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Lutchman Y, Mahajan R, Cosh SM, Harris K, Tzourio C, Tully PJ. Under pressure: A systematic review of the association between blood pressure variability with depression and anxiety. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100228. [PMID: 38974909 PMCID: PMC11225212 DOI: 10.1016/j.cccb.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/05/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024]
Abstract
Blood pressure variability (BPV) impacts brain health by influencing brain structure and cerebrovascular pathologies, though the mechanisms are poorly understood. Changes in the cerebrovasculature may lead to late-onset depression, cognitive impairment, and dementia, however the relationship between BPV with depression and anxiety remains unclear, due to methodological differences and inconsistencies in past research. This review aims to clarify the association between BPV with depression and anxiety in adults to inform understandings of the mechanisms implicating BPV in cognitive health. A systematic search from inception through to January 2024 was performed on Embase, PubMed, PsycINFO, and Web of Science. Studies that assessed BPV quantified by beat-to-beat, 24-hour, or visit-to-visit were eligible if the standardised assessment of depression and/or anxiety were reported as a linear association, or mean differences across control and affect groups. A total of 14 articles reporting on 13 samples and N = 5055 persons met the inclusion criteria (median female proportion = 61 %, range 0 % - 76 %). A meta-analysis was not possible due to methodological heterogeneity in BPV measurements and metrics across studies. Mixed results were observed across depression studies with inconsistencies and variation in the direction, strength of association, and BPV metric. There was weak evidence from only three studies to support a linear association between systolic coefficient of variation and anxiety. Collectively, the findings contribute to understanding the association between BPV and brain health, suggesting that any relationship between BPV and brain structures critical for cognitive function are independent of depression and only modestly implicate anxiety.
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Affiliation(s)
- Yuvthi Lutchman
- School of Psychology, The University of New England, Australia
| | - Rajiv Mahajan
- Adelaide Medical School, The University of Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, The University of New England, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Phillip J. Tully
- School of Psychology, The University of New England, Australia
- School of Medicine, The University of Adelaide, Australia
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2
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Goldstein DS. Post-COVID dysautonomias: what we know and (mainly) what we don't know. Nat Rev Neurol 2024; 20:99-113. [PMID: 38212633 DOI: 10.1038/s41582-023-00917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC.
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Affiliation(s)
- David S Goldstein
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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3
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Birk JL, Cumella R, Lopez-Veneros D, Agarwal S, Kronish IM. Feasibility of a remote heart rate variability biofeedback intervention for reducing anxiety in cardiac arrest survivors: A pilot trial. Contemp Clin Trials Commun 2024; 37:101251. [PMID: 38312473 PMCID: PMC10837694 DOI: 10.1016/j.conctc.2023.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/12/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Background Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention's feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress. Methods The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV. Results Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50 %) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV. Conclusion A remotely delivered HRVB intervention was acceptable, feasible, and useable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients' psychological distress, health behaviors, and autonomic dysfunction may be warranted.
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Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Robin Cumella
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - David Lopez-Veneros
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center, 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, 10032, United States
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
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4
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Siedlecki P, Ivanova TD, Garland SJ. Cardiovascular response to anticipatory and reactionary postural perturbations in young adults. Exp Physiol 2023; 108:1144-1153. [PMID: 37458232 PMCID: PMC10988459 DOI: 10.1113/ep091173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023]
Abstract
NEW FINDINGS What is the central question of this study? It has been suggested that the cardiovascular responses to a postural perturbation are centrally mediated and reflex mediated. We wanted to know the extent to which the cardiovascular responses to external perturbations could be executed in a feedforward manner, in anticipation of the perturbation. What is the main finding and its importance? We found no anticipatory component driving heart rate and systolic blood pressure responses, suggesting that reflexive mechanisms dominate cardiovascular regulation after a postural perturbation in young adults. ABSTRACT Cardiovascular responses to postural perturbations have been reported, but whether the cardiovascular responses to external perturbations could be executed in anticipation of the perturbation is unknown. The purpose of this study was to determine the effect of anticipated and reactionary perturbations on heart rate (HR) and systolic blood pressure (SBP) responses in healthy young adults. A secondary aim was to determine whether perceived state anxiety scores were correlated with the change in HR response during postural perturbation. Twenty healthy young adults stood on a treadmill and experienced two perturbation conditions (anticipatory vs. reactionary), each with two intensity levels (Step vs. No Step). The HR and SBP were collected continuously. Two-way repeated-measures statistical non-parametric mapping tests were used to compare HR and SBP responses to the perturbations over time (from -3 to +8 s). The results indicated that HR was significantly elevated in the higher intensity perturbations [Step vs. No Step, at 0.56-1.32 s (P < 0.0001) and 1.92-3.44 s (P < 0.0001) post-perturbation], while there were no differences in HR between perturbation types (anticipatory vs. reactionary) or in SBP between perturbation types and intensity levels. The perceived state anxiety scores did not differ between perturbation types and intensity levels but were correlated with the change in HR post-perturbation (P = 0.013). We suggest that reflexive mechanisms dominate cardiovascular regulation after anticipatory and reactionary perturbations. The data highlight the cardiovascular mechanism(s) associated with perturbations that should be considered when assessing postural stability in populations with poor balance performance.
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Affiliation(s)
| | | | - S. Jayne Garland
- Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Department of Physiology & PharmacologyWestern UniversityLondonOntarioCanada
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5
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Baroreflex sensitivity derived from the Valsalva manoeuvre: A physiological protective factor for anxiety induced by breathing CO 2-enriched air. Int J Psychophysiol 2022; 179:101-109. [PMID: 35809687 DOI: 10.1016/j.ijpsycho.2022.06.019] [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: 10/05/2021] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
Abstract
This study aimed to determine the capacity of baroreflex sensitivity, derived from the Valsalva manoeuvre (BRS_v), to predict state anxiety induced by a biological stressor (CO2 inhalation). Healthy adults (n = 50) breathed 7.5 % CO2-enriched air for 8 min, preceded and followed by breathing medical air for 5 min. State anxiety was evaluated with a visual analogue scale. Anxiety sensitivity (Anxiety Sensitivity Index-3; ASI-3) and trait anxiety (Trait form of the State-Trait Anxiety Inventory; STAI_T) served as cognitive-affective predictors. BRS_v was adopted as a physiological predictor. Multiple regression analysis revealed that BRS_v predicted lower anxiety during CO2 exposure, and attenuated the effect of ASI-3 in increasing anxiety. No significant effects were found for STAI_T. This is the first study to identify baroreflex sensitivity as a strong protective physiological factor for anxiety beyond the effect of anxiety sensitivity.
