Cardiovascular rhythms in the 0.15-Hz band: common origin of identical phenomena in man and dog in the reticular formation of the brain stem?

Intracortical brain-heart interplay: An EEG model source study of sympathovagal changes

The interplay between cerebral and cardiovascular activity, known as the functional brain-heart interplay (BHI), and its temporal dynamics, have been linked to a plethora of physiological and pathological processes. Various computational models of the brain-heart axis have been proposed to estimate BHI non-invasively by taking advantage of the time resolution offered by electroencephalograph (EEG) signals. However, investigations into the specific intracortical sources responsible for this interplay have been limited, which significantly hampers existing BHI studies. This study proposes an analytical modeling framework for estimating the BHI at the source-brain level. This analysis relies on the low-resolution electromagnetic tomography sources localization from scalp electrophysiological recordings. BHI is then quantified as the functional correlation between the intracortical sources and cardiovascular dynamics. Using this approach, we aimed to evaluate the reliability of BHI estimates derived from source-localized EEG signals as compared with prior findings from neuroimaging methods. The proposed approach is validated using an experimental dataset gathered from 32 healthy individuals who underwent standard sympathovagal elicitation using a cold pressor test. Additional resting state data from 34 healthy individuals has been analysed to assess robustness and reproducibility of the methodology. Experimental results not only confirmed previous findings on activation of brain structures affecting cardiac dynamics (e.g., insula, amygdala, hippocampus, and anterior and mid-cingulate cortices) but also provided insights into the anatomical bases of brain-heart axis. In particular, we show that the bidirectional activity of electrophysiological pathways of functional brain-heart communication increases during cold pressure with respect to resting state, mainly targeting neural oscillations in theδ $$ \delta $$ ,β $$ \beta $$ , andγ $$ \gamma $$ bands. The proposed approach offers new perspectives for the investigation of functional BHI that could also shed light on various pathophysiological conditions.

On the cardiorespiratory coordination assessed by the photoplethysmography imaging technique

Cardiorespiratory coordination (CRC) probes the interaction between cardiac and respiratory oscillators in which cardiac and respiratory activity are synchronized, with individual heartbeats occurring at approximately the same temporal positions during several breathing cycles. An increase of CRC has previously been related to pathological stressful states. We studied CRC employing coordigrams computed from non-contact photoplethysmography imaging (PPGI) and respiratory data using the optical flow method. In a blocked study design, we applied the cold pressure test (CPT), water at ambient temperature (AWT), and intermittent resting conditions. In controls (no intervention), CRC remained on initial low levels throughout measurements. In the experimental group (AWT and CPT intervention), CRC decreased during AWT and CPT. Following both interventions, CRC increased significantly, with a rebound effect following AWT. In controls, HR increased steadily over time. CPT evoked a significant HR increase which correlated with subjective stress/pain ratings. The CRC increase following AWT correlated significantly with subjective pain (r = .79) and stress (r = .63) ratings. Furthermore, we observed a significant correlation (r = - .80) between mean RMSSD and mean duration of CRC, which further supports an association between autonomic state and CRC level. CRC analysis obtained from cutaneous tissue perfusion data therefore appears to be a sensitive and useful method for the study of CRC and ANS activity. Future studies need to investigate the physiological principles and clinical significance of these findings.

Validation of subjective manual palpation using objective physiological recordings of the cranial rhythmic impulse during osteopathic manipulative intervention

Intermediate (IM) band physiology in skin blood flow exhibits parallels with the primary respiratory mechanism (PRM) or cranial rhythmic impulse (CRI), controversial concepts of osteopathy in the cranial field (OCF). Owing to inconsistent manual palpation results, validity of evidence of PRM/CRI activity has been questionable. We therefore tried to validate manual palpation combining instrumented tracking and algorithmic objectivation of frequencies, amplitudes, and phases. Using a standard OCF intervention, cranial vault hold (CVH), two OCF experts palpated and digitally marked CRI frequencies in 25 healthy adults. Autonomic nervous system (ANS) activity in low frequency (LF) and IM band in photoplethysmographic (PPG) forehead skin recordings was probed with momentary frequency of highest amplitude (MFHA) and wavelet amplitude spectra (WAS) in examiners and participants. Palpation errors and frequency expectation bias during CVH were analyzed for phases of MFHA and CRI. Palpated CRI frequencies (0.05-0.08 Hz) correlated highly with mean MFHA frequencies with 1:1 ratio in 77% of participants (LF-responders; 0.072 Hz) and with 2:1 ratio in 23% of participants (IM-responders; 0.147 Hz). WAS analysis in both groups revealed integer number (harmonic) waves in (very) low and IM bands in > 98% of palpated intervals. Phase analyses in participants and examiners suggested synchronization between MFHA and CRI in a subset of LF-responders. IM band physiology in forehead PPG may offer a sensible physiological correlate of palpated CRI activity. Possible coordination or synchronization effects with additional physiological signals and between examiners and participants should be investigated in future studies.

