Cardiovascular, autonomic and neuropathic physiology and their involvement in the extra-articular manifestations of hypermobility disorders
type: CreativeWork
description: Joint hypermobility has been recognised since the fourth century BC (1, 2), however, despite this there remains limited knowledge surrounding hypermobile Ehlers-Danlos Syndrome (hEDS (2017) (3), EDS Hypermobility Type (Villefranche 1998) (4), EDS III (Berlin 1988) (5)) and the less severe Hypermobility Spectrum Disorders (HSD (2017) (6), benign joint hypermobility syndrome (BJHS/JHS) (7)). In addition, although extra-articular manifestations associated with these syndromes including, but not limited to, postural orthostatic tachycardia syndrome (POTS) (8, 9), chronic pain (8) and local anaesthetic inefficacy (8, 10, 11) are recognised as being highly burdensome (3, 6, 9) research regarding their causes is scarce, limiting our understanding of their association with hypermobility and the development of evidence-based care. Therefore, this thesis focuses on potential pathophysiology relating hypermobility with the extra-articular manifestations and how this differs from the ‘normal’ physiology of healthy individuals. The initial chapters address the utility of a commercially available device (SphygmoCor, AtCor Medical) for the assessment of heart rate variability (HRV) as an indirect measure of autonomic nervous system (ANS) activity, followed by an examination of the effect of age and sex on HRV, recorded using this device in a large population of healthy volunteers, with the aim of developing a substantial normative HRV dataset in healthy individuals across a wide age-span. These results showed that older age was associated with lower HRV, attenuated parasympathetic activity and increased sympathetic activity. Furthermore, sex-specific differences were clearer in the young (≤40 years), likely due to confounding factors in the older age groups such as the menopause, with results suggestive of sympathetic dominance in young males compared to predominantly parasympathetic autonomic control in young females. In addition, this chapter contributes towards our understandin…
abstract: Joint hypermobility has been recognised since the fourth century BC (1, 2), however, despite this there remains limited knowledge surrounding hypermobile Ehlers-Danlos Syndrome (hEDS (2017) (3), EDS Hypermobility Type (Villefranche 1998) (4), EDS III (Berlin 1988) (5)) and the less severe Hypermobility Spectrum Disorders (HSD (2017) (6), benign joint hypermobility syndrome (BJHS/JHS) (7)). In addition, although extra-articular manifestations associated with these syndromes including, but not limited to, postural orthostatic tachycardia syndrome (POTS) (8, 9), chronic pain (8) and local anaesthetic inefficacy (8, 10, 11) are recognised as being highly burdensome (3, 6, 9) research regarding their causes is scarce, limiting our understanding of their association with hypermobility and the development of evidence-based care. Therefore, this thesis focuses on potential pathophysiology relating hypermobility with the extra-articular manifestations and how this differs from the ‘normal’ physiology of healthy individuals. The initial chapters address the utility of a commercially available device (SphygmoCor, AtCor Medical) for the assessment of heart rate variability (HRV) as an indirect measure of autonomic nervous system (ANS) activity, followed by an examination of the effect of age and sex on HRV, recorded using this device in a large population of healthy volunteers, with the aim of developing a substantial normative HRV dataset in healthy individuals across a wide age-span. These results showed that older age was associated with lower HRV, attenuated parasympathetic activity and increased sympathetic activity. Furthermore, sex-specific differences were clearer in the young (≤40 years), likely due to confounding factors in the older age groups such as the menopause, with results suggestive of sympathetic dominance in young males compared to predominantly parasympathetic autonomic control in young females. In addition, this chapter contributes towards our understandin…
author: Evans, Sarah
language: eng
keywords: cardiovascular, autonomic nervous system, neuropathic, hypermobility, hypermobile Ehlers-Danlos Syndrome, Heart Rate Variability, postural orthostatic tachycardia syndrome, Intraepidermal Nerve Fibre Density, local anaesthetic
license: https://www.repository.cam.ac.uk/bitstreams/7061a1d8-9614-4a9e-bdce-49f6a4430eb6/download
license: http://purl.org/NET/rdflicense/allrightsreserved
date published: 2025-06-17
date modified: 2026-07-22T22:23:59Z
provider: Cambridge University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Cambridge

PropertyValue
property ID: DOI
value: 10.17863/CAM.126933