High-frequency heart rate variability during worry predicts stress-related increases in sleep disturbances

Predicting response to stepped-care cognitive behavioral therapy for insomnia using pre-treatment heart rate variability in cancer patients

OBJECTIVE

This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework.

METHODS

177 participants (86.3 % female; Mage = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up.

RESULTS

Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses.

CONCLUSION

Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients.

Is sleep affected after microgravity and hypergravity exposure? A pilot study

Sleep is known to be affected in space travel and in residents of the international space station. But little is known about the direct effects of gravity changes on sleep, if other factors, such as sleep conditions, are kept constant. Here, as a first exploration, we investigated sleep before and after exposure to short bouts of microgravity and hypergravity during parabolic flights. Sleep was measured through actigraphy and self-report questionnaires in 20 healthy men and women before and after parabolic flight. Higher sleep fragmentation and more awakenings were found in the night after the flight as compared with the night before, which was discrepant from participants' reports showing better and longer sleep after the parabolic flight. Variable levels of experience with parabolic flights did not affect the results, nor did levels of scopolamine, a medication typically taken against motion sickness. Pre-existing sleep problems were related to sleep fragmentation and wake after sleep onset by a quadratic function such that participants with more sleep problems showed lower levels of sleep fragmentation and nighttime awakenings than those with few sleep problems. These novel findings, though preliminary, have important implications for future research, directed at prevention and treatment of sleep problems and their daytime consequences in situations of altered gravity, and possibly in the context of other daytime vestibular challenges as well.

Predicting sports performance of elite female football players through smart wearable measurement platform

Recent development of information technology and wearable devices has led to the analysis of multidimensional sports information and the enhancement of athletes' sports performance convenient and potentially more efficient. In this study, we present a novel data platform tailored for capturing athletes' cognitive, physiological, and body composition data. This platform incorporates diverse visualization modes, enabling athletes and coaches to access data seamlessly. Fourteen elite female football players (average age=20.6±1.3years; 3 forwards, 5 midfielders, 4 defenders, and 2 goalkeepers) were recruited from National Taiwan Normal University, Taiwan, as the primary observational group, and 12 female university students without regular sport/exercise habits (average age=21.6±1.3years) were recruited as control group. Through multidimensional data analysis, we identified significant differences in limb muscle mass and several cognitive function scores (e.g., reaction times of attention and working memory) between elite female football varsity team and general female university students. Furthermore, 1-month heart rate data obtained from wearable devices revealed a significant negative correlation between average heart rate median and cognitive function scores. Overall, this study demonstrates the potential of this platform as an efficient multidimensional data collection and analysis platform. Therefore, valuable insights between cognitive functions, physiological signals and body composition can be obtained via this multidimensional platform for facilitating sports performance.

The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma

Sleep reactivity is a predisposition to sleep disturbance during environmental perturbations, pharmacological challenges, or stressful life events. Consequently, individuals with highly reactive sleep systems are prone to insomnia disorder after a stressor, engendering risk of psychopathology and potentially impeding recovery from traumatic stress. Thus, there is tremendous value in ameliorating sleep reactivity to foster a sleep system that is robust to stress exposure, ultimately preventing insomnia and its downstream consequences. We reviewed prospective evidence for sleep reactivity as a predisposition to insomnia since our last review on the topic in 2017. We also reviewed studies investigating pre-trauma sleep reactivity as a predictor of adverse post-traumatic sequelae, and clinical trials that reported the effect of behavioural treatments for insomnia on mitigating sleep reactivity. Most studies measured sleep reactivity via self-report using the Ford Insomnia Response to Stress Test (FIRST), demonstrating high scores on this scale reliably indicate a sleep system with a lower capacity to tolerate stress. Nascent evidence suggests elevated sleep reactivity prior to trauma increases the risk of negative posttraumatic outcomes, namely acute stress disorder, depression, and post-traumatic stress disorder. Lastly, sleep reactivity appears most responsive to behavioural insomnia interventions when delivered early during the acute phase of insomnia. Overall, the literature strongly supports sleep reactivity as a premorbid vulnerability to incident acute insomnia disorder when faced with an array of biopsychosocial stressors. The FIRST identifies individuals at risk of insomnia a priori, thereby guiding early interventions toward this vulnerable population to prevent insomnia and promote resilience to adversity.