Analysis of Respiratory Sinus Arrhythmia and Directed Information Flow between Brain and Body Indicate Different Management Strategies of fMRI-Related Anxiety

Background: Respiratory sinus arrhythmia (RSA) denotes decrease of cardiac beat-to-beat intervals (RRI) during inspiration and RRI increase during expiration, but an inverse pattern (termed negative RSA) was also found in healthy humans with elevated anxiety. It was detected using wave-by-wave analysis of cardiorespiratory rhythms and was considered to reflect a strategy of anxiety management involving the activation of a neural pacemaker. Results were consistent with slow breathing, but contained uncertainty at normal breathing rates (0.2–0.4 Hz). Objectives and methods: We combined wave-by-wave analysis and directed information flow analysis to obtain information on anxiety management at higher breathing rates. We analyzed cardiorespiratory rhythms and blood oxygen level-dependent (BOLD) signals from the brainstem and cortex in 10 healthy fMRI participants with elevated anxiety. Results: Three subjects with slow respiratory, RRI, and neural BOLD oscillations showed 57 ± 26% negative RSA and significant anxiety reduction by 54 ± 9%. Six participants with breathing rate of ~0.3 Hz showed 41 ± 16% negative RSA and weaker anxiety reduction. They presented significant information flow from RRI to respiration and from the middle frontal cortex to the brainstem, which may result from respiration-entrained brain oscillations, indicating another anxiety management strategy. Conclusion: The two analytical approaches applied here indicate at least two different anxiety management strategies in healthy subjects.

Respiration-entrained brain oscillations in healthy fMRI participants with high anxiety

Brain-body interactions can be studied by using directed coupling measurements of fMRI oscillations in the low (0.1-0.2 Hz) and high frequency bands (HF; 0.2-0.4 Hz). Recently, a preponderance of oscillations in the information flow between the brainstem and the prefrontal cortex at around 0.15/0.16 Hz was shown. The goal of this study was to investigate the information flow between BOLD-, respiratory-, and heart beat-to-beat interval (RRI) signals in the HF band in healthy subjects with high anxiety during fMRI examinations. A multivariate autoregressive model was concurrently applied to the BOLD signals from the middle frontal gyrus (MFG), precentral gyrus and the brainstem, as well as to respiratory and RRI signals. Causal coupling between all signals was determined using the Directed Transfer Function (DTF). We found a salience of fast respiratory waves with a period of 3.1 s (corresponding to ~ 0.32 Hz) and a highly significant (p < 0.001) top-down information-flow from BOLD oscillations in the MFG to the brainstem. Additionally, there was a significant (p < 0.01) information flow from RRI to respiratory oscillations. We speculate that brain oscillations around 0.32 Hz, triggered by nasal breathing, are projected downwards to the brainstem. Particularly interesting is the driving force of cardiac to respiratory waves with a ratio of 1:1 or 1:2. These results support the binary hierarchy model with preferred respiratory frequencies at 0.32 Hz and 0.16 Hz.

Processing of fMRI-related anxiety and information flow between brain and body revealed a preponderance of oscillations at 0.15/0.16 Hz

Slow oscillations of different center frequencies and their coupling play an important role in brain-body interactions. The crucial question analyzed by us is, whether the low frequency (LF) band (0.05-0.15 Hz) or the intermediate frequency (IMF) band (0.1-0.2 Hz) is more eminent in respect of the information flow between body (heart rate and respiration) and BOLD signals in cortex and brainstem. A recently published study with the LF band in fMRI-naïve subjects revealed an intensive information flow from the cortex to the brainstem and a weaker flow from the brainstem to the cortex. The comparison of both bands revealed a significant information flow from the middle frontal gyrus (MFG) to the precentral gyrus (PCG) and from brainstem to PCG only in the IMF band. This pattern of directed coupling between slow oscillations in the cortex and brainstem not only supports the existence of a pacemaker-like structure in brainstem, but provides first evidence that oscillations centered at 0.15/0.16 Hz can also emerge in brain networks. BOLD oscillations in resting states are dominating at ~ 0.08 Hz and respiratory rates at ~ 0.32 Hz. Therefore, the frequency component at ~ 0.16 Hz (doubling-halving 0.08 Hz or 0.32 Hz) is of special interest, because phase coupled oscillations can reduce the energy demand.

