Effect of a neck compression collar on cardiorespiratory and cerebrovascular function in Postural Orthostatic Tachycardia Syndrome (POTS)

[sb4]

https://www.storkapp.me/paper/showPaper.php?id=483834412&displayKey=HK1ABS6bzR

Abstract
Postural orthostatic tachycardia syndrome (POTS) is accompanied by reduced brain blood flow, autonomic dysfunction, and orthostatic intolerance. We hypothesized that wearing a neck compression collar would attenuate orthostatic symptoms, increase brain blood flow, and influence autonomic reflexes. Ten participants with POTS (9 women, age: 36±10) underwent two trials of supine rest, paced deep breathing (6 breaths/min), Valsalva maneuver (40mmHg for 15s), and 70o upright tilt. For one trial participants wore a neck compression device (Q30 Innovations). Blood pressure, heart rate, brain blood flow velocity, stroke volume, respiratory rate, and end-tidal gases were continuously measured. The Vanderbilt Orthostatic Symptom Score was compiled at the end of tilt. The use of the collar reduced the orthostatic symptom score of participants with POTS during upright tilt (26.9±12.5 to 18.7±13.1, P=0.04). Collar compression, in the supine condition reduced the low frequency domain of heart rate variability (60±18 to 51±23nu, P=0.04) and increased the change in HR (15±5 to 17±6bpm, P=0.02) and E:I ratio (1.2±0.1 to 1.3±0.1, P=0.01) during paced deep breathing. Throughout tilt, wearing the collar reduced respiratory rate (Baseline: 13±3 to 12±4breath/min; Tilt: 18±5 to 15±5breath/min; Main effect of collar P=0.048), end-tidal oxygen (Baseline: 115±5 to 112±5mmHg; Tilt: 122±10 to 118±11mmHg; Main effect of collar P=0.026). In participants with POTS wearing the Q-collar reduced orthostatic symptoms, increased the HR response to deep breathing, and decreased resting ventilation.

Interesting that compression of the neck reduces POTS, this is the device in question

Its $250 and built to reduce TBI. I think this is by trapping more blood in the head to prevent the brain sloshing about.

Interestingly when my heart pounding is really bad I feel it heavily in my jugular area. I know there is sometimes brain issues caused by this vein/artery so perhaps something like this could help the "tone" of these veins.

Anybody else have this feeling in the neck with heart pounding?

@kangaSue @pattismith You know about these kind of issues, what is your opinion.

 

[valentinelynx]

Interestingly when my heart pounding is really bad I feel it heavily in my jugular area.

It would seem normal to me to feel heart pounding in this area, because it is where the carotid artery is. The internal jugular vein lies next to the carotid artery in the front part of your neck.

 

[kangaSue]

The scenario was visited in this paper too;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886761/
Conclusions
We observed that the use of the Q-collar compressed both the internal jugular and the carotid artery in men and women resulting in greater adrenergic control of blood pressure during Valsalva. In women, wearing the collar also increased resting brain blood flow velocity leading to a smaller increase of brain blood flow velocity during Valsalva. There were no effects of the collar on blood pressure or brain blood flow velocity in the upright posture.

The abstract for this paper concludes that; "Use of the Q-collar compresses both the jugular vein and carotid artery influencing sympathetic nerve activity in both men and women while influencing brain blood flow in women."

 

[pattismith]

The scenario was visited in this paper too;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886761/
Conclusions
We observed that the use of the Q-collar compressed both the internal jugular and the carotid artery in men and women resulting in greater adrenergic control of blood pressure during Valsalva. In women, wearing the collar also increased resting brain blood flow velocity leading to a smaller increase of brain blood flow velocity during Valsalva. There were no effects of the collar on blood pressure or brain blood flow velocity in the upright posture.

The abstract for this paper concludes that; "Use of the Q-collar compresses both the jugular vein and carotid artery influencing sympathetic nerve activity in both men and women while influencing brain blood flow in women."

