Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 6:09727531241310034.
doi: 10.1177/09727531241310034. Online ahead of print.

Investigating the Visit-to-visit Repeatability of Autonomic Neuropathy Assessment Measures in Healthy Subjects

Annie S Jose  1 , Shival Srivastav  2 , Bharati Mehta  2
Affiliations

Investigating the Visit-to-visit Repeatability of Autonomic Neuropathy Assessment Measures in Healthy Subjects

Annie S Jose et al. Ann Neurosci. .

Abstract

Background: Autonomic neuropathy assessment is needed for the diagnosis and prognostication of different clinical disorders. Heart rate variability (HRV) and autonomic reactivity assessment by Ewing's battery of tests form the cornerstones of laboratory assessment of cardiac autonomic neuropathy evaluation.

Purpose: While these tests are routinely used, there are conflicting reports regarding the visit-to-visit repeatability of these tests. Therefore, we assessed autonomic measures derived using aforementioned tests on multiple visits in healthy subjects.

Methods: We enrolled 31 healthy subjects and performed autonomic function evaluation on five visits by assessment of HRV and autonomic reactivity on day 1 forenoon and afternoon, next day, one week later and one month later. Repeatability assessment was evaluated using Intraclass correlation coefficients. Values were defined as moderate, good and excellent based on previously reported criteria.

Results: Thirty-one subjects completed all five visits (17 males, 14 females; mean age = 29 ± 5.44 years). While time-domain measures demonstrated good to excellent repeatability, frequency-domain measures were only moderately repeatable. Autonomic reactivity indices also displayed good to excellent repeatability with the exception of blood pressure response to orthostatic challenge which was moderately repeatable.

Conclusion: We recommend that sole reliance on frequency domain metrics for HRV assessment should be avoided. HRV indices and autonomic reactivity measures may continue to be used for cardiac autonomic neuropathy assessment.

Keywords: Autonomic neuropathy; clinical neuroscience; heart rate variability; reliability.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.. Comparison of Heart Rate Variability Metrics Over Different Visits – Time Domain Measures.
Figure 2.
Figure 2.. Comparison of Heart Rate Variability Metrics Over Different Visits – Frequency Domain Measures.
Figure 3.
Figure 3.. Comparison of Reactivity Parameters Over Different Visits.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Vinik AI and Erbas T.. Diabetic autonomic neuropathy. Handb Clin Neurol 2013; 117: 279–294. - PubMed
    1. Vinik AI, Erbas T and Casellini CM.. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig 2013; 4: 4–18. - PMC - PubMed
    1. Maser RE, Mitchell BD, Vinik AI. et al. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 2003; 26: 1895–1901. - PubMed
    1. Gerasimova-Meigal L, Meigal A, Sireneva N. et al. Autonomic function in Parkinson’s disease subjects across repeated short-term dry immersion: evidence from linear and non-linear HRV parameters. Front Physiol 2021; 12: 712365. - PMC - PubMed
    1. Wenning GK, Stankovic I, Vignatelli L. et al. The movement disorder society criteria for the diagnosis of multiple system atrophy. Mov Disord 2022; 37: 1131–1148. - PMC - PubMed

LinkOut - more resources