Endogenous Circadian Rhythm in Vasovagal Response to Head-Up Tilt
Open accessAbstract
Background—: The incidence of syncope exhibits a daily pattern with more occurrences in the morning, possibly as a result of influences from the endogenous circadian system and/or the daily pattern of behavioral/emotional stimuli. This study tested the hypothesis that the circadian system modulates cardiovascular responses to postural stress, leading to increased susceptibility to syncope at specific times of day. Methods and Results—: Twelve subjects underwent a 13-day in-laboratory protocol in which subjects' sleep-wake cycles were adjusted to 20 hours for 12 cycles. A 15-minute tilt-table test (60° head-up) was performed ≈4.5 hours after scheduled awakening in each cycle so that 12 tests in each subject were distributed evenly across the circadian cycle. Of 144 tests, signs/symptoms of presyncope were observed in 21 tests in 6 subjects. These presyncope events displayed a clear circadian rhythm ( P =0.028) with almost all cases (17/21) occurring in the half of the circadian cycle corresponding to the biological night (10:30 pm to 10:30 am ). Significant circadian rhythms were also observed in hemodynamic and autonomic function markers (blood pressure, heart rate, epinephrine, norepinephrine, and indices of cardiac vagal tone) that may underlie the circadian rhythm of presyncope susceptibility. Conclusions—: The circadian system affects cardiovascular responses to postural stress, resulting in greater susceptibility to presyncope during the night. This finding suggests that night-shift workers and people with disrupted sleep at night may have greater risk of syncope as a result of their exposure to postural stress during the biological night.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A 20-hour forced desynchrony in healthy individuals with tilt table tests across all phases of the circadian cycle revealed presyncope in 15% of all tests, with almost all cases (81%) occurring during the half of the circadian cycle corresponding to the biological night (2230-1030 hours).
“A 20-hour forced desynchrony in healthy individuals with tilt table tests (60° head-up for 15 minutes) across all phases of the circadian cycle revealed presyncope in 15% of all tests, with almost all cases (81%) occurring during the half of the circadian cycle corresponding to the biological night (2230-1030 hours) (91).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [91]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Heart rate variability: Standards of measurement, physiological interpretation, and clinical use
Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., & Schwartz, P. J. (1996) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a014868 · Cited by 15,289 · see citing works
Stability, precision, and near-24-hour period of the human circadian pacemaker
Czeisler, C. A., Duffy, J. F., Shanahan, T. L., Brown, E. N., Mitchell, J. F., Rimmer, D. W., Ronda, J. M., Silva, E. J., Allan, J. S., Emens, J. S., et al. (1999) · Science · doi:10.1126/science.284.5423.2177 · Cited by 1,705 · see citing works
Methods for cosinor-rhythmometry.
Nelson, W. E., Tong, Y. L., Lee, J. K., & Franz Halberg, A. (1979) · PubMed · Cited by 1,701 · see citing works
A comparison of the noise sensitivity of nine QRS detection algorithms
Friesen, G. M., Jannett, T. C., Jadallah, M. A., Yates, S. L., Quint, S. R., & Nagle, H. T. (1990) · IEEE Transactions on Biomedical Engineering · doi:10.1109/10.43620 · Cited by 1,043 · see citing works
Pagani, M., Montano, N., Porta, A., Malliani, A., Abboud, F. M., Birkett, C. L., & Somers, V. K. (1997) · Circulation · doi:10.1161/01.cir.95.6.1441 · Cited by 876 · see citing works
Impact of the human circadian system, exercise, and their interaction on cardiovascular function
Scheer, F. A. J. L., Hu, K., Evoniuk, H., Kelly, E. E., Malhotra, A., Hilton, M. F., & Shea, S. A. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1006749107 · Cited by 332 · see citing works
Self-citationDelayed orthostatic hypotension: A frequent cause of orthostatic intolerance
Gibbons, C. H., & Freeman, R. (2006) · Neurology · doi:10.1212/01.wnl.0000223828.28215.0b · Cited by 286 · see citing works
The Statistical Analysis of Circadian Phase and Amplitude in Constant-Routine Core-Temperature Data
Brown, E. N., & Czeisler, C. A. (1992) · Journal of Biological Rhythms · doi:10.1177/074873049200700301 · Cited by 224 · see citing works
Syncope prevalence in the ED compared to general practice and population: a strong selection process
Olde Nordkamp, L. R. A., van Dijk, N., Ganzeboom, K. S., Reitsma, J. B., Luitse, J. S. K., Dekker, L. R. C., Shen, W.-K., & Wieling, W. (2009) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2008.02.022 · Cited by 158 · see citing works
Physiological and anatomic evidence for regulation of the heart by suprachiasmatic nucleus in rats
Scheer, F. A. J. L., Ter Horst, G. J., van der Vliet, J., & Buijs, R. M. (2001) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.2001.280.3.h1391 · Cited by 153 · see citing works
