• Carlos Felipe Delmondes Vieira, Márcia Maria Oliveira Lima, Henrique Silveira Costa, Karen Marina Alves Diniz, João Paulo Lemos Guião, Frederico Lopes Alves, Emílio Henrique Maciel, Vanessa Gomes Brandao, and Pedro Henrique Scheidt Figueiredo.
• Cardiovascular Rehabilitation Laboratory (LABCAR), Physical Therapy School, Federal University of the Jequitinhonha and Mucuri Valleys, Rodovia MGT 367 - Km 583, nº 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39.100-000, Brazil.
• Clin. Auton. Res. 2016 Jun 1; 26 (3): 181-8.

PurposeThe autonomic maneuvers are simple methods to evaluate autonomic balance, but the association between autonomic maneuvers and heart rate variability (HRV) in hemodialysis patients remains unknown. This study aimed to evaluate the correlation between HRV and respiratory sinus arrhythmia (RSA) and Valsalva maneuver (VM) indexes in hemodialysis patients and to compare two methods for RSA indexes acquisitions.MethodsForty-eight volunteers on hemodialysis (66.7 % men) were evaluated by VM, RSA, and 24 h Holter monitoring. At the VM, the Valsalva index (VI) was the variable considered. In the RSA, the ratio and difference between the RR intervals of inspiratory and expiratory phase (E:I and E-I, respectively) were considered by traditional form (average of respiratory cycles) and independent respiratory cycles (E:Iindep and E-Iindep). The HRV indexes evaluated were standard deviation of all normal RR intervals (SDNN), standard deviation of sequential 5-min RR interval means (SDANN), root mean square of the successive differences (rMSSD) and percentage of adjacent RR intervals with difference of duration greater than 50 ms (pNN50).ResultsThe SDNN, SDANN showed significant correlation with all classic indexes of RSA (E:I: r = 0.62, 0.55, respectively, E-I: r = 0.64, 0.57, respectively), E:Iindep (r = 0.59, 0.54, respectively), E-Iindep (r = 0.47, 0.43, respectively) and VI (r = 0.42, 0.34, respectively). Significant correlation of rMSSD with E:I (r = 0.37), E-I (r = 0.41) and E:Iindep (r = 0.34) was also observed. There was no association of any variable with pNN50. Have been show high values for all variables of independent cycles method (p < 0.05).ConclusionThe autonomic maneuvers, especially RSA, are useful methods to evaluate cardiac autonomic function in hemodialysis patients. The acquisition of the RSA index by independent cycles should not be used in this population.

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