The relationship between self-reported chronic stress, physiological stress axis dysregulation and medically-unexplained symptoms

The positive feedback model of medically-unexplained symptoms posits that chronic stress affects the activity of the physiological stress axes, which in turn generates medically-unexplained symptoms. As a first step to empirically test its model assumptions, we investigated potential associations between chronic stress, physiological stress axis activity and medically-unexplained in a cross-sectional study. One hundred-ninety-nine healthy individuals provided self-reports on chronic stress and medically-unexplained symptoms, resting heart rate/variability (HR/HRV; e.g., root mean square of successive differences/RMSSD, low frequency/LF power), cortisol awakening response (CAR) and diurnal cortisol. Significant positive contributors to medically-unexplained symptoms were the chronic stress scales 'lack of social appreciation' and 'chronic worries', as well as CAR and LF HRV; diurnal cortisol was a negative contributor. Mediation analyses showed that the impact of neural indicators associated with physiological stress axis activity (HR/HRV) related to medically-unexplained symptoms, which was mediated by chronic stress, whereas the mediation effect as suggested by the positive feedback model was not significant. These cross-sectional findings do not support the positive feedback model. Longitudinal studies are required to conclude about potential mechanistic and causal relationships in the model. Nevertheless, our mediation analyses give first indication that the constitution of physiological stress axes may play a major role in how stressors are perceived and which kind of health-consequences (e.g., medically-unexplained symptoms) this may have.

A Narrative Review of Commercial Platforms Offering Tracking of Heart Rate Variability in Corporate Employees to Detect and Manage Stress

The COVID-19 pandemic has resulted in employees being at risk of significant stress. There is increased interest by employers to offer employees stress monitoring via third party commercial sensor-based devices. These devices assess physiological parameters such as heart rate variability and are marketed as an indirect measure of the cardiac autonomic nervous system. Stress is correlated with an increase in sympathetic nervous activity that may be associated with an acute or chronic stress response. Interestingly, recent studies have shown that individuals affected with COVID will have some residual autonomic dysfunction that will likely render it difficult to track both stress and stress reduction using heart rate variability. The aims of the present study are to explore web and blog information using five operational commercial technology solution platforms that offer heart rate variability for stress detection. Across five platforms we found a number that combined HRV with other biometrics to assess stress. The type of stress being measured was not defined. Importantly, no company considered cardiac autonomic dysfunction because of post-COVID infection and only one other company mentioned other factors affecting the cardiac autonomic nervous system and how this may impact HRV accuracy. All companies suggested they could only assess associations with stress and were careful not to claim HRV could diagnosis stress. We recommend that managers think carefully about whether HRV is accurate enough for their employees to manage their stress during COVID.

Associations between affective factors and high-frequency heart rate variability in primary care patients with depression

OBJECTIVE

Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups - such as those with co-occurring affective factors - exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression.

METHODS

Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period.

RESULTS

Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient β = -0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (β = 0.02, p = .78) and trait positive affect (β = -0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (β = -0.19, p = .02).

CONCLUSION

Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.

Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers

BACKGROUND

Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors.

OBJECTIVE

This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings.

METHODS

In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours.

RESULTS

Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032).

CONCLUSIONS

A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon.

The association of salivary alpha-amylase, heart rate variability, and psychological stress on objectively measured sleep behaviors among college students

Objective

This study aimed to evaluate sleep behaviors among college students, to assess salivary alpha-amylase (sAA) and heart rate variability (HRV) in association with stress, and to investigate sleep-related factors including sAA, HRV, and stress among them.

