Correlation Between Vasovagal Syncope And Generalized Anxiety Disorder

Objectives:This study aims to through the analysis of vasovagal syncope and the influence factors of generalized anxiety disorder,and upright tilt test in the two groups of patients with blood pressure variability and investigate the relationship between the two diseases,for the general management of vasovagal syncope and patients provides an objective basis for treatment of body and mind and to reduce the burden and improve patients life quality of life play a guiding role.Methods:1.Subjects:154 patients diagnosed with unexplained syncope or near-syncope in the first affiliated hospital of kunming medical university from June 2016 to December 2018 were selected,including 72 males and 82 females,with an average age of 39.1918.1 years.Basic data of all patients were inquired and recorded in detail,including gender,age,height,weight,hypertension,diabetes,dietary habits,sleep quality,family history of syncope,history of smoking and drinking,etc.Indicators related to syncope and near-syncope were further inquired,including:Syncope and approximate syncope first onset time,syncope,and the approximate number of onset of syncope,syncope and approximation attack cause of syncope,syncope,and syncope aura,duration of symptoms,syncope,and approximate syncope occurs accompanying symptoms,syncope and approximate after syncope attack symptoms,etc.,are detailed physical examination,the perfect routine 12-lead electrocardiogram,electroencephalogram(eeg),24 hour dynamic seal,heart colour to exceed or head MRI/CT,routine blood,blood biochemistry,determination of thyroid function and a series of tests,the basic rule out other causes of syncope or approximate syncope disease of heart head blood-vessel,central nervous system diseases and metabolic diseases,The cause of syncope is not known.2.Research methods:all patients signed an informed consent form before inclusion in this study,and their Generalized anxiety disorder self-rating scale(GAD-7)was scored,with a score greater than 4 as a Generalized anxiety disorder.Grouping comparison and related indicators are as follows:(1)or approximate syncope patients with unexplained syncope upright tilt test(Head-up tilt test,HUTT)inspection(including basic HUT and drug induced HUT)is divided into the HUTT positive group and the HUTT negative groups,HUTT positive diagnosis of VVS,HUTT positive conservation by HUTT hemodynamic change type is further divided into blood vessels,heart inhibited type(no heart inhibited type of cardiac arrest and accompanied by cardiac arrest heart inhibited type)and mixed type.HUTT every 2 minutes during the process of determination of an ipsilateral arm Blood pressure,and tilt test record in detail the whole stage,basic hypothesis and restore the hypothesis of the Blood pressure value,and calculate the each stage of Blood pressure variability(Blood pressure variability,BPV)indicators,including systolic Blood pressure Standard deviation,Standard deviation of systolic Blood pressure,SSD,Coefficient of variation of systolic blood pressure(sCV),Standard deviation of diastolic blood pressure(dSD),Coefficient of variation of diastolic blood pressure(dCV).(2)according to GAD-7 score,154 patients with unexplained syncope or near-syncope were divided into:no GAD group(4 points)and GAD group(>4 points).Factors influencing VVS and GAD were analyzed,anxiety scores and degrees of different types of VVS were compared in the vertical tilt test,HUTT results of different anxiety degrees were compared,and blood pressure variability indicators of the HUTT positive group(VVS group)and the negative group(intergroup and ingroup),and the GAD free group and the GAD group(intergroup and ingroup)were further analyzed.3.Statistical processing:Using SPSS 17,0 statistical software package for statistical analysis,a basic description count data than said adoption rate and composition,measurement data using normal distribution mean+/-standard deviation,according to the skewness distribution measurement data using quartile,said hypothesis test count data comparison between the 2 test,measurement data is compared between two groups of normal distribution by using two independent sample t-test,skewness distribution measurement data comparison between the two groups by using two sample rank and inspection,normal distribution measurement data matching design compared with paired t test,skewness distribution measurement data matching design compares the two related sample rank and inspection,Multivariate analysis was performed using the binary Logstic regression analysis,and P<0.05 means the difference is statistically significant.Results:1.Analysis of factors influencing the occurrence of vasovagal syncope:1.1 univariate analysis of vasovagal syncopeA total of 154 patients were included in the study,with an average age of 39.1918.1 years,including 72 males and 82 females.There were 83 patients in the HUTT positive group(VVS group),with an average age of 35.12 17.46 years,including 53 females(63.86%)and 30 males(36.14%).The positive rate of females was higher than that of males(64.63%vs41.67%,P=0.004).Among them,39(46.99%)were of vascular inhibition type and 44(53.01%)were of mixed type.There were 71 patients in the HUTT negative group,with an average age of 43.94 17.92 years,including 29 females(40.85%)and 42 males(59.15%).Univariate results showed that P values of gender,age,Body Mass Index(BMI),GAD-7 score,basal systolic blood pressure and basal diastolic blood pressure were all<0.05.1.2 multivariate analysis of the occurrence of vasovagal syncopeMultivariate regression analysis was performed with statistically significant indicators as independent variables in the univariate analysis of the occurrence of asoagal syncope and dependent variables as dependent variables.The results showed that anxiety was an independent risk factor for VVS(OR=1.120,95%ci:1.030-1.219).2.Analysis of influencing factors of generalized anxiety disorder2.1 univariate analysis of