Unexpected Cardiovascular Oscillations at 0.1 Hz During Slow Speech Guided Breathing (OM Chanting) at 0.05 Hz

Slow breathing at 0.1 Hz (i.e., 6 cycles per minute, cpm) leads to strong cardiovascular oscillations. However, the impact of breathing below 6 cpm is rarely addressed. We investigated the influence of OM chanting, an ancient Indian mantra, with approx. 3 respiratory cpm (0.05 Hz) on the synchronisation of heart period (RR), respiration (RESP) and systolic blood pressure (SBP). Nine healthy, trained speech practitioners chanted three sequences of five subsequent OM with 2 min pauses in between. Each single OM chanting consisted of taking a deep breath and a long “OM” during expiration and lasted approx. 20 s. ECG, respiration and blood pressure were recorded continuously, of which the RR tachogram, RESP and SBP were derived. Synchronisation between the signals was computed using the phase difference between two signals. During OM chanting synchronisation among the oscillations of RR, SBP and RESP was significantly increased compared to rest. Furthermore, OM chanting at breathing frequencies between 0.046 and 0.057 Hz resulted in 0.1 Hz oscillations in RR and SBP. In conclusion, OM chanting strongly synchronized cardiorespiratory and blood pressure oscillations. Unexpected oscillations at 0.1 Hz in SBP and RR appear at breathing frequencies of approx. 0.05 Hz. Such frequency doubling may originate from an interaction of breathing frequency with endogenous Mayer waves.

On the spatial phase distribution of cutaneous low-frequency perfusion oscillations

Distributed cutaneous tissue blood volume oscillations contain information on autonomic nervous system (ANS) regulation of cardiorespiratory activity as well as dominating thermoregulation. ANS associated with low-frequency oscillations can be quantified in terms of frequencies, amplitudes, and phase shifts. The relative order between these faculties may be disturbed by conditions colloquially termed ‘stress’. Photoplethysmography imaging, an optical non-invasive diagnostic technique provides information on cutaneous tissue perfusion in the temporal and spatial domains. Using the cold pressure test (CPT) in thirteen healthy volunteers as a well-studied experimental intervention, we present a method for evaluating phase shifts in low- and intermediate frequency bands in forehead cutaneous perfusion mapping. Phase shift changes were analysed in low- and intermediate frequency ranges from 0.05 Hz to 0.18 Hz. We observed that time waveforms increasingly desynchronised in various areas of the scanned area throughout measurements. An increase of IM band phase desynchronization observed throughout measurements was comparable in experimental and control group, suggesting a time effect possibly due to overshooting the optimal relaxation duration. CPT triggered an increase in the number of points phase-shifted to the reference that was specific to the low frequency range for phase-shift thresholds defined as π/4, 3π/8, and π/2 rad, respectively. Phase shifts in forehead blood oscillations may infer changes of vascular tone due to activity of various neural systems. We present an innovative method for the phase shift analysis of cutaneous tissue perfusion that appears promising to assess ANS change processes related to physical or psychological stress. More comprehensive studies are needed to further investigate the reliability and physiological significance of findings.

Negative respiratory sinus arrhythmia (nRSA) in the MRI-scanner - a physiologic phenomenon observed during elevated anxiety in healthy persons

Recently, we reported on a rare manifestation of respiratory sinus arrhythmia (RSA), namely the "switched-off" RSA (Rassler et al., 2018), also called negative RSA (nRSA). It was found in a minority of healthy persons during elevated fMRI-related anxiety characterized by slow spontaneous breathing and synchronous slow beat-to-beat interval (RRI) oscillations. From 23 healthy scanner naïve participants of an fMRI study consisting of 4 resting states, we selected resting states with highest state anxiety (AS) from 10 participants (AS=24.6±2.5) and compared them to those with lowest AS of the same participants (AS=15.1±3.8, p<0.001). During elevated anxiety, the percentage of nRSA (nRSA%) was more than twice of RSA (p=0.045), while RSA prevailed during low anxiety. This indicates that nRSA might be related to elevated anxiety. Interestingly, nRSA was not only associated with slow RRI and breathing oscillations, but also occurred at "normal" breathing rates in the 0.20-0.35 Hz range. We often observed coupled RRI oscillations at 0.1 or 0.15 Hz and respiration at 0.3 Hz (rate ratio 1:3 or 1:2) with respiration-synchronous 0.3 Hz-wavelets in the RRI rhythm (termed "superposition") indicating a reduced dominance of the respiratory rhythm over the RRI rhythm. This novel finding is supported by the work of Perlitz et al., (2004) on a "0.15 Hz rhythm" in brainstem. The concept behind such a 1:n ratio is a pacemaker-like rhythm in the brainstem that "drives" the cardiac RRI signal and secondarily also respiration as reflected in the 1:n rate ratio.