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6
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Psychological status and physical performance are independently associated with autonomic function. Biomed Eng Online 2022; 21:29. [PMID: 35513815 PMCID: PMC9074293 DOI: 10.1186/s12938-022-00996-7] [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] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Falls among older adults have become a global concern. While previous studies have established associations between autonomic function indicator; heart rate variability (HRV) and blood pressure variability (BPV) with fall recurrence, as well as physical inactivity and psychological disorders as risk factors for falls, the influence of physical activity and psychological status on autonomic dysfunction observed among older fallers has not been adequately investigated. The aim of this study was to evaluate the relationship between psychological disorder and physical performance on the autonomic nervous system (ANS) in older fallers. We hypothesised that older fallers have poorer autonomic function, greater dependency on others and were associated with psychological disorders. Furthermore, we hypothesised that both physical performance and psychological status can contribute to the worsening of the autonomic function among the elderly. Methods In this cross-sectional survey, adults aged ≥ 60 years were recruited. Continuous non-invasive BP was monitored over 5 min of supine and 3 min of standing. Psychological status was assessed in terms of depression, anxiety, stress, and concern about falling, while functional status was measured using time-up-and-go, functional reach, handgrip and Lawton’s Instrumental Activities of Daily Life (IADL) scale. Results A total of 62 participants were recruited consisting of 37 fallers and 25 non-fallers. Multivariate analysis revealed that Lawton IADL was independently associated with systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) during both supine (SBPV: r2 = 0.080, p = 0.025; DBPV: r2 = 0.064, p = 0.046) and standing (SBPV: r2 = 0.112, p = 0.008; DBPV: r2 = 0.105, p = 0.011), while anxiety score was independently associated with SBPV and DBPV during standing (SBPV: r2 = 0.112, p = 0.009; DBPV: r2 = 0.105, p = 0.011) as compared to the other parameters. Conclusion Our findings suggest that fallers had poorer ANS, greater dependence in IADLs, and were more anxious. IADL dependency and anxiety were the most predictive of autonomic dysfunction, and can be used in practice to identify poor autonomic function for the prevention of falls and cardiovascular diseases among older adults.
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7
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Siedlecki P, Shoemaker JK, Ivanova TD, Garland SJ. Cardiovascular response to postural perturbations of different intensities in healthy young adults. Physiol Rep 2022; 10:e15299. [PMID: 35531916 PMCID: PMC9082380 DOI: 10.14814/phy2.15299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 04/15/2023] Open
Abstract
The ability to regain control of balance is vital in limiting falls and injuries. Little is known regarding how the autonomic nervous system responds during recovery from balance perturbations of different intensities. The purpose of this study was to examine the cardiovascular response following a standing balance perturbation of varying intensities, quantify cardiac baroreflex sensitivity (cBRS) during standing perturbations, and to establish the stability of the cardiac baroreflex during quiet standing before and after balance disturbances. Twenty healthy participants experienced three different perturbation intensity conditions that each included 25 brief posteriorly-directed perturbations, 8-10 s apart. Three perturbation intensity conditions (low, medium, high) were given in random order. Physiological data were collected in quiet stance for 5 min before testing (Baseline) and again after the perturbation conditions (Recovery) to examine baroreflex stability. Beat-to-beat heart rate (HR) and systolic blood pressure (SBP) analysis post-perturbation indicated an immediate acceleration of the HR for 1-2 s, with elevated SBP 4-5 s post-perturbation. Heart rate changes were greatest in the medium (p = 0.035) and high (p = 0.012) intensities compared to low, while there were no intensity-dependent changes in SBP. The cBRS was not intensity-dependent (p = 0.402) but when perturbation conditions were combined, cBRS was elevated compared to Baseline (p = 0.046). The stability of baseline cBRS was excellent (ICC = 0.896) between quiet standing conditions. In summary, HR, but not SBP or cBRS were intensity-specific during postural perturbations. This was the first study to examine cardiovascular response and cBRS to postural perturbations.
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Affiliation(s)
| | | | | | - S. Jayne Garland
- Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Department of Physiology & PharmacologyWestern UniversityLondonOntarioCanada
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8
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Teixeira AL, Nardone M, Samora M, Fernandes IA, Ramos PS, Sabino-Carvalho JL, Ricardo DR, Millar PJ, Vianna LC. Potentiation of GABAergic synaptic transmission by diazepam acutely increases resting beat-to-beat blood pressure variability in young adults. Am J Physiol Regul Integr Comp Physiol 2022; 322:R501-R510. [PMID: 35348021 DOI: 10.1152/ajpregu.00291.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resting beat-to-beat blood pressure variability is a powerful predictor of cardiovascular events and end-organ damage. However, its underlying mechanisms remain unknown. Herein, we tested the hypothesis that a potentiation of GABAergic synaptic transmission by diazepam would acutely increase resting beat-to-beat blood pressure variability. In 40 (17 females) young, normotensive subjects, resting beat-to-beat blood pressure (finger photoplethysmography) was continuously measured for 5 to 10 min, 60 min after the oral administration of either diazepam (10 mg) or placebo. The experiments were conducted in a randomized, double-blinded, and placebo-controlled design. Stroke volume was estimated from the blood pressure waveform (ModelFlow) permitting the calculation of cardiac output and total peripheral resistance. Direct recordings of muscle sympathetic nerve activity (MSNA, microneurography) were obtained in a subset of subjects (N=13) and spontaneous cardiac and sympathetic baroreflex sensitivity calculated. Compared to placebo, diazepam significantly increased the standard deviation of systolic (4.7±1.4 vs. 5.7±1.5 mmHg, P=0.001), diastolic (3.8±1.2 vs. 4.5±1.2 mmHg, P=0.007) and mean blood pressure (3.8±1.1 vs. 4.5±1.1 mmHg, P=0.002), as well as cardiac output (469±149 vs. 626±259 ml/min, P<0.001) and total peripheral resistance (1.0±0.3 vs. 1.4±0.6 mmHg/l/min, P<0.001). Similar results were found using different indices of variability. Furthermore, diazepam reduced MSNA burst frequency (placebo: 22±6 vs. diazepam: 18±8 bursts/min, P=0.025) without affecting the arterial baroreflex control of heart rate (placebo: 18.6±6.7 vs. diazepam: 18.8±7.0 ms/mmHg, P=0.87) and MSNA (placebo: -3.6±1.2 vs. diazepam: -3.4±1.5 bursts/100Hb/mmHg, P=0.55). These findings suggest that GABAA receptors modulate resting beat-to-beat blood pressure variability in young adults.
