THE KURUME MEDICAL JOURNAL

Vol. 37, Supplement, p. S53-S60, 1990

Vibration Stress and the Autonomic Nervous System

MARKUS FARKKILA, ILMARI PYYKKO AND ESA HEINONEN

Departments of Neurology and Otorhinolaryngology, University Hospital of Helsinki ,
Helsinki, 00290 Finland

Summary : Raynaud's phenomenon has been considered to be due to acti-

vation of the central sympathetic vasoconstrictor reflex, and may represent
part of a larger dysfunction of higher autonomic centers. Symptoms, such as
sweating disturbances, orthostatic hypotension, insomnia and impotence have
been reported to be more common among vibration exposed workers. We stud-
ied 217 male forest workers and selected samples of this population for elec-
tromyographic (N = 80), autonomic nervous system function, controlled brea -
thing, tilting bed and valsalva manoeuvre (N=88) tests, and a full clinical
neurological examination. Mean alcohol consumption was estimated to be 3.0 kg
absolute alcohol/year. The total mean vibration exposure time was 14,100
hours. The prevalence of Raynaud's phenomenon was 5%. The variations in
heart rate (HRV) at rest and during deep breathing were observed. The tra-
ditional indexes of HRV (CV, CVS, MEAN) were computerized and calculated.
There was a significant difference (p<0.001) between the HRV indexes during
the deep breathing test in those with the shortest and the longest exposure to
vibration. The values of HRV indexes were age dependent; and in multiple
regression analysis, the total exposure time to vibration had an independent
negative association to HRV. Also association of sensory neural hearing loss
to Raynaud's phenomenon among vibration exposed workers indicates that
there is an involvement of the central nervous system in the pathogenesis of
vibration syndrome. The question, does vibration cause permanent changes in
autonomic centers of the brain or do these centers only mediate vibration
stress to end organs, remains unsettled.

Key words : vibration•\ autonomic nerves•\heart rate variation

Introduction centers of the autonomic nervous system

(Matoba et al. 1975). Also signs of other
Vibration syndrome is composed of at - autonomic dysf unctions, like orthostatic
tacks of Raynaud's phenomenon, numb- hypotension, sweating, sleeping distur -
ness in the hand and decreased muscle bances and impotence, have been observed
force (Agate, 1949; Taylor, 1974; Farkkila, to be more common among vibration ex-
1978). Raynaud's phenomenon has been posed workers (Futatsuka et al. 1980). In
considered to be due to activation of a the Soviet Union and Japan autonomic
central sympathetic vasoconstrictor reflex symptoms are considered to be a part of
(Hyvarinen et al. 1973), and other works the vibration syndrome (Matoba et al. 1982;
support the idea that Raynaud's phenom- Drogitchina, 1971; Oemne, 1984).
enon in patients with vibration disease Because symptoms of autonomic neuro-
occurs because of a disorder in the higher pathy are difficult to differentiate from

S53
 S54 FARKKILA, ET AL.

physiological responses to all kinds of QRS-complex were measured and fed into
stress, changes in heart rate were meas- a mini-computer (Eclipse, Data General,

ured during a resting state and deep Westboro, Massachusetts, USA) together

breathing. The aim was to observe ob- with the clinical data. The R-R interval

jective findings of a dysfunction of the vectors were trend - corrected using sixth

autonomic nervous system. degree polynomial correction. For the vis-

ual control of the correct event detection,

the instantaneous heart rate in each case

Subjects and methods was plotted by the computer (Fig. 1). The
following indexes were used to measure

We studied 138 professional lumberjacks HRV (Tarlo et al. 1971) : MEAN, RMSM,

(mean age 43.7•}8. 0, range 29-58 years) RMSSD, CV, CVS1' of the R -R interval
exposed to vibration (168.9 •} 43.0•~102 data during the resting state and the deep

hours), during their annual compulsory breathing test.