Processing of fMRI-related anxiety and bi-directional information flow between prefrontal cortex and brain stem

Brain-heart synchronization is fundamental for emotional-well-being and brain-heart desynchronization is characteristic for anxiety disorders including specific phobias. Recording BOLD signals with functional magnetic resonance imaging (fMRI) is an important noninvasive diagnostic tool; however, 1-2% of fMRI examinations have to be aborted due to claustrophobia. In the present study, we investigated the information flow between regions of interest (ROI's) in the cortex and brain stem by using a frequency band close to 0.1 Hz. Causal coupling between signals important in brain-heart interaction (cardiac intervals, respiration, and BOLD signals) was studied by means of Directed Transfer Function based on the Granger causality principle. Compared were initial resting states with elevated anxiety and final resting states with low or no anxiety in a group of fMRI-naïve young subjects. During initial high anxiety the results showed an increased information flow from the middle frontal gyrus (MFG) to the pre-central gyrus (PCG) and to the brainstem. There also was an increased flow from the brainstem to the PCG. While the top-down flow during increased anxiety was predominant, the weaker ascending flow from brainstem structures may characterize a rhythmic pacemaker-like activity that (at least in part) drives respiration. We assume that these changes in information flow reflect successful anxiety processing.

MRI-related anxiety can induce slow BOLD oscillations coupled with cardiac oscillations

OBJECTIVE

Although about 1-2% of MRI examinations must be aborted due to anxiety, there is little research on how MRI-related anxiety affects BOLD signals in resting states.

METHODS

We re-analyzed cardiac beat-to beat interval (RRI) and BOLD signals of 23 healthy fMRI participants in four resting states by calculation of phase-coupling in the 0.07-0.13 Hz band and determination of positive time delays (pTDs; RRI leading neural BOLD oscillations) and negative time delays (nTDs; RRI lagging behind vascular BOLD oscillations). State anxiety of each subject was assigned to either a low anxiety (LA) or a high anxiety (HA, with most participants exhibiting moderate anxiety symptoms) category based on the inside scanner assessed anxiety score.

RESULTS

Although anxiety strongly differed between HA and LA categories, no significant difference was found for nTDs. In contrast, pTDs indicating neural BOLD oscillations exhibited a significant cumulation in the high anxiety category.

CONCLUSIONS

Findings may suggest that vascular BOLD oscillations related to slow cerebral blood circulation are of about similar intensity during low/no and elevated anxiety. In contrast, neural BOLD oscillations, which might be associated with a central rhythm generating mechanism (pacemaker-like activity), appear to be significantly intensified during elevated anxiety.

SIGNIFICANCE

The study provides evidence that fMRI-related anxiety can activate a central rhythm generating mechanism very likely located in the brain stem, associated with slow neural BOLD oscillation.

Phase Velocity of Facial Blood Volume Oscillation at a Frequency of 0.1 Hz

Facial blood flow, which typically exhibits distinctive oscillation at a frequency of around 0.1 Hz, has been extensively studied. Although this oscillation may include important information about blood flow regulation, its origin remains unknown. The spatial phase distribution of the oscillation is thus desirable. Therefore, we visualized facial blood volume oscillation at a frequency of around 0.1 Hz using a digital camera imaging method with an improved approximation equation, which enabled precise analysis over a large area. We observed a slow spatial movement of the 0.1-Hz oscillation. The oscillation phase was not synchronized, but instead moved slowly. The phase velocity varies with person, measurement location, and time. An average phase velocity of 3.8 mm/s was obtained for several subjects. The results are consistent with previous studies; however, the conventional explanation that the blood flow at a certain point oscillates independently of adjacent areas should be corrected. If the primary origin of the movement is myogenic activity, the movement may ascend along a blood vessel toward the upstream. Otherwise, the oscillation and its propagation can be considered to be related to Mayer waves. By determining the mechanism, some questions regarding Mayer waves can be answered. The direction of the wave (upstream or downstream) provides important information.

