A CASE FOR A STANDARDIZED METHOD FOR THE NORMALIZATION OF MUSCLE SYMPATHETIC NERVE ACTIVITY AMPLITUDE

Purpose: MSNA has no agreed upon standard for analysis. For example, mean burst strength (MBS), total activity (TA) and total MSNA (TMSNA) rely on amplitude measurements assigned arbitrary units which are highly dependent on the method of normalization. We investigated the hypothesis that computer algorithms used for automatic normalization of MSNA amplitudes differ from those obtained with manual normalization leading to erroneous interpretations. Methods: MSNA from healthy human subjects (n=8, 2 female) was obtained by microneurography of the peroneal nerve while resting quietly in a 30* semi-recumbent position. Data was analyzed by 3 different normalization methods (Min-Max Auto (MM), Mean Auto (MA), and Rectified Manual (RM)). MSNA is quantified as burst frequency (BF), burst incidence (BI), MBS, TA, and TMSNA. Results: There were no differences in BF or BI between the three analysis methods. However, significant differences were detected between MM and RM in MBS, TA and TMSNA (p=0.002, p=0.009, and p=0.004). Rankings according to activity were not different between MM and RM but were different in MA compared to either MM or RM. Conclusions: There is an overwhelming need to standardize the analysis of MSNA. The current study points out that the variables BF and BI can be compared across studies. However, our data identify that the RM normalization is the only method to quantify MBS, TA and TMSNA for cross-study comparisons.