Methods

Saliva samples for sAA assessment and HRV measurements in the supine position were taken between 3 PM and 6 PM. The level of prolonged psychological stress for the previous week was evaluated using the Korean version of the Global Assessment of Recent Stress (GARS-K), and sleep behaviors were assessed using an actigraphy device.

Results

A total of 86 healthy college students participated in this study. Sleep behaviors of the college students were not good, with 84% sleep efficiency (SE) and 62.7 min wake after sleep onset (WASO). The average sAA level was 65.8 U/mL in the participants. Although neither the sAA level nor HRV indices were significantly correlated with prolonged psychological stress, decreased normalized high frequency (nHF) on HRV was independently associated with a higher level of stress when adjusted for age and sex. Higher stress (r = −0.276, P = 0.011) and lower sAA (r = 0.266, P = 0.030) had significant correlations with shorter time in bed; however, it was sAA that was independently associated with time in bed (β = 0.244, p = 0.044). Decreased nHF (β = 0.245, P = 0.027) and higher body mass index (BMI) (β = −0.224, P = 0.043) were independently related to and poorer SE.

Conclusions

Poor sleep behaviors were associated with decreased parasympathetic activity, a physiological change to psychological stress, rather than with psychological stress itself among college students. Thus, sAA and HRV should be considered as significant factors for impaired sleep behaviors in relation to psychological stress.

Heart Rate Variability, Sleep Quality, and Depression in the Context of Chronic Stress

BACKGROUND

Disrupted sleep quality is one of the proposed mechanisms through which chronic stress may lead to depression. However, there exist significant individual differences in sleep reactivity, which is the extent to which one experiences sleep disturbances in response to stress.

PURPOSE

The aim of the current study was to investigate whether low high-frequency heart rate variability (HRV), as a psychophysiological marker of poor emotional and physiological arousal regulation, predicts stress-related sleep disturbances associated with greater risk of depression symptoms.

METHODS

Using a chronic caregiving stress model, 125 mothers of adolescents with developmental disorders and 97 mothers of typically developing adolescents had their resting HRV and HRV reactivity recorded and completed a measure of depressive symptoms, as well as a 7 day sleep diary to assess their sleep quality. A moderated mediation model tested whether sleep quality mediated the association between chronic stress exposure and depressive symptoms and whether HRV moderated this mediation.

RESULTS

After controlling for participant age, body mass index, ethnicity, socioeconomic status, and employment status, poor sleep quality mediated the association between chronic stress and depressive symptoms. Resting HRV moderated this indirect effect such that individuals with lower HRV were more likely to report poorer sleep quality in the context of chronic stressor exposure, which, in turn, was related to greater depressive symptoms.

CONCLUSIONS

Lower HRV, a potential biomarker of increased sleep reactivity to stress, is associated with greater vulnerability to stress-related sleep disturbances, which, in turn, increases the risk for elevated depressive symptoms in response to chronic stress.

Heart rate variability moderates the between- and within-person associations between daily stress and negative affect

Stress exposure increases risk for depressive symptoms. However, there are substantial individual differences in affective responses to stress. High-frequency heart rate variability (HF-HRV), a marker of vagally-mediated parasympathetic activity, has been conceptualized as a psychophysiological index of emotion regulation that may moderate individuals' responses to stress. Using a daily diary design, we tested whether individual differences in resting HF-HRV moderated the association between daily child-related stress and negative affect among a sample of 84 heterosexual couples with preschool-aged children. After controlling for participants' age, gender, socioeconomic status, employment status, and ethnicity, hierarchical linear modeling revealed that resting HF-HRV moderated both the between-person and within-person associations between self-reported child-related stress and daily negative affect. Between-person analyses indicated that the strength of the positive association between mean daily child stress and negative affect across the daily diary period increased with decreasing resting HF-HRV. Similarly, within-person analyses indicated that on days when participants reported more child-related stress than usual, the magnitude of the increase in negative affect on that day was inversely related to resting HF-HRV. Taken together, these findings suggest that lower resting HF-HRV may index vulnerability to stress-related disturbances in negative affect. This increased negative affective response to daily stress may be one pathway through which individuals with lower resting HF-HRV are at increased risk for depressive symptoms over time.