Verification of a Central Pacemaker in Brain Stem by Phase-Coupling Analysis Between HR Interval- and BOLD-Oscillations in the 0.10-0.15 Hz Frequency Band

The origin of slow intrinsic oscillations in resting states of functional magnetic resonance imaging (fMRI) signals is still a matter of debate. The present study aims to test the hypothesis that slow blood oxygenation level-dependent (BOLD) oscillations with frequency components greater than 0.10 Hz result from a central neural pacemaker located in the brain stem. We predict that a central oscillator modulates cardiac beat-to-beat interval (RRI) fluctuations rapidly, with only a short neural lag around 0.3 s. Spontaneous BOLD fluctuations in the brain stem, however, are considerably delayed due to the hemodynamic response time of about ∼2–3 s. In order to test these predictions, we analyzed the time delay between slow RRI oscillations from thorax and BOLD oscillations in the brain stem by calculating the phase locking value (PLV). Our findings show a significant time delay of 2.2 ± 0.2 s between RRI and BOLD signals in 12 out of 23 (50%) participants in axial slices of the pons/brain stem. Adding the neural lag of 0.3 s to the observed lag of 2.2 s we obtain 2.5 s, which is the time between neural activity increase and BOLD increase, termed neuro-BOLD coupling. Note, this time window for neuro-BOLD coupling in awake humans is surprisingly of similar size as in awake head-fixed adult mice (Mateo et al., 2017).

Low-frequency facial hemodynamic oscillations distinguish migraineurs from non-headache controls

Background

Surface imaging is a promising, noninvasive approach to assess regional perfusion in craniovascular disorders such as migraine.

Methods

We used optical imaging to examine differences in facial blood volume at baseline and in response to ammonia inhalation (a noxious stimulus), as well as standardized measures of cardiovascular autonomic function, in healthy, non-headache controls (n = 43) and in interictal migraine subjects (n = 22).

Results

Resting facial cutaneous oscillation (FCO) frequency was significantly different in migraine compared to healthy controls. Following ammonia inhalation, healthy controls showed a significant increase in resting FCO frequency, whereas this response was not significant in the migraine group. Standardized autonomic reflex parameters did not differ significantly between study groups, and facial cutaneous activity did not correlate with standardized cardiovascular autonomic reflex parameters, suggesting potentially different regulation.

Conclusions

This approach to the assessment of craniofacial hemodynamic function appears to exhibit differing mechanisms from previously available techniques, and represents a promising new physiological biomarker for the study of craniofacial vascular function in migraine and potentially other craniovascular disorders.

"Switch-Off" of Respiratory Sinus Arrhythmia May Be Associated With the Activation of an Oscillatory Source (Pacemaker) in the Brain Stem

Recently, we reported on the unusual “switch-off” of respiratory sinus arrhythmia (RSA) by analyzing heart rate (HR) beat-to-beat interval (RRI) signals and respiration in five subjects during a potentially anxiety-provoking first-time functional magnetic resonance imaging (fMRI) scanning with slow spontaneous breathing waves (Rassler et al., 2018). This deviation from a fundamental physiological phenomenon is of interest and merits further research. Therefore, in this study, the interplay between blood-oxygen level-dependent (BOLD) activity in the cerebellum/brain stem, RRI, and respiration was probed. Both the cardiovascular and the respiratory centers are located in the medulla oblongata and pons, indicating that dominant slow rhythmic activity is present in the brain stem. The recording of BOLD signals provides a way to investigate associated neural activity fluctuation in the brain stem. We found slow spontaneous breathing waves associated with two types of slow BOLD oscillations with dominant frequencies at 0.10 and 0.15 Hz in the brain stem. Both BOLD oscillations were recorded simultaneously. One is hypothesized as vessel motion-based phenomenon (BOLDv) associated with the start of expiration; the other one as pattern associated with neural activity (BOLDn) acting as a driving force for spontaneous inspiration and RRI increase (unusual cessation of RSA) about 2–3 s after BOLDv. This time delay of 2–3 s corresponds to the neurovascular coupling time.

Motivational Non-directive Resonance Breathing as a Treatment for Chronic Widespread Pain

Chronic widespread pain (CWP) is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational non-directive (ND) resonance breathing, as a means of reducing pain and suffering in patients with CWP. Motivational ND resonance breathing provides patients with a noninvasive means of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life.

