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Adam J, Rupprecht S, Künstler ECS, Hoyer D. Heart rate variability as a marker and predictor of inflammation, nosocomial infection, and sepsis - A systematic review. Auton Neurosci 2023; 249:103116. [PMID: 37651781 DOI: 10.1016/j.autneu.2023.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE The autonomic nervous system interacts with the immune system via the inflammatory response. Heart rate variability (HRV), a marker of autonomic activity, is associated with inflammation, and nosocomial infections/sepsis, and has clinical implications for the monitoring of at-risk patients. Due to the vagal tone's influence on anti-inflammatory immune response, this association may predominately be reflected by vagally-mediated HRV indices. However, HRV's predictive significance on inflammation/infection remains unclear. METHODS 843 studies examining the associations/prognostic value of HRV indices on inflammation, and nosocomial infection/sepsis were screened in this systematic review. According to inclusion and exclusion criteria, 68 associative studies and 14 prediction studies were included. RESULTS HRV and pro-inflammatory state were consistently associated in healthy subjects and patient groups. Pro-inflammatory state was related to reduced total power HRV including vagally- and non-vagally-mediated HRV indices. Similar, compared to controls, HRV reductions were observed during nosocomial infections/sepsis. Only limited evidence supports the predictive value of HRV in the development of nosocomial infections/sepsis. Reduced very low frequency power HRV showed the highest predictive value in adults, even with different clinical conditions. In neonates, an increased heart rate characteristic score, combining reduced total power HRV, decreased complexity, and vagally-dominated asymmetry, predicted sepsis. CONCLUSIONS Pro-inflammatory state is related to an overall reduction in HRV rather than a singular reduction in vagally-mediated HRV indices, reflecting the complex autonomic-regulatory changes occurring during inflammation. The potential benefit of using continuous HRV monitoring for detecting nosocomial infection-related states, and the implications for clinical outcome, need further clarification.
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Affiliation(s)
- Josephine Adam
- Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Sven Rupprecht
- Department of Neurology, Jena University Hospital, Jena, Germany; Interdisciplinary Centre for Sleep and Ventilatory Medicine, Jena University Hospital, Jena, Germany
| | - Erika C S Künstler
- Department of Neurology, Jena University Hospital, Jena, Germany; Interdisciplinary Centre for Sleep and Ventilatory Medicine, Jena University Hospital, Jena, Germany
| | - Dirk Hoyer
- Department of Neurology, Jena University Hospital, Jena, Germany
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Deng S, Wang Q, Fan J, Yang X, Mei J, Lu J, Chen G, Yang Y, Liu W, Wang R, Han Y, Sheng R, Wang W, Ba L, Ding F. Correlation of Circadian Rhythms of Heart Rate Variability Indices with Stress, Mood, and Sleep Status in Female Medical Workers with Night Shifts. Nat Sci Sleep 2022; 14:1769-1781. [PMID: 36225321 PMCID: PMC9549795 DOI: 10.2147/nss.s377762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Heart rate variability (HRV) indices have been used as stress indicators. Rare studies investigated the associations of circadian rhythms of the HRV indices with the stress, mood, and sleep conditions in populations under stress. METHODS In total 257 female participants (203 shift workers and 54 non-shift workers) were included. All the participants completed a structured questionnaire to assess the stress, mood, and sleep conditions and performed 24-hour Holter electrocardiogram monitoring on the day away from shifts. Using epochs of 1-min or 5-min beat-to-beat intervals, the HRV indices (SDNN, RMSSD, LF, HF, LF/HF, and LFnu, SD1, SD2, SD1/SD2) were plotted as a function of time and fitted into cosine periodic curves, respectively. Three mathematical parameters based on the cosine periodic curves were extracted, MESOR (M, overall averages of the cosine curve), amplitude (A, amplitude of the peak of the cosine curve), and acrophase (θ, latency to the peak) to quantify the circadian rhythms of the HRV indices. Multivariable linear regression models were used to reveal the associations of these parameters with the clinical assessments of stress, mood, or sleep conditions, as well as with the 24-h averages of the HRV indices. RESULTS The parameters M and A of SDNN, RMSSD, LF, and HF, and θ of LF/HF and LFnu significantly differ between shift and non-shift workers. The parameter θ of LF/HF positively correlates with the severity of stress and anxiety. The parameter A of LF/HF and LFnu also positively correlates with daytime sleepiness and sleep fragmentation. In addition, the parameters M and A instead of θ of SDNN, RMSSD, LF, LF/HF, and LFnu significantly correlate with the 24-h averages of HRV indices. CONCLUSION The circadian rhythms of the HRV indices over 24 hours can, to some extent, predict the severity of stress, emotion and sleep conditions in female populations under stress.