Depressive and anxiety symptoms, quality of sleep, and coping during the 2019 coronavirus disease pandemic in general population in Kashmir

Background

With uncertainty surrounding the 2019 coronavirus disease pandemic, there is no knowledge of the psychological impact of this pandemic on the general public from Kashmir. We aimed to understand the psychological impact in the form of depressive symptoms, anxiety symptoms, quality of sleep, and coping during this pandemic.

Methods

This cross-sectional study was conducted using social networking sites. The questionnaire meant for this study was sent as a link to a respondent. Initial part of questionnaire collected the socio-demographic details of the respondents. Depressive and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality of sleep. There was also an open-ended question to look for coping skills used.

Results

The majority of our respondents were below 45 years (around 95%) with 54.9% from 18 to 30 years age group. 72.3% were males and 27.7% were females. 58.7% were from rural background. 55.7% were employed, and 32.2% were students. In our respondents, 55% had anxiety symptoms, 55% had depressive symptoms, around 53% had poor quality of sleep, and around 30% of used maladaptive coping skills. Significant depressive symptoms were there in the younger age group, 18–30 years (p = 0.03). Significant depressive symptoms and anxiety symptoms were present in females (p = 0.01 and 0.006, respectively). In urban population, significant anxiety symptoms (p = 0.03) were present. The mean score for anxiety symptoms and depressive symptoms was 8.05 ± 4.53 and 8.07 ± 4.56, respectively. Mean global PSQI score was 6.90 ± 3.82 and was positively correlated with score on depressive symptom scale (p = 0.001) as well as score on anxiety symptom scale (p = 0.001).

Conclusion

Younger people, females, those living in urban conditions, and those using maladaptive coping skills are likely to have anxiety symptoms and depressive symptoms as well as poor quality of sleep.

Beyond the bladder: poor sleep in women with overactive bladder syndrome

BACKGROUND

Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population.

OBJECTIVES

To provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder.

STUDY DESIGN

We conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5.

RESULTS

Of the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences.

CONCLUSIONS

Many women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep.

Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy

In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper, we summarize what is known about the stress-sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioural therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and home-schooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.

Is emotion regulation associated with cancer-related psychological symptoms?

OBJECTIVES

This study examined the cross-sectional and prospective relationships between subjective (cognitive reappraisal, expressive suppression and experiential avoidance) and objective (high-frequency heart rate variability [HF-HRV]) measures of emotion regulation (ER) and a set of psychological symptoms (anxiety, depression, fear of cancer recurrence [FCR], insomnia, fatigue, pain, and cognitive impairments) among women receiving radiation therapy for non-metastatic breast cancer.

DESIGN

Eighty-one participants completed a battery of self-report scales within 10 days before the start of radiotherapy (T1) and within 10 days after its end (T2; approximately 6 weeks after T1). HF-HRV at rest was measured at T1.

RESULTS

Canonical correlation analyses revealed that higher levels of experiential avoidance and expressive suppression were cross-sectionally associated with higher levels of all symptoms, except pain, at T1 and at T2 (both p's < 0.0001). Higher levels of suppression and reappraisal at T1 were marginally associated with reduced FCR and with increased depression and fatigue between T1 and T2 (p = 0.07). HF-HRV was not associated with symptoms cross-sectionally or prospectively.

CONCLUSIONS

Although preliminary, these results are consistent with the hypothesis that maladaptive ER strategies, assessed subjectively, may cross-sectionally act as a transdiagnostic mechanism underlying several cancer-related psychological symptoms.

High-Frequency Heart Rate Variability Reactivity and Trait Worry Interact to Predict the Development of Sleep Disturbances in Response to a Naturalistic Stressor

BACKGROUND

High-frequency heart rate variability (HF-HRV) reactivity was proposed as a vulnerability factor for stress-induced sleep disturbances. Its effect may be amplified among individuals with high trait worry or sleep reactivity.

