at: https://www.ncbi.nlm.nih.gov/books/NBK400/
16. Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. [Updated 2023 Aug 7]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541074/
17. Kornum DS, Terkelsen AJ, Bertoli D, Klinge MW, Høyer KL, Kufaishi HHA, Borghammer P, Drewes AM, Brock C, Krogh K. Assessment of gastrointestinal autonomic dysfunction: Present and future perspectives. J Clin Med 2021; 10(7):1392. DOI: https://doi.org/10.3390/jcm10071392
18. Lewsey SC, Weiss K, Schär M, Zhang Y, Bottomley PA, Samuel TJ, Xue QL, Steinberg A, Walston JD, Ger-stenblith G, Weiss RG. Exercise intolerance and rapid skeletal muscle energetic decline in human age-associated frailty. JCI Insight 2020; 5(20):e141246. DOI: https://doi.org/10.1172/jci.insight.141246
19. Cheshire WP Jr. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196:91-104. DOI: https://doi.org/10.1016/j.autneu.2016.01.001
20. Kim H, Jung HR, Kim JB, Kim DJ. Autonomic dys-function in sleep disorders: From neurobiological basis to potential therapeutic approaches. J Clin Neurol 2022; 18(2):140-151. DOI: https://doi.org/10.3988/jcn.2022.18.2.140
21. Ray JC, Cheema S, Foster E, Gunasekera L, Mehta D, Corcoran SJ, Matharu MS, Hutton EJ. Autonomic symptoms in migraine: Results of a prospective longi-tudinal study. Front Neurol 2022; 13:1036798. DOI: https://doi.org/10.3389/fneur.2022.1036798
22. Ratajska AM, Etheridge CB, Lopez FV, Kenney LE, Rodriguez K, Schade RN, Gertler J, Bowers D. The relationship between autonomic dysfunction and mood symptoms in de novo Parkinson’s disease patients over time. J Geriatr Psychiatry Neurol 2024; 37(3):242-252. DOI: https://doi.org/10.1177/08919887231204542
23. Cheshire WP Jr, Goldstein DS. Autonomic uprising: The tilt table test in autonomic medicine. Clin Auton Res 2019; 29(2):215-230. DOI: https://doi.org/10.1007/s10286-019-00598-9
24. Low PA, Tomalia VA, Park KJ. Autonomic function tests: Some clinical applications. J Clin Neurol 2013; 9(1):1-8. DOI: https://doi.org/10.3988/jcn.2013.9.1.1
25. Feigofsky S, Fedorowski A. Defining cardiac dysau-tonomia - Different types, overlap syndromes; case-based presentations. J Atr Fibrillation 2020; 13(1):2403. DOI: https://doi.org/10.4022/jafib.2403
26. Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ 2004; 329(7461):336-341. DOI: https://doi.org/10.1136/bmj.329.7461.336
27. Goh YY, Saunders E, Pavey S, Rushton E, Quinn N, Houlden H, Chelban V. Multiple system atrophy. Pract Neurol 2023; 23(3):208-221. DOI: https://doi.org/10.1136/pn-2020-002797
28. Coon EA, Singer W, Low PA. Pure autonomic failure. Mayo Clin Proc 2019; 94(10):2087-2098. DOI: https://doi.org/10.1016/j.mayocp.2019.03.009
29. Bar-Aluma BE. Familial Dysautonomia. 2003 Jan 21 [Updated 2021 Nov 4]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews®. Seattle (WA): University of Washington, Seattle; 1993-2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK1180/
30. Nakane S, Koike H, Hayashi T, Nakatsuji Y. Autoim-mune autonomic neuropathy: From pathogenesis to diagnosis. Int J Mol Sci 2024; 25(4):2296. DOI: https://doi.org/10.3390/ijms25042296
31. Słomko J, Estévez-López F, Kujawski S, Zawad-ka-Kunikowska M, Tafil-Klawe M, Klawe JJ, Morten KJ, Szrajda J, Murovska M, Newton JL, Zalewski P. Au-tonomic phenotypes in chronic fatigue syndrome (CFS) are associated with illness severity: A cluster analysis. J Clin Med 2020; 9(8):2531. DOI: https://doi.org/10.3390/jcm9082531
32. Nakane S. [Autoimmune Autonomic Ganglionopathy and Acute Autonomic Sensory Neuropathy]. Brain Nerve 2024; 76(5):562-568. Japanese. DOI: https://doi.org/10.11477/mf.1416202644
33. Ueno T, Hasegawa Y, Hagiwara R, Kon T, Nunomura JI, Tomiyama M. Integrated treatment for autonomic paraneoplastic syndrome improves performance status in a patient with small lung cell carcinoma: A case report. BMC Neurol 2018; 18(1):189. DOI: https://doi.org/10.1186/s12883-018-1192-3