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Affiliation(s)
- André L Teixeira
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.,NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Massimo Nardone
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Milena Samora
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Igor Alexandre Fernandes
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Plinio Santos Ramos
- Maternity Hospital Therezinha de Jesus, Faculty of Health and Medical Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Jeann L Sabino-Carvalho
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Djalma Rabelo Ricardo
- Maternity Hospital Therezinha de Jesus, Faculty of Health and Medical Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Philip J Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Lauro C Vianna
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
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Shahimi NH, Lim R, Mat S, Goh CH, Tan MP, Lim E. Association between mental illness and blood pressure variability: a systematic review. Biomed Eng Online 2022; 21:19. [PMID: 35313918 PMCID: PMC8935841 DOI: 10.1186/s12938-022-00985-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background Mental illness represents a major global burden of disease worldwide. It has been hypothesised that individuals with mental illness have greater blood pressure fluctuations that lead to increased cardiovascular risk and target organ damage. This systematic review aims to (i) investigate the association between mental illness and blood pressure variability (BPV) and (ii) describe methods of BPV measurements and analysis which may affect pattern and degree of variability. Methods Four electronic databases were searched from inception until 2020. The quality assessment was performed using STROBE criteria. Studies were included if they investigated BPV (including either frequency or time domain analysis) in individuals with mental illness (particularly anxiety/generalised anxiety disorder, depression/major depressive disorder, panic disorder and hostility) and without hypertension. Two authors independently screened titles, abstracts and full texts. A third author resolved any disagreements. Results Twelve studies met the inclusion criteria. Three studies measured short-term BPV, two measured long-term BPV and seven measured ultra-short-term BPV. All studies related to short-term BPV using ambulatory and home blood pressure monitoring found a higher BPV in individuals with depression or panic disorder. The two studies measuring long-term BPV were limited to the older population and found mixed results. Mental illness is significantly associated with an increased BPV in younger and middle-aged adults. All studies of ultra-short-term BPV using standard cardiac autonomic assessment; non-invasive continuous finger blood pressure and heart rate signals found significant association between BPV and mental illness. A mixed result related to degree of tilt during tilt assessment and between controlled and spontaneous breathing were observed in patients with psychological state. Conclusions Current review found that people with mental illness is significantly associated with an increased BPV regardless of age. Since mental illness can contribute to the deterioration of autonomic function (HRV, BPV), early therapeutic intervention in mental illness may prevent diseases associated with autonomic dysregulation and reduce the likelihood of negative cardiac outcomes. Therefore, these findings may have important implications for patients' future physical health and well-being, highlighting the need for comprehensive cardiovascular risk reduction.
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Affiliation(s)
- Nur Husna Shahimi
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Renly Lim
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Choon-Hian Goh
- Department of Mechatronics and BioMedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Bandar Sungai Long, 43200, Kajang, Selangor, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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10
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Bigalke JA, Carter JR. Sympathetic Neural Control in Humans with Anxiety-Related Disorders. Compr Physiol 2021; 12:3085-3117. [PMID: 34964121 DOI: 10.1002/cphy.c210027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Numerous conceptual models are used to describe the dynamic responsiveness of physiological systems to environmental pressures, originating with Claude Bernard's milieu intérieur and extending to more recent models such as allostasis. The impact of stress and anxiety upon these regulatory processes has both basic science and clinical relevance, extending from the pioneering work of Hans Selye who advanced the concept that stress can significantly impact physiological health and function. Of particular interest within the current article, anxiety is independently associated with cardiovascular risk, yet mechanisms underlying these associations remain equivocal. This link between anxiety and cardiovascular risk is relevant given the high prevalence of anxiety in the general population, as well as its early age of onset. Chronically anxious populations, such as those with anxiety disorders (i.e., generalized anxiety disorder, panic disorder, specific phobias, etc.) offer a human model that interrogates the deleterious effects that chronic stress and allostatic load can have on the nervous system and cardiovascular function. Further, while many of these disorders do not appear to exhibit baseline alterations in sympathetic neural activity, reactivity to mental stress offers insights into applicable, real-world scenarios in which heightened sympathetic reactivity may predispose those individuals to elevated cardiovascular risk. This article also assesses behavioral and lifestyle modifications that have been shown to concurrently improve anxiety symptoms, as well as sympathetic control. Lastly, future directions of research will be discussed, with a focus on better integration of psychological factors within physiological studies examining anxiety and neural cardiovascular health. © 2022 American Physiological Society. Compr Physiol 12:1-33, 2022.
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Affiliation(s)
- Jeremy A Bigalke
- Department of Psychology, Montana State University, Bozeman, Montana, USA
| | - Jason R Carter
- Department of Psychology, Montana State University, Bozeman, Montana, USA.,Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
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11
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Zhou J, Lee S, Wong WT, Leung KSK, Nam RHK, Leung PSH, Chau YLA, Liu T, Chang C, Cheung BMY, Tse G, Zhang Q. Gender- and Age-Specific Associations of Visit-to-Visit Blood Pressure Variability With Anxiety. Front Cardiovasc Med 2021; 8:650852. [PMID: 34026870 PMCID: PMC8137912 DOI: 10.3389/fcvm.2021.650852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background: There is a bidirectional relationship between blood pressure variability (BPV) and anxiety, but few studies have examined the gender- and age-specific effects of visit-to-visit BPV on incident anxiety. We examined the predictive value of BPV for the incidence of anxiety in a family clinic cohort. Methods: Consecutive patients with a first attendance to family medicine clinics in Hong Kong between January 1, 2000, and December 31, 2002, with at least three blood pressure measurements available thereafter were included. The primary endpoint was incident anxiety as identified by ICD-9 coding. Results: This study included 48,023 (50% males) patients with a median follow-up of 224 [interquartile range (IQR): 217-229] months. Females were more likely to develop incident anxiety compared to males (incidence rate: 7 vs. 2%), as were patients of older age. Significant univariate predictors were female gender, older age, preexisting cardiovascular diseases, respiratory diseases, diabetes mellitus, hypertension, and gastrointestinal diseases, various laboratory examinations, and the number of blood pressure measurements. Higher baseline, maximum, minimum, standard deviation (SD), coefficient of variation (CV), and variability score of diastolic blood pressure significantly predicted incident anxiety, as did all systolic blood pressure measures [baseline, latest, maximum, minimum, mean, median, variance, SD, root mean square (RMS), CV, and variability score]. Conclusions: The relationships between longer-term visit-to-visit BPV and incident anxiety were identified. Female and older patients with higher blood pressure and higher BPV were at the highest risks of incident anxiety.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | - Yau-Lam Alex Chau
