Decreased Sample Entropy to Orthostatic Challenge in Anorexia Nervosa

Abstract

Objective: The objective was to determine changes in heart rate variability (HRV) in response to orthostatic challenge in a convenience sample of patients with anorexia nervosa compared to age-matched controls. A decrease in HRV has been shown to correlate with an increased risk of heart attack in coronary artery disease and heart failure patients. Method: Clinical data and ECG recordings were collected from 37 patients with eating disorders of which 16 had a diagnosis of anorexia nervosa and 42 controls. HRV was analyzed using linear and nonlinear methods during rest and orthostatic challenge from sitting to standing. Results: Significant sympathovagal changes were identified in the anorexia nervosa group, especially with nonlinear HRV parameters and orthostatic challenge. Sample entropy, a nonlinear measure provided the best discrimination between the two groups on standing (1.58 ± 0.42 vs. 1.19 ± 0.4; p<0.0001) and when the change in HRV was measured from sitting to standing (-0.06 ± 0.36 vs. -0.42 ± 0.34; p<0.0001). The anorexia nervosa group had a significantly larger response to orthostatic challenge compared to the control group suggesting sympathetic dysfunction. Discussion: Including nonlinear measures and orthostatic challenge from an ECG recording of anorexia nervosa patients at initial clinical assessment on admission to hospital provides a noninvasive, sensitive tool to determine loss of normal physiological autonomic control of heart rate that may be related to an increased risk of arrhythmic events that requires further monitoring. Conclusion: Nonlinear HRV measures are more sensitive in identifying sympathetic and parasympathetic changes associated with orthostatic challenge in patients with anorexia nervosa.