I wish I could understand better the autonomic sympathetic/parasympathetic balance, I'm still struggling and feeling lost!
I wonder if the effect has something in common with carotid sinus compression, a vagal manoeuver (parasympathetic stimulation)?

 

[kangaSue]

I wish I could understand better the autonomic sympathetic/parasympathetic balance, I'm still struggling and feeling lost!
I wonder if the effect has something in common with carotid sinus compression, a vagal manoeuver (parasympathetic stimulation)?

You're not alone in that regard and in all honesty, I would have expected that, similar to carotid artery or jugular vein narrowing, deliberate compression of them would also cause problematic outcomes too. One of those medical paradoxes I guess and similar to any other form of ischemic pre-conditioning.
https://en.wikipedia.org/wiki/Ischemic_preconditioning

 

[pattismith]

You're not alone in that regard and in all honesty, I would have expected that, similar to carotid artery or jugular vein narrowing, deliberate compression of them would also cause problematic outcomes too.

I think that autonomic testing and autonomic functioning is really a complexe problem, and it's normal that we are lost, but I'm convinced we have to learn about it as autonomic failure (both sympathetic and parasympathetic) seems a common feature of ME/CFS and Fibro, and may be the core pathogenic process in these diseases.
The biggest problem is that doctors, and even neurologists themselves are not so good in this area! This is why we must promote more scientific research to do the link between our diseases and autonomic failure.

 

[pattismith]

I had a Valsalva test and it showed low blood pressure in phase II (40 mm whereas 50 is the low limit), without any orthostatic intolerance. The neuro was a bit unsure of the meaning, telling it could be the result of anemia (which I don't have) or dehydratation (which I don't have either but she decided that I was not drinking enough )....
Maybe I should try this collar

 

[sb4]

Did anyone end up trying this expensive collar? Or possible found a cheap alternative?

 

[Mary]

@sb4 - I'm wondering if something like this might have a similar effect if you adjusted it to put slight pressure on your neck: Amazon.com: Neck Brace for Neck Pain and Support - Soft Foam Cervical Collar for Sleeping - Wraps Keep Vertebrae Stable and Aligned For Relief of Cervical Spine Pressure for Women & Men (Blue-L Size) : Health & Household - there are tons of different ones available. There are warnings not to wear it for longer than a week because of potential neck muscle atrophy and other adverse effects.

I was just looking at @jeff_w 's blog (My Story of Craniocervical Instability (CCI), Myalgic Encephalomyelitis (ME/CFS), and Tethered Cord — The Mechanical Basis of ME/CFS: Craniocervical Instability, CCI, Tethered Cord, Connective Tissue) and how his symptoms were almost immediately resolved when he started wearing a neck brace.

 

[sb4]

@Mary it certaintly is an idea though I just think it could end up putting to much pressure on the trachea (? throat). If you look at the collar it doesn't pass over the throat and if you put pressure on this area it isn't nice.

I actually have an unrelated collar similar in shade to the Q-Collar but I am struggling to find a way to make it squeeze my jugular without it squeezing the rest of my throat.

I understand the company needs to recoup costs of research and development for their product but I can't bring myself to spend £200 on what is essentially a bit of plastic that may or may not work.

 

[Oliver3]

It would seem normal to me to feel heart pounding in this area, because it is where the carotid artery is. The internal jugular vein lies next to the carotid artery in the front part of your neck.

Yes, but it feels " off". It's not a normal benign feeling

 

[Murph]

This thing looks way cooler and less bizzarre than I thought. It might permit patinents with pots to do the valsava maneuver with fewer problems.

I found this old thread by searching for valsalva. I've noticed it is a way to trigger pem for me. I can lift small weights so long as I doin't get to that point where I hold my breath and go nggh. which is basically the valsava maneuvcre, which causes blod pressure to drop.

In this picture the blood pressure recovers after valsava phase 2 but for me I don't know if that is the case.