{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:55:13Z","timestamp":1790283313359,"version":"4.1.0"},"reference-count":75,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec id=\"ab-ooi240050-4\"><jats:title>Importance<\/jats:title><jats:p>The autonomic nervous system maintains internal stability by concurrently prioritizing and managing different functions. It is currently not known whether dysfunction at the aerodigestive junction could overwhelm autonomic control and impair other functions.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240050-5\"><jats:title>Objective<\/jats:title><jats:p>To compare baroreflex sensitivity, a prognostically significant index of the autonomic system\u2019s ability to stabilize blood pressure, between patients with predominantly esophagogastric (digestive) and patients with predominantly laryngopharyngeal (aerodigestive) symptoms.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240050-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A cross-sectional study, between 2018 and 2019, of adults undergoing esophagal manometry or transnasal panendoscopy was carried out in a specialist center. The analysis took place between 2023 and 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240050-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Heart rate and blood pressure were recorded and baroreflex sensitivity and heart rate variability were derived. Esophageal physiology was assessed with high-resolution manometry.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240050-8\"><jats:title>Results<\/jats:title><jats:p>There were 30 and 23 patients in the digestive and aerodigestive groups, respectively. The mean (SD) age was 61 (15) years and there were 26 women and 27 men. Compared with patients in the digestive group, more patients in the aerodigestive group had voice or throat symptoms and fewer had classic reflux symptoms (odds ratio [OR], 5.65; 95% CI, 1.82-17.5; OR, 2.07; 95% CI, 1.28-3.33; and OR, 0.60; 95% CI, 0.38-0.95, respectively). Patients in the aerodigestive group had higher mean (SD) resting heart rate (93 [17] vs 75 [13] min<jats:sup>\u22121<\/jats:sup>; difference of means, \u221218 min<jats:sup>\u22121<\/jats:sup>; 95% CI, \u221226 to \u221210), lower resting mean (SD) arterial pressure (94 [16] vs 104 [23] mm Hg, OR, 10; 95% CI, \u22121 to 21), lower mean (SD) baroreflex sensitivity (3.77 [0.79] vs 9.76 [2.92] s<jats:sup>\u22123<\/jats:sup>mm Hg<jats:sup>\u22121<\/jats:sup>; OR, 6.0 s<jats:sup>\u22123<\/jats:sup>mmHg<jats:sup>\u22121<\/jats:sup>; 95% CI, 4.7-7.2), and lower mean (SD) parasympathetic-spectrum heart rate variability (0.68 [0.15] vs 1.30 [0.53]; OR, 0.62; 95% CI, 0.39-0.85). There was a correlation between reduced lower esophageal relaxation (integrated relaxation pressure) and reduced baroreflex sensitivity (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.33; 95% CI, \u22120.58 to \u22120.03).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240050-9\"><jats:title>Conclusions<\/jats:title><jats:p>In this cross-sectional study of adults undergoing esophageal manometry or transnasal panendoscopy, patients with laryngopharyngeal symptoms had reduced baroreflex sensitivity, indicating diminished vagal control compared with patients with esophagogastric symptoms. The overwhelmed vagus hypothesis may explain these responses by considering autonomic functions as competing consumers of the finite regulatory resources of a common controller. The regulatory demands of maintaining a safe airway with concurrent laryngopharyngeal sensorimotor dysfunction, superadded to baseline demands for dual speech and aerodigestive control, could overwhelm and force the system to deprioritize less immediate functions like esophageal relaxation and the baroreflex. Measuring baroreflex sensitivity, now possible in routine clinical practice, could enable phenotyping and objective outcome assessment for laryngopharyngeal dysfunction. A neurophysiological model for considering laryngopharyngeal sensorimotor dysfunction could in turn move patient care toward a more holistic autonomic health footing.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.2270","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T15:50:00Z","timestamp":1725551400000},"page":"908","source":"Crossref","is-referenced-by-count":19,"title":["Baroreflex Sensitivity in Patients With Laryngopharyngeal Dysfunction\u2014The Overwhelmed Vagus Hypothesis"],"prefix":"10.1001","volume":"150","author":[{"given":"S. A. 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