Beat-to-beat response patterns of spectral sympathetic estimators to the cold face test and their comparison to those of the active orthostatic test

1. Cold stimulus applied to the face causes bradycardia and peripheral vasoconstriction (i.e. the diving reflex), and has been suggested as a test of the autonomic pathways involved. The purpose of this study was to define standard procedures for conducting the test and analysing the responses to the cold face test, to evaluate variability in responses between subjects and within subjects when the same test is repeated, and to examine its usefulness in clinical autonomic assessment. 2. Sixteen (nine female, seven male) healthy adult (21–35 years old) subjects were used. Cold stimulus was applied with gel-filled compresses. Forehead temperature under the compress as an indication of stimulus magnitude, heap rate, blood flow in the finger, toe and calf by venous occlusion plethysmography, and systolic and diastolic blood pressure were monitored. Three protocols were carried out in which the temperature (0, 5, 10, 15°C), placement (whole face, unilateral, forehead) and duration (20, 40, 60, 120 s) of the cold compress application were varied. 3. The data indicate that 0°C compresses applied bilaterally for 40 s produced the maximum bradycardia and peripheral vasoconstriction. No subject found this test to be obnoxious, but a 120 s application was objectionable to some subjects. This cold face test resulted in 22%, 72%, 59% and 44% reductions in heart rate and blood flow to the finger, toe and calf, respectively. There was significant between-subject variability, but good consistency in responses to tests repeated in the same subject on different days, at different times of day and in different seasons. 4. Two advantages of the cold face test are: (a) it can assess sympathetic-vascular smooth muscle pathways as well as the cardiac-vagal pathway; and (b) because its afferents are independent of the stretch and pressure receptors that are stimulated in other vagal–cardiac tests (Valsalva manoeuvre and respiratory sinus arrhythmia), it can help differentiate between abnormal vagal–cardiac and abnormal transducer–afferent pathway function.

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Cold face test in persons with spinal cord injury: age versus inactivity

Clinical Autonomic Research ◽

10.1007/s10286-009-0009-2 ◽

2009 ◽

Vol 19 (4) ◽

pp. 221-229 ◽

Cited By ~ 16

Author(s):

Jill M. Wecht ◽

Joseph P. Weir ◽

Ronald E. DeMeersman ◽

Gregory J. Schilero ◽

John P. Handrakis ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury ◽

Cold Face ◽

Cold Face Test

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Association between Cold Face Test-induced vagal inhibition and cortisol response to acute stress

Psychophysiology ◽

10.1111/j.1469-8986.2010.01078.x ◽

2011 ◽

Vol 48 (3) ◽

pp. 420-429 ◽

Cited By ~ 20

Author(s):

Roberto La Marca ◽

Patricia Waldvogel ◽

Hanna Thörn ◽

Mélanie Tripod ◽

Petra H. Wirtz ◽

...

Keyword(s):

Acute Stress ◽

Cortisol Response ◽

Cold Face ◽

Cold Face Test

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Cold face test in the assessment of trigeminal-brainstem- vagal function in humans

Annals of Neurology ◽

10.1002/ana.410070209 ◽

1980 ◽

Vol 7 (2) ◽

pp. 144-149 ◽

Cited By ~ 85

Author(s):

Ramesh K. Khurana ◽

Sadakiyo Watabiki ◽

J. R. Hebel ◽

Rodrigo Toro ◽

Erland Nelson

Keyword(s):

Cold Face ◽

Cold Face Test ◽

Vagal Function

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Feedback-Feedforward Model of the Cold Face Test Response

IFMBE Proceedings - World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany ◽

10.1007/978-3-642-03882-2_430 ◽

2009 ◽

pp. 1624-1627

Author(s):

M. Kana ◽

J. Holcik

Keyword(s):

Test Response ◽

Cold Face ◽

Cold Face Test

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Effects of age, sex, and physical fitness on responses to local cooling

Journal of Applied Physiology ◽

10.1152/jappl.1978.44.5.813 ◽

1978 ◽

Vol 44 (5) ◽

pp. 813-817 ◽

Cited By ~ 39

Author(s):

J. LeBlanc ◽

J. Cote ◽

S. Dulac ◽

F. Dulong-Turcot

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Physical Fitness ◽

Female Group ◽

Local Cooling ◽

Trained Subjects ◽

Cold Face ◽

Hand Test ◽

Older Subjects ◽

Cold Face Test

The response to local cooling was estimated by the cold hand test (5 degrees C for 2 min) and the cold face test (0 degrees C with 66 km.h-1 wind for 2 min). Heart rate, blood pressure, and skin temperature were measured before, during, and after the tests. The increase in blood pressure (cold hand test) and the fall in Tsk (cold face test) were reduced in trained subjects. Similarly older subjects (53–60 yr of age) responded less to a cold hand test than younger subjects aged 20–40. However, the bradycardia caused by the cold face test was more pronounced in the older subjects. The responses to the cold hand and cold face tests were the same for male and female subjects. During the 2 min after the test, blood pressure and heart rate fell below initial values in the female group but not in the male. It is concluded that, besides adaptation to cold, individual factors such as age, sex, and physical fitness also have a relative importance in the responses to local cooling.

