Does depth of squat-stand maneuver affect estimates of dynamic cerebral autoregulation?: Supplementary appendix

Repeated squat-stand maneuvers (SSM) are an effective way of measuring dynamic cerebral autoregulation (dCA), but the depth of SSM required to improve dCA estimations has never been studied. We compared beat-to-beat cerebral hemodynamic parameters between maximal depth SSM (SSM_D) and a shallower alternative (SSM_S) in two age groups [younger (20-34 years) vs older (50-71 years)] at a frequency of 0.05 Hz. Cerebral blood flow velocity, continuous blood pressure (BP) and end-tidal CO₂ (EtCO₂) were measured using transcranial Doppler ultrasound, the Finometer device and capnography, respectively. Coherence (at 0.05 Hz) was significantly higher in both SSM recordings compared to spontaneous BP oscillations at baseline standing (B_S). Median (IQR) autoregulation index (ARI) was reduced during SSM_D (4.46[4.03-5.22], p<0.01) compared to SSM_S (5.96[5.40-6.69]) and B_S (6.03[5.20-6.49], p<0.01) with similar relative differences also observed for phase (at 0.05 Hz). End-tidal CO₂ was increased in SSM_D (38.3 ± 3.7 mmHg, P<0.01) compared to both SSM_S(36.6 ± 3.6 mmHg) and B_S (35.5 ± 3.2 mmHg). The older group demonstrated significantly lower ARI and phase estimates during SSMs and found SSM_S more effortful than SSM_D. In conclusion, both SSM_D and SSM_S are effective at estimating dCA, and dCA appears to be less efficient during maximal depth SSM compared to baseline rest or a shallower alternative.