health examination. A medical history of
Statistical analysis:
the general state of health (N= 138) , neu-
rological symptoms, autonomic nervous The lumberjack group was divided into

system functions and symptoms of upper three subgroups according to the total
arms were taken (N =131) . The duration sawing time (<140, 140-190, >190•~102

of vibration exposure was estimated in hours), the amount of the yearly con -

hours (Farkkila, 1978). Their mean alco- sumed alcohol (those under a mean yearly

hol consumption was 3.6 •} 4.5 kg of abso - alcohol consumption of 3.9 kg and those

lute alcohol/year. Men with diabetes, col- over it) and the occurrence of the vaso -
lagenoses or hypertension (N =7) were spastic episodes 1= no episodes, 2 = some

excluded from the study. episodes occur). The whole population was
A full clinical neurological examination divided according to age into three sub-

was carried out by the same neurologist groups (group I : 28-40 yrs, N = 32; group
(MF). The following series of cardiovas- : 41-50 yrs, N=35; group III : 50-58 yrs,

cular tests were completed (N = 88) : each N = 22). Each of these age related sub-
subject quietly laid supinely for five mi - groups were again divided according to
nutes and then a bipolar ECG was rec- the total vibration exposure time (=total

orded and stored on an FM tape recorder sawing time), mean yearly alcohol con -

(Racal', Hythe, Southampton, England). sumption and the occurrence of the symp -

The subject then breathed deeply accord- toms related to vibration induced white
ing to preselected audible instructions fingers. The HRV indexes and FRP of the

given through a tape recorder (Angelo et power spectrum of both tests were com-
al. 1984). pared within each division between the
The generated trigger R - spikes of the respective subgroups.

1) The indexes used to measure heart rate variation:

MEAN = mean length of R -R intervals, msec

RMSM =root mean square of the differences from the mean R-R interval, msec; index of over-
all variation
RMSSD =root mean square of the successive R-R interval differences, msec; index of beat-to-

beat variation
CV = coefficient of overall variation; =100 •~ RMSM/MEAN (%)
CVS =coefficient of beat-to-beat variation; = 100 •~ RMSSD/MEAN (%)
 VIBRATION AUTONOMIC NERVES S55

Fig. 1. Heart rate variation and power density during the resting
state (A) and the deep breathing test (B).

Results tween the youngest (28-40 yrs) and the

oldest (50-58 yrs) groups. Heart rate did
The prevalence of active Raynaud's not vary significantly between the age
phenomenon among the lumberjacks was groups.
about 5%. The prevalence of clinical poly- There were significant differences of
neuropathy (diminished or absent reflexes HRV indexes during the deep breathing
in association with diminished sense of test when the whole lumberjack population
vibration and light touch at distal parts was divided into three groups, according
of limbs) was approximately 4%. Of the to the total vibration exposure time (Ta-
22 forest-workers with at least three ble 1).
symptoms of autonomic failure, the pre- To check the effect of the vibration
valence of VWF was 36%. exposure time on the HRV indexes, mul-
tiple linear regression analysis was car-
1. Heart rate variation ried out (Table 2). The mean R-R interval
HRV decreased with age. There were did not correlate with either age or the
significant differences of HRV between total sawing time. Both age and total
the three age groups. The differences of sawing time had a significant negative
CV and CVS during the deep breathing correlation with the HRV indexes during
test were very significant (p<0.0001) be- the deep breathing test, but only age had
 S 56 FARKKILA, ET AL.

TABLE 1
The heart rate variation index values and exposure time

Forest workers in different exposure time groups, *** p<0. 001

TABLE 2
2. Spectral analysis and frequency related
The relationship of exposure time and age on
power (FRP)
heart rate variation indexes
The spectral analysis using fast Fourier

transformation was carried out on the R -R

interval data during the resting state and

deep breathing test. Thus the various

spectral components of heart rate variation

could be visualized (Fig. 1). The whole

frequency area ranging from 0.025 Hz to

0.4 Hz was divided into eight bands, each

0.05 Hz wide. The "power" of variation

within each band was calculated, and cal-

led "frequency related power" (FRP). The

The relationships of the total vibration ex- FR'' 's in various frequency bands' were

posure time (sawing time) and the age of compared between subgroups that were
the lumberjacks to the mean R-R interval obtained by dividing the whole lumberjack
length (MEAN) and HRV indexes (CV, population according to age, total expo-
CVS) are listed. The values given are the sure, time, occurrence of traumatic vas -
regression coefficients from the multiple
ospastic episodes and amount of the yearly
linear regression analyses
consumed alcohol.
(* p<0.05, ** p<0.01) .
The FRP's in the resting state de-
creased with age at all the frequency