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Affiliation(s)
- Saiyue Deng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Quan Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
| | - Jingjing Fan
- Cardiac Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xiaoyun Yang
- Cardiac Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Junhua Mei
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, 430022, People's Republic of China
| | - Jiajia Lu
- Cardiac Unit, Wuhan No.1 Hospital, Wuhan, 430022, People's Republic of China
| | - Guohua Chen
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, 430022, People's Republic of China
| | - Yuan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wenhua Liu
- Department of Clinical Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
| | - Runsen Wang
- Huawei Technologies Co, Shenzhen, People's Republic of China
| | - Yujia Han
- Huawei Technologies Co, Shenzhen, People's Republic of China
| | - Rong Sheng
- Huawei Technologies Co, Shenzhen, People's Republic of China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Li Ba
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Fengfei Ding
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.,Department of Pharmacology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Singh SP, Anirvan P, Khandelwal R, Satapathy SK. Nonalcoholic Fatty Liver Disease (NAFLD) Name Change: Requiem or Reveille? J Clin Transl Hepatol 2021; 9:931-938. [PMID: 34966656 PMCID: PMC8666378 DOI: 10.14218/jcth.2021.00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/21/2021] [Accepted: 07/18/2021] [Indexed: 12/04/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects about a quarter of the world's population and poses a major health and economic burden globally. Recently, there have been hasty attempts to rename NAFLD to metabolic-associated fatty liver disease (MAFLD) despite the fact that there is no scientific rationale for this. Quest for a "positive criterion" to diagnose the disease and destigmatizing the disease have been the main reasons put forth for the name change. A close scrutiny of the pathogenesis of NAFLD would make it clear that NAFLD is a heterogeneous disorder, involving different pathogenic mechanisms of which metabolic dysfunction-driven hepatic steatosis is only one. Replacing NAFLD with MAFLD would neither enhance the legitimacy of clinical practice and clinical trials, nor improve clinical care or move NAFLD research forward. Rather than changing the nomenclature without a strong scientific backing to support such a change, efforts should be directed at understanding NAFLD pathogenesis across diverse populations and ethnicities which could potentially help develop newer therapeutic options.
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Affiliation(s)
- Shivaram P. Singh
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha, India
- Correspondence to: Shivaram P Singh, Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha 753007, India. ORCID: https://orcid.org/0000-0002-8197-2674. Tel: +91-9437578857, Fax: +91-671-2433865, E-mail:
| | - Prajna Anirvan
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha, India
| | - Reshu Khandelwal
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha, India
| | - Sanjaya K. Satapathy
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, USA
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Jarczok MN, Koenig J, Wittling A, Fischer JE, Thayer JF. First Evaluation of an Index of Low Vagally-Mediated Heart Rate Variability as a Marker of Health Risks in Human Adults: Proof of Concept. J Clin Med 2019; 8:jcm8111940. [PMID: 31717972 PMCID: PMC6912519 DOI: 10.3390/jcm8111940] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022] Open
Abstract
Multiple studies have demonstrated low vagally-mediated heart rate variability (HRV) being associated with a range of risk factors for heart disease and stroke, including inflammation, hyperglycemia, hyperlipidemia, and hypertension. Yet, no cut point exists that indicates elevated risk. In the present study we sought to identify a cut point-value for HRV that is associated with elevated risk across a range of known risk factors. Methods: A total of 9550 working adults from 19 study sites took part in a health assessment that included measures of inflammation, hyperglycemia, hyperlipidemia, and hypertension and vagally-mediated HRV (Root mean square of successive differences between normal heartbeats (RMSSD)). Multiple age and sex adjusted logistic regressions were calculated per risk factor (normal versus clinical range), with RMSSD being entered in binary at different cut points ranging from 15–39 msec with a 2 msec increment. Results: For daytime RMSSD, values below 25 ± 4 indicated elevated risk (odds ratios (OR) 1.5–3.5 across risk factors). For nighttime RMSSD, values below 29 ± 4 indicated elevated risk (OR 1.2–2.0). Conclusion: These results provide the first evidence that a single value of RMSSD may be associated with elevated risk across a range of established cardiovascular risk factors and may present an easy to assess novel marker of cardiovascular risk.
