Do blood pressure and heart rate responses to perceived stress vary according to endogenous estrogen level in women?

Physiological reactions to acute stressors and subjective stress during daily life: A systematic review on ecological momentary assessment (EMA) studies

OBJECTIVE

This review aims to provide an overview of ecological momentary assessment (EMA) studies analyzing stress reactivity during daily life in terms of direct and moderated influence of acute stress on physiological responses.

MATERIALS AND METHODS

A systematic literature search was performed on November 29, 2021 using Web of Science, MEDLINE and PsycINFO to identify prospective EMA studies targeting acute stressors or stress under naturalistic conditions, without restrictions of publication date or population. Study quality was assessed for multiple EMA-specific sources of bias.

RESULTS

Out of 4285 non-duplicate records, 107 publications involving 104 unique studies were included. The majority of studies assessed acute physiological stress responses primarily through salivary cortisol (n = 59) and cardiovascular outcomes (n = 32). Most studies performed at least three measurements per day (n = 59), and had a moderate risk of recall bias (n = 68) and confounding (n = 85). Fifty-four studies reported a compliance of ≥80%. Direct, non-moderated positive associations were observed between acute stress exposure and concurrent cortisol levels (44%, n = 11/25), systolic (44%, 8/18) and diastolic blood pressure (53%, 8/15) and heart rate (53%, 9/17). Several inter- and intra-individual moderators were identified, such as age, gender, health status, chronic stress, work-related resources, physical activity and stress coping indicators.

CONCLUSIONS

About half of the reviewed EMA studies demonstrated direct associations between everyday acute stress exposure and physiological responses, including increased cortisol levels, blood pressure and heart rate. Results further suggested various moderator variables that could help develop tailored prevention strategies and identify groups at higher risk for dysfunctional stress responses.

REGISTRATION

PROSPERO-Reg.-No.: PROSPERO 2020 CRD42020163178.

Acute physiological response to a normobaric hypoxic exposure: sex differences

Although preliminary studies suggested sex-related differences in physiological responses to altitude/hypoxia, controlled studies from standardised exposures to normobaric hypoxia are largely lacking. Hence, the goals of this study were to provide information on cardiorespiratory responses to a 7-h normobaric hypoxia exposure and to explore potential differences between men and women. In this crossover study, a total of 15 men and 14 women were subjected to a 7-h exposure in normoxia (FiO₂: 21%) and normobaric hypoxia (FiO₂: 15%). Values of peripheral oxygen saturation, heart rate, systolic and diastolic blood pressure and respiratory gases were recorded every hour (8 time points), and oxygen saturation every 30 min (15 time points). Compared to normoxia, exposure to hypoxia significantly increased minute ventilation from baseline to hour 7 in males (+ 71%) and females (+ 40%), significantly greater in men (p < 0.05). A steeper decrease in peripheral oxygen saturation until 2.5 h in hypoxia was seen in females compared to males (p < 0.05). In conclusion, the ventilatory response to hypoxia was more pronounced in men compared to women. Moreover, during the first hours in hypoxia, peripheral oxygen saturation dropped more markedly in women than in men, likely due an initially lower and/or less efficient ventilatory response to moderate hypoxia. Those findings should be considered when performing interventions for therapy or prevention in normobaric hypoxia. Nevertheless, further large-scaled and well-controlled studies are needed.

The association between self-reported stress and cardiovascular measures in daily life: A systematic review

BACKGROUND

Stress plays an important role in the development of mental illness, and an increasing number of studies is trying to detect moments of perceived stress in everyday life based on physiological data gathered using ambulatory devices. However, based on laboratory studies, there is only modest evidence for a relationship between self-reported stress and physiological ambulatory measures. This descriptive systematic review evaluates the evidence for studies investigating an association between self-reported stress and physiological measures under daily life conditions.

METHODS

Three databases were searched for articles assessing an association between self-reported stress and cardiovascular and skin conductance measures simultaneously over the course of at least a day.