"Switch-Off" of Respiratory Sinus Arrhythmia Can Occur in a Minority of Subjects During Functional Magnetic Resonance Imaging (fMRI)

A group of 23 healthy scanner naïve participants of a functional magnetic resonance imaging (fMRI) study with increased state anxiety exhibited 0.1 Hz oscillations in blood-oxygenation-level-dependent (BOLD) signals, heart rate (HR) beat-to-beat intervals (RRI) and respiration. The goal of the present paper is to explore slow oscillations in respiration and RRI and their phase-coupling by applying the dynamic "wave-by-wave" analysis. Five participants with either high or moderate levels of fMRI-related anxiety (age 23.8 ± 3.3y) were found with at least one bulk of consecutive breathing waves with a respiration rate between 6 to 9 breaths/min in a 5-min resting state. The following results were obtained: (i) Breathing oscillations with dominant frequencies at 0.1 Hz and 0.15 Hz displayed a 1:1 coupling with RRI. (ii) Inspiration time was significantly longer than expiration time. (iii) RRI minima (start of HR decrease) coincided with the early inspiration, and RRI maxima (start of HR increase) coincided with the late inspiration. (iv) RRI rhythm led over the respiratory rhythm. This phase-coupling pattern is quite contrary to typical respiratory sinus arrhythmia where HR increases during inspiration and decreases during expiration.

Synchronization of intrinsic 0.1-Hz blood-oxygen-level-dependent oscillations in amygdala and prefrontal cortex in subjects with increased state anxiety

Low-frequency oscillations with a dominant frequency at 0.1 Hz are one of the most influential intrinsic blood-oxygen-level-dependent (BOLD) signals. This raises the question if vascular BOLD oscillations (originating from blood flow in the brain) and intrinsic slow neural activity fluctuations (neural BOLD oscillations) can be differentiated. In this study, we report on two different approaches: first, on computing the phase-locking value in the frequency band 0.07-0.13 Hz between heart beat-to-beat interval (RRI) and BOLD oscillations and second, between multiple BOLD oscillations (functional connectivity) in four resting states in 23 scanner-naïve, anxious healthy subjects. The first method revealed that vascular 0.1-Hz BOLD oscillations preceded those in RRI signals by 1.7 ± 0.6 s and neural BOLD oscillations lagged RRI oscillations by 0.8 ± 0.5 s. Together, vascular BOLD oscillations preceded neural BOLD oscillations by ~90° or ~2.5 s. To verify this discrimination, connectivity patterns of neural and vascular 0.1-Hz BOLD oscillations were compared in 26 regions involved in processing of emotions. Neural BOLD oscillations revealed significant phase-coupling between amygdala and medial frontal cortex, while vascular BOLD oscillations showed highly significant phase-coupling between amygdala and multiple regions in the supply areas of the anterior and medial cerebral arteries. This suggests that not only slow neural and vascular BOLD oscillations can be dissociated but also that two strategies may exist to optimize regulation of anxiety, that is increased functional connectivity between amygdala and medial frontal cortex, and increased cerebral blood flow in amygdala and related structures.

Evaluation of stress response using psychological, biological, and electrophysiological markers during immersive simulation of life threatening events in multidisciplinary teams

Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men, <7years of experience) were included. Measures were performed at baseline (T0), after simulation (T1), after debriefing (T2), and 30min after debriefing (T3). There was an increase in stress level at T1 (p<0.001) and a decrease at T2 (p<0.001). However, the variations of stress parameters induced by simulation (T0-T1 difference and T1-T2 difference) estimated by the three approaches were not correlated, while, as expected, Holter parameters were well-correlated to each other. Immersive SBE produced a change of stress level in all MDT members with no evidence for status effect but with gender difference. None developed a PTSD. These results support the hypothesis of a complementarity of the stress paths (collective reaction with increased stress level during simulation and a decrease during debriefing) but with relative independence of these paths (lack of correlation to each other). This study also suggests that because of the lack of correlation, stress response should be assessed by a combination of psychological, biological and electrophysiological parameters.

Cardiac cycle time effects on selection efficiency in vision

The effect of cardiac cycle time on attentional selection was investigated in an experiment in which participants classified target letters in a visual selection task. Stimulus onsets were aligned to the R wave of the electrocardiogram and stimuli presented either during the ventricular systole or diastole. Selection efficiency was operationalized as difference in target selection performance under conditions of homogeneous and heterogeneous distractors. Differences in performance (i.e., the impact selection difficulty had on the ability to select the target) were attenuated for stimuli presented during the ventricular systole compared to the diastole. Increased baroafferent signal transmission during the systole appears to reduce interference of highly distracting stimuli on visual selection efficiency.

State Anxiety and Nonlinear Dynamics of Heart Rate Variability in Students

OBJECTIVES

Clinical and experimental research studies have demonstrated that the emotional experience of anxiety impairs heart rate variability (HRV) in humans. The present study investigated whether changes in state anxiety (SA) can also modulate nonlinear dynamics of heart rate.

METHODS

A group of 96 students volunteered to participate in the study. For each student, two 5-minute recordings of beat intervals (RR) were performed: one during a rest period and one just before a university examination, which was assumed to be a real-life stressor. Nonlinear analysis of HRV was performed. The Spielberger's State-Trait Anxiety Inventory was used to assess the level of SA.

