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Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Sixty-six patients with severe TBI (median age 33 [interquartile range 26\u201350] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253\u2009\u00b1\u2009178 vs. 176\u2009\u00b1\u2009227 ms<jats:sup>2<\/jats:sup>; <jats:italic>p<\/jats:italic>\u2009=\u20090.035) and lower heart rates (HRs; 70\u2009\u00b1\u20097 vs. 78\u2009\u00b1\u200919 bpm; <jats:italic>p<\/jats:italic>\u2009=\u20090.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve\u00a0(AUC)\u2009=\u20090.73, <jats:italic>p<\/jats:italic>\u2009=\u20090.006) and HRV in the LF (AUC\u2009=\u20090.70, <jats:italic>p<\/jats:italic>\u2009=\u20090.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio\u00a0(OR) = 10.82, 95% confidence interval\u00a0(CI) = 1.70\u201368.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.012) and HR (OR =\u00a00.91, 95% \u00a0CI 0.84\u20130.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.021) were significant factors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation\u2013ANS relationship in PSH prognostication.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12028-024-02149-1","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T16:03:10Z","timestamp":1730217790000},"page":"864-877","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome"],"prefix":"10.1007","volume":"42","author":[{"given":"Ma\u0142gorzata","family":"Burzy\u0144ska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jowita","family":"Wo\u017aniak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Urba\u0144ski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaros\u0142aw","family":"K\u0119dziora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafa\u0142","family":"Za\u0142uski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldemar","family":"Go\u017adzik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8183-7643","authenticated-orcid":false,"given":"Agnieszka","family":"Uryga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"issue":"4","key":"2149_CR1","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","volume":"130","author":"MC Dewan","year":"2018","unstructured":"Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. 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