Determinants of skin sympathetic nerve responses to isometric exercise

Differential control of sympathetic outflow to muscle and skin during physical and cognitive stressors

PURPOSE

Sympathetic nerve activity towards muscle (MSNA) and skin (SSNA) regulates various physiological parameters. MSNA primarily functions in blood pressure and flow, while SSNA operates in thermoregulation. Physical and cognitive stressors have been shown to have effects on both types of sympathetic activity, but there are inconsistencies as to what these effects are. This article aims to address the discrepancies in the literature and compare MSNA and SSNA responses.

METHODS

Microelectrode recordings were taken from the common peroneal nerve in 29 participants: MSNA (n = 21), SSNA (n = 16) and both MSNA and SSNA (n = 8). Participants were subjected to four different 2-min stressors: two physical (isometric handgrip task, cold pressor test) and two cognitive (mental arithmetic task, Stroop colour-word conflict test), the latter of which saw participants separated into responders and non-responders to the stressors. It was hypothesised that the physical stressors would have a greater effect on MSNA than SSNA, while the cognitive stressors would operate conversely.

RESULTS

Peristimulus time histogram (PSTH) analysis showed the mental arithmetic task to significantly increase both MSNA and SSNA; the isometric handgrip task and cold pressor test to increase MSNA, but not SSNA; and Stroop test to have no significant effects on changing MSNA or SSNA from baseline. Additionally, stress responses did not differ between MSNA and SSNA in participants who had both sets of data recorded.

CONCLUSIONS

This study has provided evidence to support the literature which claims cognitive stressors increase sympathetic activity, and provides much needed SSNA data in response to stressors.

Effects of sex and menstrual cycle on sweating during isometric handgrip exercise and postexercise forearm occlusion

NEW FINDINGS

What is the central question of this study? Do sex and menstrual cycle modulate sweating during isometric handgrip exercise and muscle metaboreceptor stimulation? What is the main finding and its importance? Sex modulates sweating during isometric handgrip exercise, as indicated by the lower sweat output per gland in women than in men, but not during muscle metaboreceptor stimulation. Sweat output per gland during isometric handgrip exercise and muscle metaboreceptor stimulation were lower in the mid-luteal phase than in the early follicular phase in women. Cholinergic sweat gland sensitivity might explain, in part, the individual variation of the response. Our results provide new insights regarding sex- and menstrual cycle-related modulation of the sweating response.

ABSTRACT

We investigated whether sex and menstrual cycle could modulate sweating during isometric handgrip (IH) exercise and muscle metaboreceptor stimulation. Twelve young, healthy women in the early follicular (EF) and mid-luteal (ML) phases and 14 men underwent two experimental sessions consisting of a 1.5 min IH exercise at 25 and 50% of maximal voluntary contraction (MVC) in a hot environment (35°C, relative humidity 50%) followed by 2 min forearm occlusion to stimulate muscle metaboreceptors. Sweat rates, the number of activated sweat glands and the sweat output per gland (SGO) on the forearm and chest were assessed. Pilocarpine-induced sweating was also assessed via transdermal iontophoresis to compare the responses with those of IH exercise and muscle metaboreceptor stimulation, based on correlation analysis. Sweat rates on the forearm and chest during IH exercise and muscle metaboreceptor stimulation did not differ between men and women in either menstrual cycle phase (all P ≥ 0.144). However, women in both phases showed lower SGO on the forearm and/or chest compared with men during IH exercise at 50% of MVC, with no differences in muscle metaboreceptor stimulation. Women in the ML phase had a lower forearm sweat rate during IH exercise at 50% of MVC (P = 0.015) and SGO during exercise and muscle metaboreceptor stimulation (main effect, both P ≤ 0.003) compared with those in the EF phase. Overall, sweat rate and SGO during IH exercise and muscle metaboreceptor stimulation were correlated with pilocarpine-induced responses (all P ≤ 0.064, r ≥ 0.303). We showed that sex and menstrual cycle modulate sudomotor activity during IH exercise and/or muscle metaboreceptor stimulation. Cholinergic sweat gland sensitivity might explain, in part, the individual variation of the response.

Measuring and quantifying skin sympathetic nervous system activity in humans

Development of the technique of microneurography has substantially increased our understanding of the function of the sympathetic nervous system (SNS) in health and in disease. The ability to directly record signals from peripheral autonomic nerves in conscious humans allows for qualitative and quantitative characterization of SNS responses to specific stimuli and over time. Furthermore, distinct neural outflow to muscle (MSNA) and skin (SSNA) can be delineated. However, there are limitations and caveats to the use of microneurography, measurement criteria, and signal analysis and interpretation. MSNA recordings have a longer history and are considered relatively more straightforward from a measurement and analysis perspective. This brief review provides an overview of the development of the technique as used to measure SSNA. The focus is on the utility of measuring sympathetic activity directed to the skin, the unique issues related to analyzing and quantifying multiunit SSNA, and the challenges related to its interpretation.