RESULTS

Before adjusting for heart rate, a Wilcoxon matched pairs test showed significant decreases in Poincaré plot measures, entropy, largest Lyapunov exponent (LLE), and pointwise correlation dimension (PD2), and an increase in the short-term fractal-like scaling exponent of detrended fluctuation analysis (α1) during the exam session, compared with the rest period. A Pearson analysis indicated significant negative correlations between the dynamics of SA and Poincaré plot axes ratio (SD1/SD2), and between changes in SA and changes in entropy measures. A strong negative correlation was found between the dynamics of SA and LLE. A significant positive correlation was found between the dynamics of SA and α1. The decreases in Poincaré plot measures (SD1, complex correlation measure), entropy measures, and LLE were still significant after adjusting for heart rate. Corrected α1 was increased during the exam session. As before, the dynamics of adjusted LLE was significantly correlated with the dynamics of SA.

CONCLUSIONS

The qualitative increase in SA during academic examination was related to the decrease in the complexity and size of the Poincaré plot through a reduction of both the interbeat interval and its variation.

Coupling between intrinsic prefrontal HbO2 and central EEG beta power oscillations in the resting brain

There is increasing interest in the intrinsic activity in the resting brain, especially that of ultraslow and slow oscillations. Using near-infrared spectroscopy (NIRS), electroencephalography (EEG), blood pressure (BP), respiration and heart rate recordings during 5 minutes of rest, combined with cross spectral and sliding cross correlation calculations, we identified a short-lasting coupling (duration [Formula: see text] s) between prefrontal oxyhemoglobin (HbO2) in the frequency band between 0.07 and 0.13 Hz and central EEG alpha and/or beta power oscillations in 8 of the 9 subjects investigated. The HbO2 peaks preceded the EEG band power peaks by 3.7 s in 6 subjects, with moderate or no coupling between BP and HbO2 oscillations. HbO2 and EEG band power oscillations were approximately in phase with BP oscillations in the 2 subjects with an extremely high coupling (squared coherence [Formula: see text]) between BP and HbO2 oscillation. No coupling was identified in one subject. These results indicate that slow precentral (de)oxyhemoglobin concentration oscillations during awake rest can be temporarily coupled with EEG fluctuations in sensorimotor areas and modulate the excitability level in the brains' motor areas, respectively. Therefore, this provides support for the idea that resting state networks fluctuate with frequencies of between 0.01 and 0.1 Hz (Mantini et.al. PNAS 2007).

Effects of a facial nerve lesion on responses in forehead microvessels to conjunctival irritation and paced breathing

To investigate parasympathetic influences on the forehead microvasculature, blood flow was monitored bilaterally in seven participants with a unilateral facial nerve lesion during conjunctival irritation with Schirmer's strips and while breathing at 0.15 Hz. Blood flow and slow-wave frequency increased on the intact side of the forehead during Schirmer's test but did not change on the denervated side. However, a 0.15 Hz vascular wave strengthened during paced breathing, particularly on the denervated side. These findings indicate that parasympathetic activity in the facial nerve increases forehead blood flow during minor conjunctival irritation, but may interfere with the 0.15 Hz vascular wave.

Facial nerve activity disrupts psychomotor rhythms in the forehead microvasculature

Forehead blood flow was monitored in seven participants with a unilateral facial nerve lesion during relaxation, respiratory biofeedback and a sad documentary. Vascular waves at 0.1Hz strengthened during respiratory biofeedback, in tune with breathing cycles that also averaged 0.1Hz. In addition, a psychomotor rhythm at 0.15Hz was more prominent in vascular waveforms on the denervated than intact side of the forehead, both before and during relaxation and the sad documentary. These findings suggest that parasympathetic activity in the facial nerve interferes with the psychomotor rhythm in the forehead microvasculature.

Does conscious intention to perform a motor act depend on slow cardiovascular rhythms?

Slow oscillations around 0.1 Hz are characteristic features of both the cardiovascular and central nervous systems. Such oscillation have been reported, e.g. in blood pressure, heart rate, EEG and brain oxygenation. Hence, conscious intention of a motor act may occur only as a result of brain activity changes in frontal and related brain areas, or might be entrained by slow oscillations in the blood pressure. Twenty-six subjects were asked to perform voluntary, self-paced (at free will) brisk finger movements. Some subjects performed self-paced movements in relatively periodic intervals of around 10s at the decreasing slope of the slow 0.1-Hz blood pressure oscillation. Our study reveals the first time that self-paced movements, at least in some subjects, do not stem from "free will" based on brain activity alone, but are influenced by slow blood pressure oscillations.