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Carlin Chang
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
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12
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Araújo C, Ferreira-Silva R, Gara E, Goya T, Guerra R, Matheus L, Toschi-Dias E, Rodrigues A, Barbosa E, Fazan R, Lorenzi-Filho G, Negrão C, Ueno-Pardi L. Effects of exercise training on autonomic modulation and mood symptoms in patients with obstructive sleep apnea. Braz J Med Biol Res 2021; 54:e10543. [PMID: 33729391 PMCID: PMC7959152 DOI: 10.1590/1414-431x202010543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
We evaluated the effects of exercise training (ET) on the profile of mood states (POMS), heart rate variability, spontaneous baroreflex sensitivity (BRS), and sleep disturbance severity in patients with obstructive sleep apnea (OSA). Forty-four patients were randomized into 2 groups, 18 patients completed the untrained period and 16 patients completed the exercise training (ET). Beat-to-beat heart rate and blood pressure were simultaneously collected for 5 min at rest. Heart rate variability (RR interval) was assessed in time domain and frequency domain (FFT spectral analysis). BRS was analyzed with the sequence method, and POMS was analyzed across the 6 categories (tension, depression, hostility, vigor, fatigue, and confusion). ET consisted of 3 weekly sessions of aerobic exercise, local strengthening, and stretching exercises (72 sessions, achieved in 40±3.9 weeks). Baseline parameters were similar between groups. The comparisons between groups showed that the changes in apnea-hypopnea index, arousal index, and O2 desaturation in the exercise group were significantly greater than in the untrained group (P<0.05). The heart rate variability and BRS were significantly higher in the exercise group compared with the untrained group (P<0.05). ET increased peak oxygen uptake (P<0.05) and reduced POMS fatigue (P<0.05). A positive correlation (r=0.60, P<0.02) occurred between changes in the fatigue item and OSA severity. ET improved heart rate variability, BRS, fatigue, and sleep parameters in patients with OSA. These effects were associated with improved sleep parameters, fatigue, and cardiac autonomic modulation, with ET being a possible protective factor against the deleterious effects of hypoxia on these components in patients with OSA.
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Affiliation(s)
- C.E.L. Araújo
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Ferreira-Silva
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E.M. Gara
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T.T. Goya
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R.S. Guerra
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L. Matheus
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E. Toschi-Dias
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A.G. Rodrigues
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E.R.F. Barbosa
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Fazan
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G. Lorenzi-Filho
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C.E. Negrão
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Escola de Educação Física e Esportes, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.M. Ueno-Pardi
- Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil
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13
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Leung JH, Bayomy OF, Bonyhay I, Celli J, White J, Freeman R, Adler GK. ACTH Infusion Impairs Baroreflex Sensitivity-Implications for Cardiovascular Hypoglycemia-Associated Autonomic Failure. J Clin Endocrinol Metab 2020; 105:5827417. [PMID: 32353115 PMCID: PMC7255850 DOI: 10.1210/clinem/dgaa221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/27/2020] [Indexed: 01/22/2023]
Abstract
CONTEXT Hypoglycemia attenuates cardiovascular homeostatic autonomic control. This attenuation, known as the cardiovascular component of hypoglycemia-associated autonomic failure (HAAF), is characterized most notably by decreased baroreflex sensitivity (BRS) that begins during hypoglycemia and persists until at least the next day, despite return to euglycemia. Understanding the mechanisms underlying this reduction in BRS is important because BRS attenuation is associated with increased morbidity and mortality. OBJECTIVE The objective of this work is to investigate the role of the adrenocorticotropin (ACTH)-adrenal axis in decreasing BRS. We tested the hypothesis that infusion of ACTH 1-24 (cosyntropin), as compared to placebo, would acutely suppress BRS, and that this decrease in BRS would be present the next day. DESIGN A double-blind, placebo-controlled, random-order, cross-over study was conducted. SETTING This study took place in a clinical research center. PARTICIPANTS Participants included healthy men and women. INTERVENTIONS Interventions included an intravenous infusion of cosyntropin (70 μg/hour for 2.5 hours in the morning and again in the early afternoon) vs normal saline placebo. MAIN OUTCOME MEASURES Outcome measures included BRS during and 16 hours after cosyntropin vs placebo infusions. RESULTS Cosyntropin infusion attenuated BRS (mm Hg/ms) as compared to placebo (baseline 17.8 ± 1.38 vs 17.0 ± 2.07; during 14.4 ± 1.43 vs 17.3 ± 1.65; and next day 14.8 ± 1.42 vs 18.9 ± 2.04; P < .05, time by treatment, analysis of variance). BRS was decreased during the final 30 minutes of the morning cosyntropin infusion as compared to baseline (P < .01) and remained suppressed the next day (16 hours after afternoon infusion) (P < .025). Placebo infusion did not significantly change BRS. Corrected QT interval was not affected. CONCLUSIONS ACTH attenuates BRS, raising the possibility that hypoglycemia-induced increases in ACTH may contribute to the cardiovascular component of HAAF.
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Affiliation(s)
- Janet H Leung
- Division of Endocrinology and Diabetes, Virginia Mason Medical Center, Seattle, Washington
| | - Omar F Bayomy
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Istvan Bonyhay
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Johanna Celli
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey White
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Gail K Adler
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Gail K. Adler, MD, PhD, FAHA, Brigham and Women’s Hospital, Division of Endocrinology, Diabetes and Hypertension, 221 Longwood Avenue, Boston, MA 02115. E-mail:
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14
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Nas Z, Riese H, van Roon AM, Rijsdijk FV. Higher Anxiety Is Associated with Lower Cardiovascular Autonomic Function in Female Twins. Twin Res Hum Genet 2020; 23:156-164. [PMID: 32539904 DOI: 10.1017/thg.2020.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Anxiety symptoms co-occur with cardiovascular health problems, with increasing evidence suggesting the role of autonomic dysfunction. Yet, there is limited behavior genetic research on underlying mechanisms. In this twin study, we investigated the phenotypic, genetic and environmental associations between a latent anxiety factor and three cardiovascular autonomic function factors: interbeat interval (IBI, time between heart beats), heart rate variability (HRV, overall fluctuation of heart-beat intervals) and baroreflex sensitivity (BRS, efficiency in regulating blood pressure [BP]). Multivariate twin models were fit using data of female twins (N = 250) of the Twin Interdisciplinary Neuroticism Study (TWINS). A significant negative association was identified between latent anxiety and BRS factors (r = -.24, 95% CI [-.40, -.07]). Findings suggest that this relationship was mostly explained by correlated shared environmental influences, and there was no evidence for pleiotropic genetic or unique environmental effects. We also identified negative relationships between anxiety symptoms and HRV (r = -.17, 95% CI [-.34, .00]) and IBI factors (r = -.13, 95% CI [-.29, .04]), though these associations did not reach statistical significance. Findings implicate that higher anxiety scores are associated with decreased efficiency in short-term BP regulation, providing support for autonomic dysfunction with anxiety symptomatology. The baroreflex system may be a key mechanism underlying the anxiety-cardiovascular health relationship.
