The Role of Insulin Sensitivity and Body Mass Index on Orthostatic Intolerance

Abstract

Objective: To assess the effects of insulin sensitivity and anthropometric measurements on orthostatic intolerance syndromes. Methods: This is a retrospective study. Patients with history of syncope aged between 7-18 years were analyzed according to insulin sensitivity index and anthropometric measurements. Patients were grouped according to the head-up tilt test results (test positive and test negative). Also, patients who had positive tilt tests were divided into four subgroups such as vasodepressor vasovagal syncope (VVS), cardioinhibitory VVS, mixed VVS, and postural orthostatic tachycardia syndrome. Results: A total of 509 patients were included in the study. The mean age was 13.45 ± 2.82 years, and %64.4 were girls. The tilt test was positive in 214 patients and negative in 295. With the tilt test results, 173 patients were diagnosed with VVS and 41 patients (19 %) with POTS. There were no statistically significant difference between the groups according to the insulin sensitivity indices. In anthropometric measurements, a significant difference was observed between the two groups in height, height standard deviation score (SDS), BMI SDS and BMI p (p =0.008, p= 0.02, p=0.036, p=0.03, respectively). Conclusion: In our study, while the low BMI and being tall were the predisposing factors for VVS episodes especially in young girls, there was no relationship between the insulin sensitivity indices and positive head-up tilt test result. Providing appropriate treatment by shedding light on factors that cause recurrent syncope can contribute to the quality of life of patients.

Keywords

• Syncope
• postural tachycardia syndrome
• vasovagal syncope
• head-up tilt test

İnsülin Duyarlılığı ve Vücut Kitle İndeksinin Ortostatik İntolerans Üzerine Etkileri

Abstract

Amaç: Çalışmanın amacı insülin duyarlılığı ve antropometrik ölçümlerin ortostatik intolerans sendromları üzerindeki etkilerini değerlendirmektir. Yöntem: Retrospektif bir çalışmadır. 7-18 yaş arası senkop öyküsü ile başvuran hastalarda insülin duyarlılık indeksleri hesaplandı ve antropometrik ölçümlerine değerlendirildi. Hastalar head-up tilt test sonuçlarına göre test pozitif ve test negatif olarak gruplandırıldı. Ayrıca tilt testi pozitif olan hastalar vazodepresör vazovagal senkop (VVS), kardiyoinhibitör VVS, mikst VVS ve postural ortostatik taşikardi sendromu olmak üzere dört alt gruba ayrıldı. Bulgular: Çalışmaya toplam 509 hasta dahil edildi. Yaş ortalaması 13,45 ± 2,82 yıldı ve %64,4'ü kızdı. Tilt testi 214 hastada pozitif, 295 hastada negatifti. Tilt testi sonuçları ile 173 hastaya VVS ve 41 hastaya (%19) POTS tanısı konuldu. İnsülin duyarlılık indekslerine göre gruplar arasında istatistiksel olarak anlamlı fark yoktu. Antropometrik ölçümlerde boy, boy standart deviasyonu, vücut kitle indeksi (VKİ) standart deviasyonu ve VKİ persentili (sırasıyla p=0,008, p=0,02, p=0,036, p=0,03) açısından iki grup arasında anlamlı farklılık gözlendi. Sonuç: Çalışmamızda özellikle genç kızlarda düşük VKİ ve uzun boylu olmak vazovagal senkop ataklarına zemin hazırlayan faktörler iken, insülin duyarlılık indeksleri ile pozitif head-up tilt test sonucu arasında ilişki bulunmadı. Tekrarlayan senkoplara neden olan faktörlere ışık tutarak uygun tedavinin sağlanması hastaların yaşam kalitelerine katkı sağlayabilir.

Keywords

• Senkop
• Postural taşikardi sendromu
• Vazovagal senkop
• Head-up tilt testi

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