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Affiliation(s)
- Marc N. Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, 68167 Mannheim, Germany;
- Correspondence:
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, 69115 Heidelberg, Germany;
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, CH-3000 Bern, Switzerland
| | - Arne Wittling
- Center for Neuroscience Research NPO, 54296 Trier, Germany;
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, 68167 Mannheim, Germany;
| | - Julian F. Thayer
- Department of Psychological Science, The University of California, Irvine, Irvine, CA 92697-7085, USA;
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Matura LA, Malone S, Jaime-Lara R, Riegel B. A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness. Biol Res Nurs 2018. [PMID: 29540066 DOI: 10.1177/1099800418764326] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatigue, a commonly reported symptom, is defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. To date, cancer researchers have been in the forefront in investigating the possible biological mechanisms of fatigue, identifying inflammation, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and activation of the autonomic nervous system. The purpose of this systematic review is to describe fatigue and what is known about the biological mechanisms described in cancer in five chronic, noninfectious illnesses: heart failure, multiple sclerosis, chronic kidney disease, rheumatoid arthritis, and chronic obstructive pulmonary disease. We searched PubMed and EMBASE using fatigue as a major Medical subject headings (MeSH) heading with each individual disease added as a search term followed by each biological mechanism. We included only primary research articles published in English between 1996 and 2016 describing studies conducted in adult humans. We identified 26 relevant articles. While there is some evidence that the biological mechanisms causing fatigue in cancer are also associated with fatigue in other chronic illnesses, more research is needed to explore inflammation, the HPA axis, and the autonomic nervous system, and other mechanisms in relation to fatigue in a variety of chronic illnesses.
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Affiliation(s)
- Lea Ann Matura
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Malone
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barbara Riegel
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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The circadian pattern of cardiac autonomic modulation and obesity in adolescents. Clin Auton Res 2014; 24:265-73. [PMID: 25358502 DOI: 10.1007/s10286-014-0257-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the impact of obesity and population attributes on the circadian pattern of cardiac autonomic modulation (CAM) in a population-based sample of adolescents. METHODS We used data from 421 adolescents who completed the follow-up exam in the Penn State Children Cohort study. CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat, normal R-R intervals from a 24-hour ECG, on a 30-minute basis. The HRV indices included frequency-domain (HF, LF, and LF/HF ratio) and time-domain (SDNN, RMSSD, and HR) variables. Nonlinear mixed-effect models were used to calculate a cosine periodic curve, each having three parameters quantifying its circadian period: M (mean levels of the HRV variables), Â (amplitude of the oscillation), and θ (the time of the highest oscillation). RESULTS The mean (SD) age was 16.9 (2.2) years, with 54 % male and 77 % white. The mean BMI percentile was 66, with 16 % obese (BMI percentile ≥ 95). Overall, HF (a marker of parasympathetic modulation) gradually increased from the late afternoon, reached peak amplitude around 3 a.m., and then decreased throughout the daytime until late afternoon. In contrast, obesity had adverse effects on all circadian parameters. The age, sex and race showed varying differences on the CAM circadian parameters. The adjusted means (95 %Cls) of M, Â, and θ for HF were 5.99 (5.79-6.19), 0.77 (0.66-0.89), 3:15 (2:15-4:15) a.m., and 6.21 (6.13-6.29), 0.66 (0.61-0.70), 2:45 (2:30-3:15) a.m. for obese and non-obese subjects, respectively. CONCLUSION The circadian pattern of CAM can be quantified by the three cosine parameters. Obesity is associated with lower HRV even in young individuals like children/adolescents.
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Liao D, Rodríguez-Colón SM, He F, Bixler EO. Childhood obesity and autonomic dysfunction: risk for cardiac morbidity and mortality. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:342. [PMID: 25143120 DOI: 10.1007/s11936-014-0342-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OPINION STATEMENT The epidemic of childhood obesity is becoming a major predictor for risk of cardiovascular diseases (CVD) and mortality during adulthood. Alterations in the morphology of the heart due to obesity could be a predictor for the dysfunction of cardiac autonomic modulation (CAM). A number of epidemiologic studies have evaluated the effect of obesity and CAM in children, finding that obesity impaired the balance of CAM toward a sympathetic overflow and reduced parasympathetic modulation, a significant predictor of CVD morbidity and mortality in adults. Lifestyle modifications, for example long-term exercise programs, have been shown to improve CAM in the obese. This review discusses the recent evidence on childhood and adolescent obesity and its impact on CAM, as well as how early lifestyle changes could help improve CAM, which may in turn reduce the burden of CVD in adults.