34. Y Lei L, S Chew D, K Sandhu R, S Sheldon R, R Raj S. Non-pharmacological and pharmacological manage-ment of cardiac dysautonomia syndromes. J Atr Fi-brillation 2020; 13(1):2395. DOI: https://doi.org/10.4022/jafib.2395
35. Nachawati D, Patel JB. Alpha-Blockers. [Updated 2023 Jul 3]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK556066/
36. Singh D, Saadabadi A. Venlafaxine. [Updated 2024 Feb 26]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535363/
37. Mar PL, Raj V, Black BK, Biaggioni I, Shibao CA, Paranjape SY, Dupont WD, Robertson D, Raj SR. Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: A randomized, crossover trial. J Psychopharmacol 2014; 28(2):155-161. DOI: https://doi.org/10.1177/0269881113512911
38. Veazie S, Peterson K, Ansari Y, Chung KA, Gibbons CH, Raj SR, Helfand M. Fludrocortisone for orthostatic hypotension. Cochrane Database Syst Rev 2021; 5(5):CD012868. DOI: https://doi.org/10.1002/14651858.CD012868.pub2
39. Rahman M, Anjum F. Fludrocortisone. [Updated 2024 Mar 21]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK564331/
40. Snapper H, Cheshire WP. Oral and intravenous hydra-tion in the treatment of orthostatic hypotension and postural tachycardia syndrome. Auton Neurosci. 2022; 238:102951. DOI: https://doi.org/10.1016/j.autneu.2022.102951
41. Do T, Diamond S, Green C, Warren M. Nutritional im-plications of patients with dysautonomia and hypermo-bility syndromes. Curr Nutr Rep 2021; 10(4):324-333. DOI: https://doi.org/10.1007/s13668-021-00373-1
42. Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci 2018; 215:20-27. DOI: https://doi.org/10.1016/j.autneu.2018.07.001
43. Luyer MD, Habes Q, van Hak R, Buurman W. Nutri-tional stimulation of the autonomic nervous system. World J Gastroenterol 2011; 17(34):3859-3863. DOI: https://doi.org/10.3748/wjg.v17.i34.3859
44. Bagai K, Song Y, Ling JF, Malow B, Black BK, Biaggioni I, Robertson D, Raj SR. Sleep disturbances and di-minished quality of life in postural tachycardia syn-drome. J Clin Sleep Med 2011; 7(2):204-210.
45. Gurel NZ, Hadaya J, Ardell JL. Stress-related dysau-tonomias and neurocardiology-based treatment ap-proaches. Auton Neurosci 2022; 239:102944. DOI: https://doi.org/10.1016/j.autneu.2022.102944
46. Li QQ, Shi GX, Xu Q, Wang J, Liu CZ, Wang LP. Acu-puncture effect and central autonomic regulation. Evid Based Complement Alternat Med 2013; 2013:267959. DOI: https://doi.org/10.1155/2013/267959
47. Corrado J, Iftekhar N, Halpin S, Li M, Tarrant R, Gri-maldi J, Simms A, O’Connor RJ, Casson A, Sivan M. HEART rate variability biofeedback for Long COVID dysautonomia (HEARTLOC): Results of a feasibility study. Adv Rehabil Sci Pract 2024; 13:27536351241227261. DOI: https://doi.org/10.1177/27536351241227261
48. Jia S, Lu W, Hang M, Zhang C, Ma Z, Xue K, Lu Y, Zhang S, Guo Y, Zhang J, Zhang X, Wang Y, Zhao H. Study on the effect of acupuncture treatment on au-tonomic nerve dysfunction in convalescent period of stroke based on heart rate variability assessment technique. Medicine (Baltimore) 2022; 101(50):e32355. DOI: https://doi.org/10.1097/MD.0000000000032355
49. Prados G, Miró E, Martínez MP, Sánchez AI, Pichot V, Medina-Casado M, Chouchou F. Effect of cogni-tive-behavioral therapy on nocturnal autonomic activity in patients with fibromyalgia: A preliminary study. Brain Sci 2022; 12(7):947. DOI: https://doi.org/10.3390/brainsci12070947
50. Mustafa HI, Fessel JP, Barwise J, Shannon JR, Raj SR, Diedrich A, Biaggioni I, Robertson D. Dysautonomia: Perioperative implications. Anesthesiology 2012; 116(1):205-215. DOI: https://doi.org/10.1097/ALN.0b013e31823db712
How to Cite
Zar, R. M. (2024). Dysautonomia: Recommendations from A to Z. Science Insights, 45(2), 1483–1489. https://doi.org/10.15354/si.24.re1046
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