Effects of stress on heart rate complexity--a comparison between short-term and chronic stress

This study examined chronic and short-term stress effects on heart rate variability (HRV), comparing time, frequency and phase domain (complexity) measures in 50 healthy adults. The hassles frequency subscale of the combined hassles and uplifts scale (CHUS) was used to measure chronic stress. Short-term stressor reactivity was assessed with a speech task. HRV measures were determined via surface electrocardiogram (ECG). Because respiration rate decreased during the speech task (p<.001), this study assessed the influence of respiration rate changes on the effects of interest. A series of repeated-measures analyses of covariance (ANCOVA) with Bonferroni adjustment revealed that short-term stress decreased HR D2 (calculated via the pointwise correlation dimension PD2) (p<.001), but increased HR mean (p<.001), standard deviation of R-R (SDRR) intervals (p<.001), low (LF) (p<.001) and high frequency band power (HF) (p=.009). Respiratory sinus arrhythmia (RSA) and LF/HF ratio did not change under short-term stress. Partial correlation adjusting for respiration rate showed that HR D2 was associated with chronic stress (r=-.35, p=.019). Differential effects of chronic and short-term stress were observed on several HRV measures. HR D2 decreased under both stress conditions reflecting lowered functionality of the cardiac pacemaker. The results confirm the importance of complexity metrics in modern stress research on HRV.

Detection of activation phases and quantification of coupling in NREM sleep EEG by pointwise transinformation

BACKGROUND

The coupling dynamics of two time series can be assessed by pointwise transinformation (PTI). Due to its high temporal resolution, this algorithm is ideal for analysis of sleep microstructure. Different types of electroencephalographic (EEG) activation phases, like single K-complexes, K-complexes associated with spindle or alpha activity, K-complexes mixed with delta waves, and arousals, can be detected and changes in EEG coupling can be quantified.

METHODS

Nine hundred ninety-one one-minute EEG segments (C3-A2/C4-A1) containing the described types of activation phases were selected from the sleep EEGs of 12 healthy persons. PTI was calculated with 250 Hz resolution and an embedding dimension of 20. An averaged PTI curve was assessed for single K-complexes and K-complexes followed by spindle and alpha activity, respectively.

RESULTS

During background activity, PTI was nearly 0. With the onset of a K-complex, PTI increased significantly in a sequence of distinct phases (rising - peak - decay). For single K-complexes, the PTI curve had a nearly symmetric dome-shaped form. The decay phase was prolonged by subsequent spindle or alpha activity. In K-complexes mixed with delta activity and in arousals, repetitive maxima of PTI were obtained. The durations of arousals and their coupling phases were correlated (r=0.83).

CONCLUSIONS

PTI displays the coupling dynamics of the sleep EEG with high resolution. It detects phases of activation represented by single K-complexes and various types of arousals. These induce a specific run of the PTI curve clearly distinguishable from background activity. PTI might, therefore, prove useful in the analysis of sleep microstructure.

Coordination dynamics of circulatory and respiratory rhythms during psychomotor drive reduction

A 0.15-Hz rhythm band in cutaneous blood oscillations in awake human subjects was studied in cardiovascular-respiratory time series of five subjects relaxing naïvely or practicing hypnoid relaxation (autogenic training, or AT). Time series analysis used nonlinear algorithms, time-frequency distribution (TFD), postevent scan (PES) method, and linear fast Fourier transform (FFT) algorithm. This 0.15-Hz rhythm band caused phase synchronization with respiration at 1:2, 1:1, and 2:1 integer number (n/m) ratios for extended periods. During wave epochs, the 0.15-Hz rhythm band was amplified, causing the 0.15-Hz rhythm band to also appear in interbeat intervals and arterial blood pressure fluctuations. If phase synchronization of the 0.15-Hz rhythm band with respiration was established at a 1:1 integer number ratio, it was maintained and resulted in consensualization of all cardiovascular-respiratory oscillations at this frequency. Simultaneous cardiovascular and respiratory oscillations at about 0.1 Hz did not affect the appearance of the 0.15-Hz rhythm band in the photoplethysmography (PPG) signal. Recent evidence suggests the emergence of the 0.15-Hz rhythm band and n/m phase synchronization to result from nonequilibrium phase transitions operational in the network of lower brainstem neurons and associated parasympathetic neuronal effectors. These findings corroborate our notion of the 0.15-Hz rhythm band as a marker of the trophotropic mode of operation.