Augmented supraorbital skin sympathetic nerve activity responses to symptom trigger events in rosacea patients

Facial flushing in rosacea is often induced by trigger events. However, trigger causation mechanisms are currently unclear. This study tested the central hypothesis that rosacea causes sympathetic and axon reflex-mediated alterations resulting in trigger-induced symptomatology. Twenty rosacea patients and age/sex-matched controls participated in one or a combination of symptom triggering stressors. In protocol 1, forehead skin sympathetic nerve activity (SSNA; supraorbital microneurography) was measured during sympathoexcitatory mental (2-min serial subtraction of novel numbers) and physical (2-min isometric handgrip) stress. In protocol 2, forehead skin blood flow (laser-Doppler flowmetry) and transepithelial water loss/sweat rate (capacitance hygrometry) were measured during sympathoexcitatory heat stress (whole body heating by perfusing 50°C water through a tube-lined suit). In protocol 3, cheek, forehead, forearm, and palm skin blood flow were measured during nonpainful local heating to induce axon reflex vasodilation. Heart rate (HR) and mean arterial pressure (MAP) were recorded via finger photoplethysmography to calculate cutaneous vascular conductance (CVC; flux·100/MAP). Higher patient transepithelial water loss was observed (rosacea 0.20 ± 0.02 vs. control 0.10 ± 0.01 mg·cm(-2)·min(-1), P < 0.05). HR and MAP changes were not different between groups during sympathoexcitatory stressors or local heating. SSNA during early mental (32 ± 9 and 9 ± 4% increase) and physical (25 ± 4 and 5 ± 1% increase, rosacea and controls, respectively) stress was augmented in rosacea (both P < 0.05). Heat stress induced more rapid sweating and cutaneous vasodilation onset in rosacea compared with controls. No axon reflex vasodilation differences were observed between groups. These data indicate that rosacea affects SSNA and that hyperresponsiveness to trigger events appears to have a sympathetic component.

Melatonin attenuates the skin sympathetic nerve response to mental stress

Melatonin attenuates muscle sympathetic nerve responses to sympathoexcitatory stimuli, but it is unknown whether melatonin similarly attenuates reflex changes in skin sympathetic nerve activity (SSNA). In this double-blind, placebo-controlled, crossover study, we tested the hypothesis that melatonin (3 mg) would attenuate the SSNA response to mental stress (mental arithmetic). Twelve healthy subjects underwent experimental testing on two separate days. Three minutes of mental stress occurred before and 45 min after ingestion of melatonin (3 mg) or placebo. Skin temperature was maintained at 34°C. Reflex increases in SSNA (peroneal nerve), mean arterial pressure, and heart rate (HR) to mental stress before and after melatonin were determined. Melatonin lowered HR (pre, 66 ± 3 beats/min; and post, 62 ± 3 beats/min, P = 0.046) and SSNA (pre, 14,282 ± 3,706 arbitrary units; and post, 9,571 ± 2,609 arbitrary units, P = 0.034) at rest. In response to mental stress, SSNA increases were significantly attenuated following melatonin ingestion (second minute, 114 ± 30 vs. 74 ± 14%; and third minute, 111 ± 29 vs. 54 ± 12%, both P < 0.05). The mean arterial pressure increase to mental stress was blunted in the third minute (20 ± 2 vs. 17 ± 2 mmHg, P = 0.032), and the HR increase was blunted in the first minute (33 ± 3 vs. 29 ± 3 beats/min, P = 0.034) after melatonin. In summary, exogenous melatonin attenuates the SSNA response to mental stress.

Mental Stress Elicits Sustained and Reproducible Increases in Skin Sympathetic Nerve Activity

Mental stress (MS) is a known trigger of myocardial infarction and sudden death. By activating the sympathetic nervous system, MS may have deleterious effect on the cardiovascular system but this process is not completely understood. The primary aim of this study was to quantify the effect of MS on skin sympathetic nerve activity (SSNA). The secondary aim was to determine the reproducibility of SSNA to MS within a given day and ∼1 week later. Ten subjects (26 ± 1 year) performed two bouts of mental arithmetic lasting 3 min. The bouts were separated by 45 min. One week later the subjects returned to repeat MS. All experiments were conducted in the supine posture during the morning hours. To maintain neutral skin temperature, each subject wore a custom suit (34–35°C). Skin blood flow and sweat rate were measured on the dorsal foot. MS elicited a marked increase in SSNA within the first 10 sec (184 ± 42%; P < 0.01) in all subjects, which was less during the remaining period of MS, but remained elevated (87 ± 20; P < 0.01). The pattern of responses to MS was unchanged during the second bout (10 sec, 247 ± 55%; 3 min average, 133 ± 29%) and during the retest 1 week later (10 sec, 196 ± 55%; 3 min average, 117 ± 36%). MS did not significantly affect cutaneous vascular conductance or sweat rate during any trial. In summary, MS elicits robust and reproducible increases in SSNA in humans, which may be followed over time to observe alterations in the regulation of the autonomic nervous system.

