Vagal modulation in pediatric disorders of gut–brain interaction: the role of 24 h heart rate variability

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BACKGROUND: Disorders of gut-brain interaction (DGBI) are common in pediatrics. Though the name clearly implies a neural contribution, the role of the autonomic nervous system remains unclear. Heart rate in healthy subjects (HC) follows a circadian pattern with dipping during the night with increased high frequency (hf) heart rate variability (HRV) and root mean square of successive differences (RMSSD). Our hypothesis was that reduced vagal modulation in adolescents with DGBI is associated with blunted rise in nocturnal vagal modulation. METHODS: An institutional review board (IRB) approved this study, which included children aged 12-18 years with a DGBI and carefully screened HC. All subjects underwent 24 h HRV recording. The following questionnaires/tools were included: Pain Catastrophizing Scale for Children (PCS-C), Pain Catastrophizing Scale for Parents (PCS-P), Revised Child Anxiety and Depression Scale (RCADS), Trauma Symptom Checklist for Children (TSCC), and Functional Disability Inventory (FDI). RESULTS: In total, 12 HC and 15 participants with DGBI participated (female individuals with DGBI versus HC: 93% versus 58%, p = 0.08). There was no age difference (median [range] HC 16.6 years [13.4, 18.2]; DGBI 16.8 years [13.8, 18.7], p = 0.92). The 24 h, daytime and nighttime HRV demonstrated that RMSSD, low-frequency (lf) HRV, and high-frequency (hf) HRV were lower in the DGBI group (p < 0.001). A nocturnal rise in RMSSD was present in the DGBI group, but less so in the HC group (p = 0.021). Higher catastrophizing correlated with lower nocturnal RMSSD (PCS-C correlation coefficient [CC]: -0.46), depression (RCADS depression CC: -0.51), and post-traumatic stress disorder (PTSD; TSCC PTSD CC: -0.58). CONCLUSIONS: HRV is reduced in patients with DGBI with a blunted rise in nocturnal RMSSD at night. As expected, vagal modulation is inversely correlated with catastrophizing, depression, PTDS, and FDI, with nocturnal HRV showing generally better correlations than daytime HRV.

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