RESULTS

We reviewed findings of 36 studies investigating an association between self-reported stress and cardiovascular measures with overall 135 analyses of associations between self-reported stress and cardiovascular measures. Overall, 35% of all analyses showed a significant or marginally significant association in the expected direction. The most consistent results were found for perceived stress, high-arousal negative affect scales, and event-related self-reported stress measures, and for frequency-domain heart rate variability physiological measures. There was much heterogeneity in measures and methods.

CONCLUSION

These findings confirm that daily-life stress-dynamics are complex and require a better understanding. Choices in design and measurement seem to play a role. We provide some guidance for future studies.

Hyper-Frequency Network Topology Changes During Choral Singing

Choral singing requires the coordination of physiological subsystems within and across individuals. Previously, we suggested that the choir functions as a superordinate system that imposes boundary conditions on the dynamic features of the individual singers and found reliable differences in the network topography by analyzing within- and cross-frequency couplings (WFC and CFC, respectively). Here, we further refine our analyses to investigate hyper-frequency network (HFN) topology structures (i.e., the layout or arrangement of connections) using a graph-theoretical approach. In a sample of eleven singers and one conductor engaged in choral singing (aged between 23 and 56 years, and including five men and seven women), we calculated phase coupling (WFC and CFC) between respiratory, cardiac, and vocalizing subsystems across ten frequencies of interest. All these couplings were used for construction of HFN with nodes being a combination of frequency components and subsystems across choir participants. With regard to the network topology measures, we found that clustering coefficients (CCs) as well as local and global efficiency were highest and characteristic path lengths, correspondingly, were shortest when the choir sang a canon in parts as compared to singing it in unison. Furthermore, these metrics revealed a significant relationship to individual heart rate, as an indicator of arousal, and to an index of heart rate variability indicated by the LF/HF ratio (low and high frequency, respectively), and reflecting the balance between sympathetic and parasympathetic activity. In addition, we found that the CC and local efficiency for groups singing the same canon part were higher than for groups of singers constructed randomly post hoc, indicating stronger neighbor–neighbor connections in the former. We conclude that network topology dynamics are a crucial determinant of group behavior and may represent a potent biomarker for social interaction.

Effects of sex and menstrual cycle phase on cardiac response and alpha- amylase levels in psychosocial stress

The impact of sex and the menstrual cycle phase on the autonomic response to psychosocial stress remains controversial. This study explored autonomic nervous system activity through salivary alpha-amylase, heart rate, and heart rate variability responses to the Trier Social Stress Test (TSST) in healthy young people. The sample was composed of 25 men, 26 women in the luteal phase, and 25 women in the follicular phase, from 18 to 25 years of age. Participants were exposed to the TSST or a control condition. The results indicate that women in their follicular phase showed a blunted alpha-amylase response to stress compared to men and women in the luteal phase. In addition, men showed higher sympatho-vagal activity in the stress condition compared to the two groups of women. These results confirm that sex and the menstrual cycle phase are potential modulators of autonomic nervous system reactivity to psychosocial stress.

Salivary α-amylase and cortisol after exercise in menopause: influence of long-term HRT

OBJECTIVES

This observational prospective study analyzed the effect of an incremental cardiopulmonary exercise test (CPET) on the secretion of salivary biomarkers of the adrenergic nervous system and hypothalamus-pituitary-adrenal (HPA) axis activity by measuring salivary α-amylase and cortisol diurnal trajectories in the setting of long-term hormone replacement therapy (HRT).

METHODS

Fifteen healthy sedentary postmenopausal women who were current HRT users and 15 women who had never used HRT were consecutively recruited. α-Amylase and cortisol were measured in salivary samples collected on the CPET day and on a rest day. Cardiovascular and respiratory fitness parameters were recorded during the CPET challenge.