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Affiliation(s)
- Zeynep Nas
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Arie M van Roon
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Frühling V Rijsdijk
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension. Curr Hypertens Rep 2019; 21:66. [DOI: 10.1007/s11906-019-0972-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Kim J, Chou E, Le J, Wong S, Chu M, Khine M. Soft Wearable Pressure Sensors for Beat-to-Beat Blood Pressure Monitoring. Adv Healthc Mater 2019; 8:e1900109. [PMID: 31033256 DOI: 10.1002/adhm.201900109] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/01/2019] [Indexed: 01/01/2023]
Abstract
Wrinkled gold thin films on elastomeric substrates are used as robust parallel plate electrodes for soft capacitive pressure sensors. The wrinkled structures create a robust integration with the polymer, allowing repeated normal force to deform the thin film without failure. By incorporating microridged structures that support the counter electrodes to create air cavities within the elastomeric dielectric layer, pressure sensitivity is further increased to 0.148 kPa-1 over a wide dynamic range of up to 10 kPa. The wide dynamic range and pressure sensitivity of the pressure sensor allow for consistent measurements of the pressure exerted by the radial artery located on the wrist. The soft capacitive pressure sensor displays comparable results when tested against an FDA approved device (Clearsight, Edwards Lifesciences, Irvine, CA) measuring beat-to-beat blood pressure. These soft pressure sensors using wrinkled thin films, therefore, illustrate considerable potential to continuously monitor beat-to-beat blood pressure.
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Affiliation(s)
- Joshua Kim
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - En‐Fan Chou
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Jamie Le
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Sabrina Wong
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michael Chu
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michelle Khine
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
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17
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Detection of Emotions Induced by Colors in Compare of Two Nonlinear Mapping of Heart Rate Variability Signal: Triangle and Parabolic Phase Space (TPSM, PPSM). J Med Biol Eng 2019. [DOI: 10.1007/s40846-018-0458-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Liou M, Hsieh JF, Evans J, Su IW, Nayak S, Lee JD, Savostyanov AN. Resting heart rate variability in young women is a predictor of EEG reactions to linguistic ambiguity in sentences. Brain Res 2018; 1701:1-17. [PMID: 30006295 DOI: 10.1016/j.brainres.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 07/01/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
Recent research has found a relationship between heart rate variability (HRV) and cognitive control mechanisms underlying various experimental tasks. This study explored the interaction between gender and resting-state HRV in brain oscillatory activity during visual recognition of linguistic ambiguity while taking state and trait anxiety scores into account. It is well known that stress or anxiety increases arousal levels, particularly under uncertainty situations. We tasked 50 young Mandarin speakers (26 women; average age 26.00 ± 4.449) with the recognition of linguistic ambiguity in English (foreign) sentences with the purpose of imposing a sense of uncertainty in decision-making. Our results revealed a dependency between resting-state HRV and theta/alpha power in individual women. Low HRV women showed stronger theta/alpha desynchronization compared with their high HRV counterparts, independent of topographic localization. However, low and high HRV men exhibited comparable theta/alpha activity. Trait anxiety scores affected alpha power in the parieto-occipital regions, whereas men with higher scores and women with lower scores showed stronger alpha desynchronization. We posit that stress-provoking situations may impose additional effects on theta/alpha desynchronization in the frontal and temporal regions, a condition in which the interdependency between brain oscillatory activity and resting-state HRV could interact with cognitive control differently in men and women.
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Affiliation(s)
- Michelle Liou
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
| | - Jih-Fu Hsieh
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Jonathan Evans
- Institute of Linguistics, Academia Sinica, Taipei, Taiwan
| | - I-Wen Su
- Graduate Institute of Linguistics, National Taiwan University, Taipei, Taiwan
| | - Siddharth Nayak
- Interdisciplinary Neuroscience Graduate Program, Academia Sinica, Taipei, Taiwan
| | - Juin-Der Lee
- Graduate Institute of Business Administration, National Chengchi University, Taipei, Taiwan
| | - Alexander N Savostyanov
- State Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia
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19
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Heart rate variability, salivary cortisol and competitive state anxiety responses during pre-competition and pre-training moments. Biol Sport 2018; 36:39-46. [PMID: 30899138 PMCID: PMC6413577 DOI: 10.5114/biolsport.2018.78905] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
The study aimed to investigate physiological and psychological states prior to competition and prior to training in three different demanding activities. Eighteen canoe athletes, 18 street runners and 18 jiu-jitsu fighters were included in this study (n=54). The Competitive State Anxiety Inventory-2 (CSAI-2), salivary cortisol and heart rate variability (HRV) were measured at two time points (pre-training and pre-competition). Somatic anxiety (F1,42 = 15.29, p = 0.0003), HRV (F1,42 = 23.24, p < 0.0001) and salivary cortisol (F1,42 = 22.96, p < 0.0001) were significantly greater at the pre-competition measurement point than at the pre-training point, but without a main effect of the type of athlete on these variables. A main effect of the type of athlete was found on somatic anxiety (F2,42 = 6.58, p = 0.0033), cognitive anxiety (F2,42 = 10.69, p = 0.0002) and self-confidence (F2,42 = 5.42, p = 0.0080). Correlations between most CSAI-2 and physiological parameters were not significant (p > 0.05). In conclusion, the results indicated that both emotional indices and psychophysiological indices of stress are higher before competition than before training, with differences between emotional states between these sports. Although correlations between emotional states and psycho-physiological states before competition and before training were largely non-significant, these findings reinforce the importance of psychological monitoring of athletes in association with traditional physiological markers such as cortisol and HRV in sportive training programmes as complementary resources to improve both competition performance and the training routine.