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Reduced baroreflex sensitivity in elderly humans is not due to efferent autonomic dysfunction

Clinical Science ◽

10.1042/cs0980103 ◽

1999 ◽

Vol 98 (1) ◽

pp. 103-110 ◽

Cited By ~ 12

Author(s):

D. O'MAHONY ◽

C. BENNETT ◽

A. GREEN ◽

A. J. SINCLAIR

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Baroreflex Sensitivity ◽

Reflex Response ◽

Cognitive Stress ◽

Age Related ◽

Cold Face ◽

Blood Pressure Responses ◽

Age Range ◽

Cold Face Test

A progressive decline in baroreflex sensitivity (BRS) is a characteristic feature of human aging, the basis of which is poorly understood. The purpose of the present study was to determine whether alterations in efferent baroreflex function might contribute to the age-related decrease in BRS. We studied 10 healthy young (mean age 30.5 years; age range 22–40 years; six male) and 10 healthy elderly (mean age 70.7 years; age range 67–75 years; five male) volunteers. We tested efferent cardiac vagal function using the bradycardiac response to the cold face test, and efferent sympathetic function using heart rate and blood pressure responses to four stress tests: (i) low-level cognitive stress, (ii) high-level cognitive stress, (iii) hand immersion in ice water (cold pressor test) and (iv) isometric sustained hand-grip. Haemodynamic responses to these stresses are mediated via efferent baroreflex pathways, whereas the afferent components of each reflex response are independent of afferent baroreflex pathways. BRS was measured from simultaneous Finapres-derived continuous blood pressure and digital ECG R–R interval data using the sequence analysis paradigm. As expected, BRS was significantly reduced in the elderly group (7.29±0.74 ms/mmHg; mean±S.E.M.) compared with the young group (13.84±1.13 ms/mmHg; P < 0.001). However, neither the bradycardiac responses to the cold face test nor the efferent sympathetically mediated heart rate/blood pressure responses to the stress test battery were significantly different between the young and elderly groups. We conclude that the age-related decrease in BRS is not attributable to impairments in the efferent sympathetic or parasympathetic system components of the baroreceptor reflex pathway.

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Cold face test demonstrates parasympathetic cardiac dysfunction in familial dysautonomia

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1999.276.6.r1833 ◽

1999 ◽

Vol 276 (6) ◽

pp. R1833-R1839 ◽

Cited By ~ 5

Author(s):

M. J. Hilz ◽

B. Stemper ◽

P. Sauer ◽

U. Haertl ◽

W. Singer ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Blood Flow ◽

Transfer Function ◽

Power Spectra ◽

Familial Dysautonomia ◽

Cold Face ◽

Parasympathetic Dysfunction ◽

Transfer Function Gain ◽

Cold Face Test

In familial dysautonomia (FD), i.e., Riley-Day syndrome, parasympathetic dysfunction has not been sufficiently evaluated. The cold face test is a noninvasive method of activating trigeminal brain stem cardiovagal and sympathetic pathways and can be performed in patients with limited cooperation. We performed cold face tests in 11 FD patients and 15 controls. For 60 s, cold compresses (0–1°C) were applied to the cheeks and forehead while we monitored heart rate, respiration, beat-to-beat radial artery blood pressure, and laser-Doppler skin blood flow at the first toe pulp. From these measurements heart rate variability parameters were calculated: root mean square of successive differences (RMSSD), coefficient of variation (CV), low- and high-frequency (LF and HF, respectively) power spectra of the electrocardiogram, and the LF transfer function gain between blood pressure and heart rate. All patients perceived cold stimulation and acknowledged discomfort. In controls, heart rate and skin blood flow decreased significantly during cold face test; in patients, both parameters decreased only briefly and not significantly. In controls, blood pressure, RMSSD, CV, and heart rate HF-power spectra increased but remained unchanged in patients. Respiration, as well as heart rate LF power spectra, did not change in either group. In controls, LF transfer function gain between blood pressure and heart rate indicated that bradycardia was not secondary to blood pressure increase. We conclude that the cold face test demonstrated that patients with FD have a reduced cardiac parasympathetic response, which implies efferent parasympathetic dysfunction.

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