RESULTS

The participants had very homogeneous somatic characteristics, and they were all in generally good health. The postmenopausal never-HRT users presented an abnormal diurnal pattern of α-amylase at baseline and a flattened response to CPET. In contrast, women on HRT had a physiological α-amylase diurnal pattern and increased salivary α-amylase production during the CPET-induced challenge. The CPET challenge physiologically activated the HPA axis activity, as shown by the increase in the concentration of salivary cortisol during the effort test. HPA axis activity was not affected by long-term HRT. Postmenopausal women using HRT exhibited a cardiorespiratory functional capacity that was significantly (p < 0.05) higher than that of non-users.

CONCLUSIONS

Our findings show that healthy postmenopausal women present an asymmetry between adrenergic nervous system and HPA axis activities under both basal and stress conditions. HRT was able to modify the abnormal adrenergic nervous system activity, most likely by reducing the sympathetic hyperactivity that characterizes menopause.

Denial is associated with higher ambulatory blood pressure across the menstrual cycle

BACKGROUND

Studies show that stress perception is associated with increased daily ambulatory blood pressure (BP) and that denying the negative effects of stress increases BP as well. Whether these effects persist over the menstrual cycle is unknown.

AIM

To examine the effects of measures of stress and stress denial on ambulatory work and home BP during the follicular and luteal phases of the menstrual cycle.

SUBJECTS AND METHODS

Seventy-one women (age = 34.9 ± 7.7 years) employed as secretaries or technicians wore an ambulatory BP monitor during the follicular (between day 7-10; Mean = 8 ± 2) and luteal (between day 19-25; Mean = 22 ± 2) phases of their cycle. During each phase, relationships between BPs averaged at work and home and various stress measures and demographic and anthropometric variables were examined using stepwise regression.

RESULTS

Ambulatory BPs did not change from the follicular to luteal phase. Stress denial was generally associated with higher ambulatory BP (p < 0.05) over the menstrual cycle, while other parameters had varying effects in different situations (work and home) and cycle phases.

CONCLUSION

Stress denial has a persistent effect on BP, regardless of menstrual phase; however, shifts in the hormonal environment throughout the menstrual cycle may mediate other somatic and behavioural associations with BP.

Mechanisms underlying hemodynamic and neuroendocrine stress reactivity at different phases of the menstrual cycle

This study examined the association of menstrual cycle phase with stress reactivity as well as the hormonal and neuroendocrine mechanisms contributing to cycle effects. Fifty-seven women underwent a modified Trier Social Stress Test during the early follicular, late follicular, and luteal phases of the menstrual cycle. Greater increases in cardiac index (CI) and greater decreases in vascular resistance index (VRI) during speech were observed in the luteal phase relative to other phases, while greater increases in epinephrine (EPI) was observed during the late follicular and luteal phases compared to the early follicular phase. Luteal phase estradiol predicted luteal EPI reactivity but not CI or VRI reactivity, while luteal phase EPI reactivity predicted luteal phase CI and VRI reactivity. Thus, cycle-related changes in EPI reactivity may be a stronger determinant of cycle effects on hemodynamic reactivity than sex hormones per se.

Cardiovascular, hormonal, and emotional responses to the TSST in relation to sex and menstrual cycle phase

The prevalence of stress disorders differs between men and women. An understanding of how men and women vary in acute stress responses may help to understand these sex differences. We compared responses to the TSST and a control task in healthy men (N=28) and women tested in two phases (Follicular N=29, Luteal N=23) of the menstrual cycle. Men exhibited greater cortisol responses to stress than women in either phase. Luteal women exhibited the greatest subjective and allopregnanolone responses to stress, whereas follicular women exhibited blunted noradrenaline responses. Partial correlations controlling for group differences revealed that individuals who were most sensitive to the subjective effects of stress exhibited the largest salivary cortisol, noradrenaline, and allopregnanolone responses and the smallest progesterone responses to stress. We discuss our findings in the context of sex differences in the prevalence of stress-linked disorders.