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20
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Tully PJ, Debette S, Tzourio C. The association between systolic blood pressure variability with depression, cognitive decline and white matter hyperintensities: the 3C Dijon MRI study. Psychol Med 2018; 48:1444-1453. [PMID: 28950920 DOI: 10.1017/s0033291717002756] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Accumulating evidence links blood pressure variability (BPV) with white matter hyperintensities (WMH) and stroke. The longitudinal association between BPV with late onset depression (LOD) and cognitive decline remains unexplored. METHODS Prospective cohort study of 2812 participant's age ⩾65 years (median age 72 years, 63.6% female) without dementia or stroke. Serial clinic visits assessed blood pressure, cognitive function, depression disorder, and depressive symptoms. A brain magnetic resonance imaging (MRI) substudy was performed in 1275 persons to examine possible associations with WMH. RESULTS The interaction between symptomatic LOD and systolic BPV was associated with cognitive decline on the Isaac Set Test [slope -4.45; 95% confidence interval (CI) -8.92 to -0.16, p = 0.04], Benton Visual Retention Test (slope -0.89; 95% CI -1.77 to -0.01, p = 0.049), Mini Mental State Examination (slope -1.08; 95% CI -1.86 to -0.30, p = 0.007) and Finger Tapping Test (slope -7.53; 95% CI -13.71 to -1.34, p = 0.017) but not Trail Making Test-A or -B/A. The MRI substudy demonstrated that systolic BPV was associated with cognitive decline via interactions with depression and total WMH volume, but this was not dependent on either deep or periventricular WMH volumes. CONCLUSIONS The findings show that the interaction between systolic BPV with symptomatic depression and WMH increases cognitive decline in persons ⩾65 years of age. Future work could extend these findings by examining systolic BPV in relation to cognitive decline and WMH in older populations with depression.
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Affiliation(s)
- P J Tully
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
| | - S Debette
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
| | - C Tzourio
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
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21
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O'Neil A, Scovelle AJ. Intimate Partner Violence perpetration and cardiovascular risk: A systematic review. Prev Med Rep 2018; 10:15-19. [PMID: 29868353 PMCID: PMC5984211 DOI: 10.1016/j.pmedr.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/30/2017] [Accepted: 01/14/2018] [Indexed: 12/24/2022] Open
Abstract
Intimate Partner Violence (IPV) perpetration may induce cardiovascular reactivity and risk markers thereby precipitating early onset cardiovascular disease (CVD). However, this relationship has been largely under-researched in comparison to the health impacts of IPV victimisation. We therefore aimed to systematically review the current evidence investigating the relationship between IPV perpetration and CV risk. Six databases (CINAHL, Ovid MEDLINE, Pubmed, Scopus, ProQuest, Google Scholar) were searched between August 2016 and August 2017 using a predefined search strategy. Inclusion criteria were studies of cross sectional and longitudinal design published since 2010, presenting IPV status by perpetrators (as distinct from victims) and an outcome of CVD (e.g. cardiac disease, stroke), CV risk markers (e.g. blood pressure) and/or a composite CV risk score. Twenty two potentially eligible studies were identified and full texts recovered. After ineligible studies were excluded, four remained (total n = 10,665). Positive relationships were observed between IPV perpetration and (i) short term CV reactivity markers (higher heart rate, lower vagal ratios, shorter pre-ejection periods) and (ii) longer term CV risk factors and outcomes including greater systolic blood pressure, incident hypertension, elevated 30 year CV risk score and self-report cardiac disease. Despite being a neglected area of research characterised by a high degree of heterogeneity, the early evidence suggests that IPV perpetration may be associated with elevated risk of CVD. We discuss these findings in the context of CVD prevention from the individual, family and inter-generational perspectives and directions for future studies.
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Affiliation(s)
- Adrienne O'Neil
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Victoria 3010, Australia
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22
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Associations between symptoms of depression and heart rate variability: An exploratory study. Psychiatry Res 2018; 262:482-487. [PMID: 28958456 DOI: 10.1016/j.psychres.2017.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/27/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) is associated with decreased heart rate variability (HRV), a predictor of cardiovascular morbidity by many, but not all studies. This inconsistency could be due to the association of HRV with specific depressive symptoms. Here, we investigated the association of HRV parameters with components of depressive symptoms from 120 MDD patients, at baseline of a published trial comparing the effect of sertraline to transcranial direct current stimulation. We used Principal Component Analysis to extract components of the Hamilton Rating Scale for Depression (HAM-D-17), the Montgomery Asberg Depression Rating Scale (MADRS) and the Beck Inventory for Depressive Symptomatology (BDI). We constructed one equation of multiple linear regression for each HRV parameter as the dependent variable, and the components of depressive symptoms of the three scales as the independent ones, adjusted for age and gender. A component of HAM-D-17 predicted LF/HF (low frequency/high frequency) and a component of MADRS predicted LF (low frequency). "Guilt" and "loss of interest/pleasure in activities" were present in the components of both scales, and the MADRS component also included "psychomotor retardation". These results suggest that melancholic features might be relevant for the association between MDD and HRV. Considering multiple comparisons, these results are preliminary.
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23
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Holwerda SW, Luehrs RE, Gremaud AL, Wooldridge NA, Stroud AK, Fiedorowicz JG, Abboud FM, Pierce GL. Relative burst amplitude of muscle sympathetic nerve activity is an indicator of altered sympathetic outflow in chronic anxiety. J Neurophysiol 2018. [PMID: 29537916 DOI: 10.1152/jn.00064.2018] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Relative burst amplitude of muscle sympathetic nerve activity (MSNA) is an indicator of augmented sympathetic outflow and contributes to greater vasoconstrictor responses. Evidence suggests anxiety-induced augmentation of relative MSNA burst amplitude in patients with panic disorder; thus we hypothesized that acute stress would result in augmented relative MSNA burst amplitude and vasoconstriction in individuals with chronic anxiety. Eighteen participants with chronic anxiety (ANX; 8 men, 10 women, 32 ± 2 yr) and 18 healthy control subjects with low or no anxiety (CON; 8 men, 10 women, 39 ± 3 yr) were studied. Baseline MSNA and 24-h blood pressure were similar between ANX and CON ( P > 0.05); however, nocturnal systolic blood pressure % dipping was blunted among ANX ( P = 0.02). Relative MSNA burst amplitude was significantly greater among ANX compared with CON immediately preceding (anticipation) and during physiological stress [2-min cold pressor test; ANX: 73 ± 5 vs. CON: 59 ± 3% arbitrary units (AU), P = 0.03] and mental stress (4-min mental arithmetic; ANX: 65 ± 3 vs. CON: 54 ± 3% AU, P = 0.02). Increases in MSNA burst frequency, incidence, and total activity in response to stress were not augmented among ANX compared with CON ( P > 0.05), and reduction in brachial artery conductance during cold stress was similar between ANX and CON ( P = 0.92). Relative MSNA burst amplitude during mental stress was strongly correlated with state ( P < 0.01) and trait ( P = 0.01) anxiety (State-Trait Anxiety Inventory), independent of age, sex, and body mass index. Thus in response to acute stress, both mental and physiological, individuals with chronic anxiety demonstrate selective augmentation in relative MSNA burst amplitude, indicating enhanced sympathetic drive in a population with higher risk for cardiovascular disease. NEW & NOTEWORTHY Relative burst amplitude of muscle sympathetic nerve activity in response to acute mental and physiological stress is selectively augmented in individuals with chronic anxiety, which is a prevalent condition that is associated with the development of cardiovascular disease. Augmented sympathetic burst amplitude occurs with chronic anxiety in the absence of common comorbidities. These findings provide important insight into the relation between anxiety, acute stress and sympathetic activation.