PURPOSE

This study evaluated whether HF-HRV reactivity to a worry induction, sleep reactivity, and trait worry predict increases in sleep disturbances in response to academic stress, a naturalistic stressor.

METHOD

A longitudinal study following 102 undergraduate students during an academic semester with well-defined periods of lower and higher academic stress was conducted. HF-HRV reactivity to a worry induction, trait worry using the Penn State Worry Questionnaire, and sleep reactivity using the Ford Insomnia Stress Reactivity Test were measured during the low stress period. Sleep disturbances using the Pittsburgh Sleep Quality Index were assessed twice during the lower stress period and three times during the higher stress period.

RESULTS

Greater reductions in HF-HRV in response to the worry induction predicted increases in sleep disturbances from the lower to the higher academic stress period. Trait worry moderated this association: individuals with both higher trait worry and greater HF-HRV reactivity to worry had larger increases in stress-related sleep disturbances over time, compared to participants with lower trait worry and HF-HRV reactivity. A similar, but marginally significant effect was found for sleep reactivity.

CONCLUSION

This study supports the role of HF-HRV reactivity as a vulnerability factor for stress-induced sleep disturbances. The combination of high trait worry and high HF-HRV reactivity to worry might identify a subgroup of individuals most vulnerable to stress-related sleep disturbances.

Psychoneuroimmunological aspects of cardiovascular diseases: a preliminary report

Aim of the study

Due to their prevalence and negative social effects, cardiovascular diseases belong to a group of civilization diseases. Previous research suggests comorbidity of heart diseases, mood disorders and impaired cognitive functioning. The aim of this study was to evaluate the psychoneuroimmunological aspects of functioning in patients diagnosed with cardiovascular diseases.

Material and methods

Ten persons, mean age 48.2 years old, diagnosed with primary hypertension, were studied. All of them were treated with beta blockers and ACE inhibitors with unsuccessful therapeutic effect. This group also included 4 subjects with heart rate disturbances. The control group included 10 clinically healthy volunteers in mean age 46.8. All participants had 24-hour ECG monitoring with Holter method in order to evaluate the autonomic activity with time and frequency domain analysis (heart rate variability). Patients also underwent neuropsychological assessment of quality of life and personality traits (EQ-5D, NEO-PI-R, PSS10, SWLS, MHLC). Quantitative evaluation of immune system parameters included: TCD3, TCD4, CD8, CD16/CD56, CD19, HLA-DR+.

Results

The cardiovascular disease group showed significantly lower time and frequency domain parameters (p < 0.05) except low/high frequency (LF/HF) power ratio. The heart rhythm disorder group demonstrated significant relationships such as: Quality of life with Total Power of HRV and day-time LF/HF ratio, pNN50 and rMSSD – negative correlation.

Conclusions

1. In cardiovascular disease patients, activity of the autonomic nervous system is significantly reduced. 2. Impaired modulation of the autonomic nervous system activity affects mood and decreases quality of life. 3. In patients with heart rhythm disturbances, increased sympathetic nervous system activity affects prolonged tension and the immune response.

Sleep, Circadian Rhythms, and Anxious Traits

Anxiety is adaptive and plays an important role in keeping us safe. However, when anxiety becomes too extreme, it can cause significant disruptions and distress. Understanding the mechanisms underlying excessive anxiety and how to best treat it is a priority for researchers and clinicians. There is increasing recognition that disruptions in the amount and timing of sleep are associated with anxiety symptoms and characteristics. In the current paper, we explore the intersections between sleep, circadian rhythms, and anxiety. First, we review accumulating evidence that anxiety is associated with disruptions in sleep and circadian rhythms in both clinical and nonclinical samples and across ages. Next, we discuss the data linking sleep disruptions with anxiety-related traits (anxiety sensitivity, neuroticism, and perfectionism) and patterns of cognition and emotion. Finally, potential treatment implications are highlighted. Overall, these data suggest that delineating the role of disruptions in the amount and timing of sleep holds promise for improving the lives of individuals with heightened anxiety.