a significant negative correlation on the bands studied (0.05-0.4 Hz). There was a
HRV indices of the resting state. There significant difference between the FRP's

were no significant differences of HRV of the youngest and oldest group at the
indexes between those who had vasospastic frequencies of 0.05-0.35 Hz (Fig. 2A). In
episodes and those without them. Neither the deep breathing test there was a strong

were there any significant differences be- gathering of power around the stimulation
tween the subgroups of the whole popula - frequency (0.1 •} 0.025 Hz). There were

tion divided by the amount of the yearly very significant differences of the FRP's
consumed alcohol. between the youngest and the two older
 VIBRATION AUTONOMIC NERVES S57

age groups, but not much difference be- quency bands of 0.05-0.25 Hz, and in the
tween the two older groups (Fig. 2B). deep breathing test in the frequency bands
When the material was divided into three 0.5-0.3 Hz (Fig. 3). The division of the
subgroups according to the total sawing data into two subgroups according to the
time, there were significant differences occurrence of the Raynaud's phenomenon
(p<0.05) between the FRP's of those with or the amount of the consumed alcohol did
a vibration exposure time less than 140X not yield any significant differences be-
102 and those with more than 190•~102 tween the subgroups.
hours during the resting state in the fre-

Fig. 2. Relationship between frequency related power (FRP) and the ages
during the resting state (A) and the deep breathing test (B).

Fig. 3. Relationship between frequency related power (FRP) and the vibration
exposure time during the resting state (A) and the deep breathing test (B).
 S58 FARKKILA, ET AL.

TABLE 3 resemble the signs of physical or mental

Symptoms that we probably related
tonomic nervous system dysfunctions
131 forest workers
to au- stress (Bruyn 1984). The forest work is
among physically strenuous (Korhonen et al.
1983), and vibration, cold and noise have
been shown to be CNS stressors (Futatsuka
et al. 1980; Pyykko et al. 1981).

Heart rate variation measurements

In this study RV decreased with age,
which is a physiological phenomenon
(Smith 1982). According to the multiple
linear regression analysis the total vibra-
tion exposure time had an independent
decreasing effect on the HRV indexes
during the deep breathing test, but not
during the resting state. This would in-
dicate that prolonged exposure to vibra-
tion caused by the chain saw has a de-
pressing effect on parasympathetic acti-
3. Autonomic symptoms vity. This conclusion was reached because
The symptoms probably associated with respiratory arrhythmias are usually vag-
autonomic nervous system disturbancies ally mediated. Perhaps prolonged stim-
are listed in Table 3. Orthostatic hypo- ulation of the CNS by the afferent in-
tension was the most common, 22.7%. formation from the Pacinian receptors in
Headache was found in 33% and vertigo the hand-arm system causes dysfunction
in 19.4% of lumberjacks. Patients with of the autonomic nervous system by in-
migraine headache often also had creasing the activity of the sympathetic
Raynaud's phenomenon, 36%. The vertigo nervous system. The measurements were
was the orthostatic type in 51%. made at least 16 hours after occupational
exposure to vibration, thus the acute ef-
fects of vibration were excluded.
Discussion Autonomic neuropathy associated with
systemic diseases like diabetes is seen
In this employed group of forest work- predominantly in patients with concomi-
ers, the prevalence of autonomous nervous tant sensorimotor neuropathy. There are
system disorders was studied. 16.7% of also reports of central autonomic failure
professional lumberjacks suffered from without any sensorimotor neuropathy in
symptoms resembling those of autonomic nondiabetic terminal uremia (Solders et
neuropathy. These symptoms were not al. 1985) and in brain damaged adults
due to excess alcohol drinking or diabetes. (Lowensohn et al. 1977). The sensory and
Orthostatic hypotension was the most motor disturbances in vibration syndrome
common symptom, as is true for auto- have been shown to be due to local tissue
nomic failure from other causes (Bannister, swelling and compression of peripheral
1979). The diagnosis of autonomic failure nerves in the wrists and arms (Lundborg
may be based on clinical symptoms, on et al. 1986). The vibration probably does
nerve biopsies or on attenuation of re- not cause generalized polyneuropathy
flexes (Hilsted, 1983; Ewing et al. 1973). (Farkkila et al. 1988). Thus it can be con-
The symptoms of autonomic dysfunction cluded that autonomic central failure in
 VIBRATION AUTONOMIC NERVES S59