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Affiliation(s)
- Seth W Holwerda
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa.,Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa
| | - Rachel E Luehrs
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Allene L Gremaud
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Nealy A Wooldridge
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Amy K Stroud
- Department of Psychiatry, University of Iowa , Iowa City, Iowa
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Iowa , Iowa City, Iowa.,Department of Epidemiology, University of Iowa , Iowa City, Iowa.,Department of Internal Medicine, University of Iowa , Iowa City, Iowa.,Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa
| | - Francois M Abboud
- Department of Internal Medicine, University of Iowa , Iowa City, Iowa.,Department of Molecular Physiology and Biophysics, University of Iowa , Iowa City, Iowa.,Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa.,Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa.,Fraternal Order of Eagles Diabetes Research Center, University of Iowa , Iowa City, Iowa
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24
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Joung KI, Cho SI. Association of low blood pressure with suicidal ideation: a cross-sectional study of 10,708 adults with normal or low blood pressure in Korea. BMC Public Health 2018; 18:200. [PMID: 29490622 PMCID: PMC5831223 DOI: 10.1186/s12889-018-5106-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 01/19/2018] [Indexed: 01/13/2023] Open
Abstract
Background Whether constitutional low blood pressure (BP) causes substantive health problems has been controversial, and subjects with hypotension exhibit a range of symptoms, from mild typical conditions such as tiredness and dizziness to more specific psychological conditions and even cognitive disorders. This study investigated whether low BP is associated with suicidal ideation in the general population. Methods Four years of data from the 2010–2013 Korean National Health and Nutrition Examination Survey were used. Among the 23,163 participants, aged 19–101 years, 10,708 with normal or low BP were included in the analysis of the association between low BP and suicidal ideation. The criterion used for low BP was systolic BP (SBP) < 100 mmHg, and in comparative analyses, the criteria used for low BP were SBP < 110, < 95, and < 90 mmHg. The association of prehypertension or hypertension with suicidal ideation was also examined. Suicidal ideation was assessed by a questionnaire. Results Compared with the normotensive reference group, the odds ratios (ORs) for suicidal ideation were significantly higher in the three hypotensive groups after adjusting for sex, age, body mass index, total cholesterol level, household income, educational level, marital status, current smoking status, alcohol intake, and the interaction between sex and age (OR = 1.29, 95% confidence interval [CI], 1.08 to 1.55; OR = 1.44, 95% CI, 1.14 to 1.82; and OR = 1.71, 95% CI, 1.11 to 2.62 for SBP < 100, SBP < 95, and SBP < 90 mmHg, respectively). Adding the clinical morbidities of diabetes mellitus, stroke, myocardial infarction/angina pectoris, and depression as covariates had little effect on the strength of the associations (OR = 1.25, 95% CI, 1.04 to 1.50; OR = 1.43, 95% CI, 1.13 to 1.81; and OR = 1.74, 95% CI, 1.14 to 2.68 for SBP < 100, < 95, and < 90 mmHg, respectively). Conclusions Low SBP showed an association with suicidal ideation in the general Korean population. The association was significant for low BP, defined as a SBP < 100 mmHg, and the strength of the association increased as the criteria for low BP increased in strictness. Electronic supplementary material The online version of this article (10.1186/s12889-018-5106-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyung-In Joung
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea.
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Lischke A, Pahnke R, Mau-Moeller A, Behrens M, Grabe HJ, Freyberger HJ, Hamm AO, Weippert M. Inter-individual Differences in Heart Rate Variability Are Associated with Inter-individual Differences in Empathy and Alexithymia. Front Psychol 2018. [PMID: 29541046 PMCID: PMC5836598 DOI: 10.3389/fpsyg.2018.00229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In the present study, we investigated whether inter-individual differences in vagally mediated heart rate variability (vmHRV) would be associated with inter-individual differences in empathy and alexithymia. To this end, we determined resting state HF-HRV in 90 individuals that also completed questionnaires assessing inter-individual differences in empathy and alexithymia. Our categorical and dimensional analyses revealed that inter-individual differences in HF-HRV were differently associated with inter-individual differences in empathy and alexithymia. We found that individuals with high HF-HRV reported more empathy and less alexithymia than individuals with low HF-HRV. Moreover, we even found that an increase in HF-HRV was associated with an increase in empathy and a decrease in alexithymia across all participants. Taken together, these findings indicate that individuals with high HF-HRV are more empathetic and less alexithymic than individuals with low HF-HRV. These differences in empathy and alexithymia may explain why individuals with high HF-HRV are more successful in sharing and understanding the mental and emotional states of others than individuals with low HF-HRV.
