Applications of the valsalva maneuver in assessing the autonomic nervous system
- Author:
Hyunwoo KANG
1
;
Jin-Woo PARK
Author Information
- Publication Type:Review Article
- From: Annals of Clinical Neurophysiology 2026;28(1):15-21
- CountryRepublic of Korea
- Language:English
- Abstract: The valsalva maneuver is a gold standard test for evaluating cardiovascular autonomic function. By inducing characteristic heart rate and blood pressure changes across four phases, it allows simultaneous assessment of sympathetic and parasympathetic responses. Quantitative indices such as the valsalva ratio, pressure recovery time, and baroreflex sensitivities provide precise evaluation of autonomic reflex pathways. Specific patterns like the square-wave phenomenon offer diagnostic clues to differentiate peripheral from central autonomic disorders. This review summarizes the physiological mechanisms underlying the valsalva maneuver, key derived metrics, and examples of its clinical applications in diagnosing autonomic dysfunction in neurological disorders, including pure autonomic failure, Parkinson’s disease, and amyotrophic lateral sclerosis. Owing to its simplicity, noninvasiveness, and diagnostic utility, the valsalva maneuver remains a fundamental tool in clinical and research settings for autonomic assessment.
