{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:29:40Z","timestamp":1777465780991,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMR"],"published-print":{"date-parts":[[2022,1,12]]},"abstract":"<jats:p>BACKGROUND: Fibromyalgia (FM) is associated with widespread autonomic dysfunction where sympathetic predominance explains associated complaints such as widespread pain, sleep disorders and anxiety. Recent studies indicate a possible neurovascular autonomic interaction in the pathogenesis of FM. OBJECTIVE: Our study paradigm included a modified Ewing\u2019s battery of autonomic function tests to find the cardiac autonomic neuropathy (CAN) in FM patients. The battery comprises some tests such as the Valsalva maneuver, which are effort-dependent, so we also aimed to identify a potential simplified test out of the whole battery as an index marker of CAN in FM patients. METHODS: Forty-two female patients with FM were included in this study and were administered sympathetic and parasympathetic reactivity tests to explore the presence of CAN. We compared the results from each sympathetic and parasympathetic reactivity test against CAN. RESULTS: Delta heart rate in the deep breathing test was significantly different in patients with and without CAN. Delta heart rate also exhibited best diagnostic performance (AUC = 0.769, 95% CI: 0.619\u20130.920, p&lt; 0.001), with 88% sensitivity, 64% specificity, and 89% negative predictive value (NPV). The 30: 15 ratio during the lying to standing test also emerged as a suitable index; however it did not show any difference between CAN and non-CAN patients. CONCLUSION: The delta heart rate has the best diagnostic accuracy, primarily in CAN\u2019s exclusion by its very high sensitivity and NPV.<\/jats:p>","DOI":"10.3233\/bmr-200209","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T12:29:20Z","timestamp":1622809760000},"page":"111-117","source":"Crossref","is-referenced-by-count":3,"title":["Cardiac autonomic neuropathy in fibromyalgia: Revisited"],"prefix":"10.1177","volume":"35","author":[{"given":"Poorvi","family":"Kulshreshtha","sequence":"first","affiliation":[{"name":"Department of Physiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kishore Kumar","family":"Deepak","sequence":"additional","affiliation":[{"name":"Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj Kumar","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didhiti","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"2","key":"10.3233\/BMR-200209_ref1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/cpf.12000","article-title":"Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review","volume":"33","author":"Kulshreshtha","year":"2013","journal-title":"Clin Physiol Funct Imaging."},{"issue":"3","key":"10.3233\/BMR-200209_ref2","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1097\/RHU.0000000000000089","article-title":"Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case-control studies","volume":"20","author":"Mart\u00ednez-Mart\u00ednez","year":"2014","journal-title":"J Clin Rheumatol."},{"issue":"1","key":"10.3233\/BMR-200209_ref3","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/1756-0500-3-156","article-title":"Proinflammatory cytokine levels in fibromyalgia patients are independent of body mass index","volume":"3","author":"Hernandez","year":"2010","journal-title":"BMC Res Notes."},{"key":"10.3233\/BMR-200209_ref4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.autneu.2017.09.003","article-title":"Cardiovascular autonomic regulation, inflammation and pain in rheumatoid arthritis","volume":"208","author":"Adlan","year":"2017","journal-title":"Auton Neurosci."},{"issue":"12","key":"10.3233\/BMR-200209_ref5","doi-asserted-by":"publisher","first-page":"3167","DOI":"10.1007\/s10067-018-4300-2","article-title":"Fibromyalgia and small fiber neuropathy: the plot thickens","volume":"37","author":"Mart\u00ednez-Lav\u00edn","year":"2018","journal-title":"Clin Rheumatol."},{"issue":"4","key":"10.3233\/BMR-200209_ref6","doi-asserted-by":"publisher","first-page":"216","DOI":"10.24015\/JAPM.2015.0029","article-title":"Progress in sympathetically mediated pathological pain","volume":"2","author":"Chen","year":"2015","journal-title":"J Anesth Perioper Med."},{"issue":"5","key":"10.3233\/BMR-200209_ref7","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1186\/ar2296","article-title":"Is fibromyalgia a cardiovascular disease? 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