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Affiliation(s)
- Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, 90 Hope Drive, Suite 2000/A210, PO Box 855, Hershey, PA, 17033, USA,
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Cognitive function is associated with impaired heart rate variability in ageing adults: the Irish longitudinal study on ageing wave one results. Clin Auton Res 2014; 23:313-23. [PMID: 24077752 DOI: 10.1007/s10286-013-0214-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 08/23/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the independent association between heart rate variability (HRV) and cognitive performance, in a nationally representative population study of older adults. METHODS Cross-sectional analysis of wave 1 data from the Irish longitudinal study on ageing (TILDA) was performed. A subset of 4,763 participants who underwent ECG recording during resting and paced breathing periods were used for the analysis. HRV indices were divided into quintiles for comparison of values and cognitive performance was defined using the Montreal cognitive assessment (MOCA) score. Multivariate linear regression was used to model the association between cognition and different quintiles of each HRV index, after adjustment for covariates. RESULTS The mean age was 61.7 ± 8.3 years and 2,618 (55 %) were female. Lower quintiles of SDNN (P = 0.01-paced), LF (P = 0.001-paced), and LF:HF ratio (P = 0.049-paced) were significantly associated with lower MOCA scores (during both recording periods), independent of confounders. Sub-domains of MOCA responsible for the relationship were predominantly memory recall and language. INTERPRETATION Reduced HRV is significantly associated with lower cognitive performance at a population level in people aged 50 and older. This further strengthens the relationship between autonomic dysfunction and cognitive disorders.
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Dursun H, Kilicaslan B, Aydin M. The assessment of cardiac autonomic functions in adolescents with a family history of premature atherosclerosis. Clinics (Sao Paulo) 2014; 69:823-7. [PMID: 25627994 PMCID: PMC4286671 DOI: 10.6061/clinics/2014(12)06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/12/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Subclinical atherosclerosis has been recently detected in adolescents with a family history of premature atherosclerosis. However, no studies in the literature have assessed the cardiac autonomic functions of these adolescents. The aim of this study was to evaluate the cardiac autonomic functions of adolescents with a family history of premature atherosclerosis compared with those of age- and gender-matched adolescents without a family history of atherosclerosis. METHOD We evaluated the cardiac autonomic functions of 36 adolescents with a family history of premature atherosclerosis (Group 1) and compared them with those of 31 age- and gender-matched adolescents whose parents did not have premature atherosclerosis (Group 2). Twenty-four-hour time domain (standard deviation of all normal sinus RR intervals [SDNN], standard deviation of the mean of normal RR intervals in each 5-minute segment [SDANN], root-mean-square differences in successive RR intervals) and frequency domain (very low frequency, low frequency, high frequency, low frequency/high frequency) parameters of heart rate variability were used for the evaluation of cardiac autonomic functions. RESULTS There were no differences in the time and frequency domain parameters of heart rate variability between the two groups. Heart rate was negatively correlated with SDNN (r=-0.278, p=0.035), while age was significantly correlated with root-mean-square differences in successive RR intervals, high frequency, low frequency and low frequency/high frequency (r=-0.264, -0.370, 0.265 and 0.374, respectively; p<0.05 for all). CONCLUSION We found that the cardiac autonomic functions of adolescents with a family history of premature atherosclerosis were not different compared with those of adolescents without a positive family history of premature atherosclerosis. It appears that subclinical atherosclerosis does not reach a critical value such that it can alter cardiac autonomic functions in adolescence.
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Affiliation(s)
- Huseyin Dursun
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Baris Kilicaslan
- Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Aydin
- Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
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Özcan F, Turak O, Avci S, Tok D, İşLeyen A, aras D, Aydoğdu S. Heart rate variability and red cell distribution width in patients with systolic left heart failure. SCAND CARDIOVASC J 2013. [DOI: 10.3109/14017431.2012.755561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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