Scheer, F. A. J. L., Shea, T. J., Hilton, M. F., & Shea, S. A. (2008) · Journal of Biological Rhythms · doi:10.1177/0748730408318081 · Cited by 139 · see citing works
Self-citationParameter Estimation in Studying Circadian Rhythms
Tong, Y. L. (1976) · Biometrics · doi:10.2307/2529340 · Cited by 124 · see citing works
Verheyden, B., Liu, J., van Dijk, N., Westerhof, B. E., Reybrouck, T., Aubert, A. E., & Wieling, W. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.09.003 · Cited by 101 · see citing works
The management of vasovagal syncope
Kenny, R. A., & McNicholas, T. (2016) · QJM · doi:10.1093/qjmed/hcw089 · Cited by 100 · see citing works
Circadian rhythm of baroreflex reactivity and adrenergic vascular response
Hossmann, V., FitzGerald, G. A., & Dollery, C. T. (1980) · Cardiovascular Research · doi:10.1093/cvr/14.3.125 · Cited by 92 · see citing works
Sorajja, D., Nesbitt, G. C., Hodge, D. O., Low, P. A., Hammill, S. C., Gersh, B. J., & Shen, W.-K. (2009) · Circulation · doi:10.1161/circulationaha.108.827626 · Cited by 86 · see citing works
Brooks, R., Ruskin, J. N., Powell, A. C., Newell, J. B., Garan, H., & McGovern, B. A. (1993) · The American Journal of Cardiology · doi:10.1016/0002-9149(93)90542-k · Cited by 84 · see citing works
Taylor, J. A., Williams, T. D., Seals, D. R., & Davy, K. P. (1998) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.1998.274.4.h1194 · Cited by 81 · see citing works
Sympathoadrenal imbalance before neurocardiogenic syncope
Goldstein, D. S., Holmes, C. S., Frank, S. M., Naqibuddin, M., Dendi, R., Snader, S., & Calkins, H. G. (2003) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02997-1 · Cited by 80 · see citing works
Comparing linear and nonlinear mixed model approaches to cosinor analysis
Mikulich, S. K., Zerbe, G. O., Jones, R. H., & Crowley, T. J. (2003) · Statistics in Medicine · doi:10.1002/sim.1560 · Cited by 72 · see citing works
Omboni, S., Smit, A. A. J., LIESHOUT, J. J. V., et al. (2001) · Clinical Science · doi:10.1042/cs1010609 · Cited by 64 · see citing works
Endogenous circadian control of the human autonomic nervous system
Hilton, M. F., Umali, M., Czeisler, C. A., Wyatt, J. K., & Shea, S. A. (2002) · Computers in cardiology · doi:10.1109/cic.2000.898490 · Cited by 51 · see citing works
Self-citationLow and High Frequency Components of Blood Pressure Variability
Pagani, M., Lucini, D., Rimoldi, O. E., Furlan, R., Piazza, S., Porta, A., & Malliani, A. (1996) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1996.tb26704.x · Cited by 47 · see citing works
Vasovagal syncope interrupting sleep?
Krediet, C. T. P., Jardine, D. L., Cortelli, P., Visman, A. G. R., & Wieling, W. (2004) · Heart · doi:10.1136/hrt.2003.031294 · Cited by 42 · see citing works
The management of vasovagal syncope
Parry, S. W. (1999) · QJM · doi:10.1093/qjmed/92.12.697 · Cited by 42 · see citing works
A model for the genesis of arterial pressure Mayer waves from heart rate and sympathetic activity
Myers, C. W., Cohen, M. A., Eckberg, D. L., & Taylor, J. A. (2001) · Autonomic Neuroscience · doi:10.1016/s1566-0702(01)00289-2 · Cited by 38 · see citing works
van Dijk, N., Boer, M. C., Santo, T. D., Grovale, N., AERTS, A. J. J., Boersma, L. V. A., & Wieling, W. (2007) · EP Europace · doi:10.1093/europace/eum104 · Cited by 34 · see citing works
Jardine, D. L., Krediet, C. T. P., Cortelli, P., & Wieling, W. (2006) · Clinical Autonomic Research · doi:10.1007/s10286-006-0314-y · Cited by 27 · see citing works
A simplified two-component model of blood pressure fluctuation
Brychta, R. J., Shiavi, R., Robertson, D., Biaggioni, I., & Diedrich, A. (2006) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00645.2006 · Cited by 26 · see citing works
Circadian Variation of Vasovagal Syncope
Mineda, Y., Sumiyoshi, M., Tokano, T., Yasuda, M., Nakazato, K., Nakazato, Y., Nakata, Y., & Yamaguchi, H. (2000) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2000.tb01751.x · Cited by 25 · see citing works
Pathophysiological Mechanisms Underlying Vasovagal Syncope in Young Subjects
Wieling, W., Smit, A. A. J., C.E, C., et al. (1997) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1997.tb03622.x · Cited by 23 · see citing works
Circadian and Infradian Rhythms of Vasovagal Syncope in Young and Middle‐Aged Subjects
Zoghi, M., Duygu, H., Güngör, H., Nalbantgil, S., Özerkan, F., Akıllı, A., & Akın, M. (2008) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2008.01229.x · Cited by 22 · see citing works
Omboni, S., Smit, A. A. J., LIESHOUT, J. J. V., et al. (2001) · Clinical Science · doi:10.1042/cs20010071 · Cited by 21 · see citing works
(2009) · European Heart Journal · doi:10.1093/eurheartj/ehp393 · Cited by 17 · see citing works
Curtis, A. B., & Epstein, A. E. (2009) · Circulation · doi:10.1161/circulationaha.109.890335 · Cited by 13 · see citing works
The hemodynamic pattern of the syndrome of delayed orthostatic hypotension
Podoleanu, C., Maggi, R., Oddone, D., Solano, A., Donateo, P., Croci, F., Caraşca, E., Ginghină, C., & Brignole, M. (2009) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-009-9429-0 · Cited by 12 · see citing works
Vasovagal syncope and vasovagal disease.