the occurrence of generalized anxiety disorderA total of 154 patients were included in the study,with an average age of 39.1918.1 years,including 72 males and 82 females.A total of 69 patients in the GAD group were aged from 19 to 48,including 44 females(53.66%)and 25 males(34.72%).Female patients had more GAD than male patients(53.66%vs34.72%,P=0.018).A total of 85 GAD clients were aged from 24 to 59,including 38 females(44.71%)and 47 males(55.29%).Univariate results showed that P values of gender,age,syncope frequency and HUTT results were all<0.05.Meanwhile,the incidence of GAD in the HUTT positive group was 59.04%,that in the HUTT negative group was 28.17%,that in the GAD group was 71.01%,and that in the GAD group was 40%,suggesting the correlation between VVS and GAD.In addition,the incidence of anxiety in the VVS group was high,and that in the GAD group was high.2.2 multivariate analysis of the occurrence of generalized anxiety disorderMultivariate regression analysis was performed with statistically significant indicators as independent variables in univariate analysis of GAD occurrence and dependent variables as dependent variables.The results showed that:(1)age was the protective factor for GAD occurrence(OR=0.98,95%ci:0.960-0.999).The number of syncope was an independent risk factor for GAD(OR:1.113,95%CI:1.007-1.229).VVS was the independent risk factor for GAD(OR:2.510,95%CI:1.208-5.214).3.Comparison of anxiety scores of different positive response types in the upright tilt table test for vasovagal syncopeThere was no significant difference in anxiety score between the angiopathogenic group and the mixed group(P>0.05).4.Comparison of vertical tilt test results with different anxiety levelsHUTT positive rate was 67.65%(23/34)in mild anxiety,moderate anxiety HUTT positive rate was 69.23%(18/26),moderately severe anxiety HUTT positive rate was 88.89%(8/9),mild anxiety,moderate anxiety,moderately severe anxiety HUTT were obvious difference between three groups(P=0.001<0.05),and increased with anxiety HUTT positive rate increases,prompt VVS and GAD degree is positive correlation.5.BPV analysis in the vertical tilt table test for vasovagal syncope and generalized anxiety disorder5.1 comparison of BPV between the HUTT positive group and the negative group5.1.1 comparison of BPV between the HUTT positive group and the negative groupHUTT positive than negative group based recumbent period sCV,dSD,dCV difference was statistically significant(P<0.05),the recovery phase recumbent sSD,sCV and dSD,dCV difference was statistically significant(P<0.05),the HUTT positive than negative group based recumbent period there was no statistical significance(P>0.05)difference sSD,tilt the whole sSD,sCV,dSD,there was no statistical significance(P>0.05)difference dCV.This indicated that the BPV of the HUTT positive group was higher in the basal and recovery recumbent phase than that of the HUTT negative group,suggesting that the patients in the HUTT positive group(VVS group)had some dysfunction in autonomic nerve function regulation.5.1.2 comparison of BPV between the HUTT positive group and the negative group:There were statistically significant differences in sSD,sCV,dSD and dCV between the HUTT positive group and the basic supine stage(P<0.05),while there were statistically significant differences in dSD and dCV between the HUTT negative group and the basic supine stage(P<0.05),and no statistically significant differences in sSD and sCV between the HUTT negative group and the basic supine stage(P>0.05).Suggesting HUTT positive in restoring recumbent tilt test period,sSD,sCV,dSD,dCV up from basic recumbent period,negative groups in tilt testing stage recumbent dSD,dCV is basic recumbent,HUTT positive group of systolic pressure,diastolic blood pressure variability change was statistically significant,negative groups only diastolic blood pressure variability change was statistically significant,and the HUTT positive BPV rise which is greater than the negative group,tip HUTT positive than negative group in the resume the function of autonomic nervous prostration period adjustment ability,not proper autonomic nervous regulation resulting in the occurrence of syncope or approximate syncope.5.2.Comparison of BPV between the GAD group and the GAD free group5.2.1 comparison of BPV between the GAD group and the GAD free groupThe differences in sSD,sCV,dSD,and dCV in the GAD group were statistically significant(P<0.05),and the differences in sSD,sCV,dSD,and dCV in the whole process of the tilt test and the basic prosopal stage in the GAD group were not statistically significant(P>0.05).This indicated that the GAD group had higher BPV than the non-gad group during the recovery prostration period,suggesting that GAD patients had certain abnormal autonomic nerve function regulation.5.2.2 comparison of BPV between the GAD group and the GAD free groupThe differences in sSD,sCV,dSD and dCV between the GAD group and the GAD group were statistically significant(P<0.05).GAD and GAD group in the HUTT recovery stage recumbent the basic recumbent BPV is high,both groups show the systolic pressure,diastolic blood pressure variability change was statistically significant,but the GAD group of systolic pressure,diastolic blood pressure variability is no GAD group increased significantly,suggesting the GAD group and GAD group in the HUTT has certain function of autonomic nervous regulation is unusual,but the GAD group adjust autonomic ability is weaker than the GAD group.Conclusions:1.Vasovagal syncope and generalized anxiety disorder are independent risk factors for each other,and the number of syncope is an independent risk factor for generalized anxiety disorder.2.There was an increase in blood pressure variability in the two disease groups of vasovagal syncope and generalized anxiety disorder,suggesting that both groups had abnormal autonomic nervous function.3.Blood pressure variability in the upright tilt table test can be used as a means of assessing autonomic nervous function.