Characterizing sympathetic neurovascular transduction in humans

Despite its critical role for cardiovascular homeostasis in humans, only a few studies have directly probed the transduction of sympathetic nerve activity to regional vascular responses – sympathetic neurovascular transduction. Those that have variably relied on either vascular resistance or vascular conductance to quantify the responses. However, it remains unclear which approach would better reflect the physiology. We assessed the utility of both of these as well as an alternative approach in 21 healthy men. We recorded arterial pressure (Finapres), peroneal sympathetic nerve activity (microneurography), and popliteal blood flow (Doppler) during isometric handgrip exercise to fatigue. We quantified and compared transduction via the relation of sympathetic activity to resistance and to conductance and via an adaptation of Poiseuille’s relation including pressure, sympathetic activity, and flow. The average relationship between sympathetic activity and resistance (or conductance) was good when assessed over 30-second averages (mean R² = 0.49±0.07) but lesser when incorporating beat-by-beat time lags (R² = 0.37±0.06). However, in a third of the subjects, these relations provided relatively weak estimates (R²<0.33). In contrast, the Poiseuille relation reflected vascular responses more accurately (R² = 0.77±0.03, >0.50 in 20 of 21 individuals), and provided reproducible estimates of transduction. The gain derived from the relation of resistance (but not conductance) was inversely related to transduction (R² = 0.37, p<0.05), but with a proportional bias. Thus, vascular resistance and conductance may not always be reliable surrogates for regional sympathetic neurovascular transduction, and assessment from a Poiseuille relation between pressure, sympathetic nerve activity, and flow may provide a better foundation to further explore differences in transduction in humans.

Sympathetic skin responses evoked by muscle contraction

INTRODUCTION

Voluntary muscle contraction is accompanied by an increase in sympathetic nerve activity. The sympathetic skin response (SSR) is a simple and non-invasive method of autonomic assessment that reflects a synchronized activity of the sweat glands. The aim of our study was to examine the possible relationship between isometric muscle contraction (IC) and changes in the SSR.

METHODS

In 11 healthy right-handed volunteers, we recorded the SSR from the palm of the hand induced by contralateral triceps IC (mSSR) of variable intensities and durations. We measured the latency, duration, amplitude, waveform and habituation index (HI) of the mSSR, in comparison to the SSR induced by supramaximal electrical stimulation (eSSR) of the brachial plexus at the axillae.

RESULTS

A single mSSR was always present at a mean latency of 1.34+/-0.5s after the onset of IC. Response amplitude, but not latency or duration, correlated positively with the intensity of IC (r=0.67; p<0.001). The latency was shorter, the duration was longer and the HI was reduced in the mSSR in comparison to the eSSRs (ANOVA; p<0.05 for all comparisons).

CONCLUSIONS

The mSSR is likely generated endogenously together with the motor commands since inputs from muscle afferents cannot account for response onset. This, together with its low level of habituation, underscores the possibilities of physiological and clinical studies using the mSSR, especially in the assessment of autonomic function in patients with nerve afferent problems.

Inhibition of nitric oxide synthase evokes central sympatho-excitation in healthy humans

Animal studies have indicated that nitric oxide is a key signalling molecule involved in the tonic restraint of central sympathetic outflow from the brainstem. Extension of these findings to humans has been difficult because systemic infusion of nitric oxide synthase (NOS) inhibitors increases blood pressure due to inhibition of endothelial NOS, resulting in activation of the arterial baroreflex and subsequent inhibition of central sympathetic outflow. To overcome this confounding inhibitory influence of the baroreflex, in the current study we directly measured skin sympathetic nerve activity (SNA), which is not under baroreceptor control. Healthy, normotensive humans were studied before, during a 60 min intravenous infusion of the NOS inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME; 4 mg kg(1)), and for 120 min following the infusion (i.e. 180 min total). Skin SNA and arterial blood pressure (BP) were continuously measured. BP was increased from baseline at the end of the l-NAME infusion (14 +/- 2 mmHg; P < 0.05) and remained significantly elevated for the remainder of the experiment (18 +/- 3 mmHg; P < 0.05). Similarly, systemic NOS inhibition produced time-dependent increases in skin SNA, such that skin SNA was elevated at the end of the l-NAME infusion (total activity, 200 +/- 22% baseline; P = 0.08) and was further increased at the end of the study protocol (total activity, 350 +/- 41% baseline; P < 0.05). Importantly, skin SNA remained unchanged during time and hypertensive (phenylephrine) control experiments. These findings indicate that pharmacological inhibition of NOS causes sympathetic activation and support a role of nitric oxide in central sympathetic control in humans.