the vibration syndrome is possible, al- BANNISTER, R. (1979). Chronic autonomic failure
though there are no signs of sensorimotor with postural hypotension. Lancet. 404-406.
neuropathy (Tuck et al. 1981). BRUYN,G. W. (1984). Hand-arm vibration and
In this study a correlation between vi - the central autonomic nervous system. J. Low
Frequency Noise Vibr. 1 (special issue), 100-
bration exposure at work and autonomic
107.
failure was observed. The prevalence of DROGITCHINA, E. A. (1971). The clinical picture
Raynaud's phenomenon among lumber- of vibration disease. In: Vibration in indus-
jacks with autonomic symptoms was higher try. Letaveta, A. A., Drogitchina, E. A. Eds.
(36%) than among all lumer jacks (7%); Izdotel'stvo "Meditsina", Moscow 122-159(In
which supports the concept, that the le- Russian).
sion is at the afferent side of sympathetic SWING,D. J., CAMPBELL,I. W., BURT, A. A, and
nervous system, because the vasocon- CLARKE,B. F. (1973). Vascular reflexes in di-
strictor response to stressors prevails abetic autonomic neuropathy. Lancet, II,
1354-1356.
(Bannister, 1979). The finding of auto-
FUTATSUKA, M., TAKAMATSU, M., SAKURAI,T.,
nomic nervous system disturbances among
MAEDA,K., ESAKI,H., HIROSAWA, I. and Wakaba,
vibration exposed subjects is supported by
K. (1980). Vibration hazards in forestry
earlier results of an increased left ven- workers of the chain saw operators of a de-
tricular ejection fraction among vibration terminated areas in Japan. J. Sci. Labour,
subjects (Matoba et al. 1983) and by a 56, 27-38.
higher degree of cochlear degeneration FARKKILA, M. A. (1978). Grip force in vibration
with vibration induced Raynaud's pheno- disease. Scand. J. Work Environ. Health, 4,
menon (Pyykko et al. 1981). 159-166.
Matoba (1975) also reported that digi- FARKKILA,M., PYYKKO,I., JANTTI, V., AATOLA,S.,
STARCK,J, and KORHONEN, O. (1988). Forestry
tal plethysmographic responses to auditory
workers exposed to vibration : a neurological
stimuli were delayed in patients with vi-
study. Brit. J. Ind. Med. 45, 188-192.
bration syndrome suggesting a disorder
GEMNE,G. (1984). Classification of the vibration
of the autonomic nervous system. Our disease in the Sovjet Union. J. Low Frequency
findings, a negative association between Noise Vibr. 1 (special issue), 19-35.
the heart rate variability and prolonged HILSTED,J. (1983). Autonomic neuropathy : the
exposure to vibration caused by chain diagnosis. Acta Neurol. Scand, 67, 193-201.
saws, which indicates that occupational HYVARINEN, J., PYYKKO,I. and Sundberg, S. (1973).
vibration may cause autonomic dysf unc - Vibration f requecies and amplitudes in the
tion. aetiology of traumatic vasospastic disease.
Lancet, I, 791-794.
Although inconclusive, these findings
KORHONEN, O., SOININEN,H., FARKKILA,M. and
suggest that autonomic nervous function
PYYKKO, I. (1983). Kuormituskoe metsaty®mi-
should be further studied, because these esten maaraaikaistarkastuksessa. Suom la-
studies do not adequately separate the akaril, 30, 2628-2631 (In Finnish).
effects of age and exposure time. LOWENSOHN, R. I., WEISS,M, and HON,E. H. (1977).
Heart-rate variability in brain damaged
adults. Lancet, I, 626-628.
LUNDBORG, G., DAHLIN,L. B., DANIELSEN, N., HANSSON,
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