Brignole, M. (2008) · PubMed · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The Functional and Clinical Significance of the 24-Hour Rhythm of Circulating Glucocorticoids
Oster, H., Challet, E., Ott, V., Arvat, E., de Kloet, E. R., Dijk, D.-J., Lightman, S., Vgontzas, A., & Van Cauter, E. (2017) · Endocrine Reviews · doi:10.1210/er.2015-1080 · Cited by 548 · see citing works
Role of the circadian system in cardiovascular disease
Thosar, S. S., Butler, M. P., & Shea, S. A. (2018) · Journal of Clinical Investigation · doi:10.1172/jci80590 · Cited by 443 · see citing works
Self-citationCircadian system, sleep and endocrinology
Morris, C. J., Aeschbach, D., & Scheer, F. A. J. L. (2012) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2011.09.003 · Cited by 403 · see citing works
Self-citationCircadian rhythms govern cardiac repolarization and arrhythmogenesis
Jeyaraj, D., Haldar, S. M., Wan, X., McCauley, M. D., Ripperger, J. A., Hu, K., Lu, Y., Eapen, B. L., Sharma, N., Ficker, E., et al. (2012) · Nature · doi:10.1038/nature10852 · Cited by 343 · see citing works
Self-citationScheer, F. A. J. L., Morris, C. J., & Shea, S. A. (2013) · Obesity · doi:10.1002/oby.20351 · Cited by 296 · see citing works
Self-citationThe impact of the circadian timing system on cardiovascular and metabolic function
Morris, C. J., Yang, J. N., & Scheer, F. A. J. L. (2012) · Progress in Brain Research · doi:10.1016/b978-0-444-59427-3.00019-8 · Cited by 215 · see citing works
Self-citationScheer, F. A. J. L., Michelson, A. D., Frelinger, A. L., Evoniuk, H., Kelly, E. E., McCarthy, M., Doamekpor, L. A., Barnard, M. R., & Shea, S. A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0024549 · Cited by 206 · see citing works
Self-citationExistence of an Endogenous Circadian Blood Pressure Rhythm in Humans That Peaks in the Evening
Shea, S. A., Hilton, M. F., Hu, K., & Scheer, F. A. J. L. (2011) · Circulation Research · doi:10.1161/circresaha.110.233668 · Cited by 179 · see citing works
Self-citationScheer, F. A. J. L., & Shea, S. A. (2014) · Blood · doi:10.1182/blood-2013-07-517060 · Cited by 172 · see citing works
Self-citation
- Authors
- Hu, K., Scheer, F. A. J. L., Laker, M., Smales, C., & Shea, S. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2011-03-08
- Volume
- 123
- Issue
- 9
- Pages
- 961-970
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC3089897
- OpenAlex
- W1968914004
- Cited by
- 74
- References
- 37
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 9 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 2 · 2015: 4 · 2014: 3 · 2013: 10 · 2012: 5
- FWCI
- 7.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1k99hl102241-01)
- National Heart, Lung, and Blood Institute (K99-HL102241, K24HL076446, R01HL076409, P30HL101299)
- National Center for Research Resources (KL2RR025757, M01RR002635)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- circadian rhythm, syncope, vasovagal reaction, head-up tilt, presyncope, postural stress, autonomic function, cardiac vagal tone, norepinephrine, epinephrine, blood pressure, heart rate, night shift workers, sleep disruption
- MeSH terms
- Adult, Blood Pressure, Circadian Rhythm, Female, Humans, Male, Posture, Tilt-Table Test, Syncope, Vasovagal, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