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Affiliation(s)
- Alexander Lischke
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Rike Pahnke
- Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Anett Mau-Moeller
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Martin Behrens
- Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany.,HELIOS Klinikum Stralsund, Stralsund, Germany
| | - Alfons O Hamm
- Department of Psychology, University of Greifswald, Greifswald, Germany
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Effect of olfactory stimulation with essential oils on cardiovascular reactivity during the moving beans task in stroke patients with anxiety. Complement Ther Med 2018; 36:20-24. [DOI: 10.1016/j.ctim.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022] Open
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Thomas SA, Wilson T, Jain A, Deros DE, Um M, Hurwitz J, Jacobs I, Myerberg L, Ehrlich KB, Dunn EJ, Aldao A, Stadnik R, De Los Reyes A. Toward Developing Laboratory-Based Parent-Adolescent Conflict Discussion Tasks that Consistently Elicit Adolescent Conflict-Related Stress Responses: Support from Physiology and Observed Behavior. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 26:3288-3302. [PMID: 29249892 PMCID: PMC5730341 DOI: 10.1007/s10826-017-0844-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Parent-adolescent conflict poses risk for youth maladjustment. One potential mechanism of this risk is that stress in the form of increased arousal during conflict interactions results in adolescents' impaired decision-making. However, eliciting consistent adolescent stress responses within laboratory-based tasks of parent-adolescent conflict (i.e., conflict discussion tasks) is hindered by task design. This limitation may stem from how conflict topics are assessed and selected for discussion. Within a sample of 47 adolescents (ages 14-17) and parents, we investigated whether a modified version of a conflict discussion task could elicit physiological (i.e., arousal) and behavioral (i.e., hostility) displays of adolescents' conflict-related stress responses. We assessed parent-adolescent conflict via structured interview to identify topics for dyads to discuss during the task. We randomly assigned dyads to complete a 5-minute task to discuss either a putatively benign topic (i.e., control condition) or a conflict topic while undergoing direct assessments of continuous arousal. Trained raters coded dyad members' hostile behavior during the task. Adolescents in the conflict condition exhibited significantly greater levels of arousal than adolescents in the control condition. We observed an interaction between discussion condition and baseline conflict. Specifically, higher baseline conflict predicted greater hostile behavior for adolescents in the conflict condition, yet we observed the inverse relation for adolescents in the control condition. Our modified laboratory discussion task successfully elicited both physiological and behavioral displays of adolescent conflict-related stress. These findings have important implications for leveraging experimental paradigms to understand causal links between parent-adolescent conflict and adolescent psychopathology, and their underlying mechanisms.
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Affiliation(s)
- Sarah A Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903
| | - Tristan Wilson
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Anjali Jain
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Danielle E Deros
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Miji Um
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Joanna Hurwitz
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Irene Jacobs
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Lindsay Myerberg
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | | | - Emily J Dunn
- Department of Psychology, Ohio State University, Columbus, OH 43210
| | - Amelia Aldao
- Department of Psychology, Ohio State University, Columbus, OH 43210
| | | | - Andres De Los Reyes
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
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Panayiotou G, Constantinou E. Emotion dysregulation in alexithymia: Startle reactivity to fearful affective imagery and its relation to heart rate variability. Psychophysiology 2017; 54:1323-1334. [PMID: 28480975 DOI: 10.1111/psyp.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 12/14/2022]
Abstract
Alexithymia is associated with deficiencies in recognizing and expressing emotions and impaired emotion regulation, though few studies have verified the latter assertion using objective measures. This study examined startle reflex modulation by fearful imagery and its associations with heart rate variability in alexithymia. Fifty-four adults (27 alexithymic) imagined previously normed fear scripts. Startle responses were assessed during baseline, first exposure, and reexposure. During first exposure, participants, in separate trials, engaged in either shallow or deep emotion processing, giving emphasis on descriptive or affective aspects of imagery, respectively. Resting heart rate variability was assessed during 2 min of rest prior to the experiment, with high alexithymic participants demonstrating significantly higher LF/HF (low frequency/high frequency) ratio than controls. Deep processing was associated with nonsignificantly larger and faster startle responses at first exposure for alexithymic participants. Lower LF/HF ratio, reflecting higher parasympathetic cardiac activity, predicted greater startle amplitude habituation for alexithymia but lower habituation for controls. Results suggest that, when exposed to prolonged threat, alexithymics may adjust poorly, showing a smaller initial defensive response but slower habituation. This pattern seems related to their low emotion regulation ability as indexed by heart rate variability.
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Affiliation(s)
- Georgia Panayiotou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.,Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
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Mather M, Joo Yoo H, Clewett DV, Lee TH, Greening SG, Ponzio A, Min J, Thayer JF. Higher locus coeruleus MRI contrast is associated with lower parasympathetic influence over heart rate variability. Neuroimage 2017; 150:329-335. [PMID: 28215623 DOI: 10.1016/j.neuroimage.2017.02.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/19/2017] [Accepted: 02/10/2017] [Indexed: 12/17/2022] Open
Abstract
The locus coeruleus (LC) is a key node of the sympathetic nervous system and suppresses parasympathetic activity that would otherwise increase heart rate variability. In the current study, we examined whether LC-MRI contrast reflecting neuromelanin accumulation in the LC was associated with high-frequency heart rate variability (HF-HRV), a measure reflecting parasympathetic influences on the heart. Recent evidence indicates that neuromelanin, a byproduct of catecholamine metabolism, accumulates in the LC through young and mid adulthood, suggesting that LC-MRI contrast may be a useful biomarker of individual differences in habitual LC activation. We found that, across younger and older adults, greater LC-MRI contrast was negatively associated with HF-HRV during fear conditioning and spatial detection tasks. This correlation was not accounted for by individual differences in age or anxiety. These findings indicate that individual differences in LC structure relate to key cardiovascular parameters.
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Affiliation(s)
- Mara Mather
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA.
| | - Hyun Joo Yoo
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - David V Clewett
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - Tae-Ho Lee
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - Steven G Greening
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - Allison Ponzio
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - Jungwon Min
- Emotion and Cognition Lab, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Palix J, Akselrod M, Cungi C, Giuliani F, Favrod J. Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders. Front Psychiatry 2017; 8:4. [PMID: 28203208 PMCID: PMC5285363 DOI: 10.3389/fpsyt.2017.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research. METHOD Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient's level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states. RESULTS Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4). CONCLUSION The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.
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Affiliation(s)
- Julie Palix
- School of Nursing Sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Akselrod
- Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | | | - Fabienne Giuliani
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Jérôme Favrod
- School of Nursing Sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
Ambulatory blood pressure (ABP) has long been recognized by researchers as the gold standard of blood pressure (BP) measurement. Researchers and clinicians typically rely on the mean measure of ABP; however, there is considerable variability in the beat-to-beat BP. Although often ignored, this variability has been found to be an independent predictor of cardiovascular disease and mortality. The aim of this paper is to provide a conceptual review of ABP variability (ABPV) focusing on the following: associations between ABPV and health, whether ABPV is reliable, how to calculate ABPV, predictors of ABPV, and treatments for ABPV. Two future directions are discussed involving better understanding ABPV by momentary assessments and improving knowledge of the underlying physiology that explains ABPV. The results of this review suggest that the unique characteristics of ABPV provide insight into the role of BP variability in hypertension and subsequent cardiovascular illness.
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32
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Princip M, Scholz M, Meister-Langraf RE, Barth J, Schnyder U, Znoj H, Schmid JP, Thayer JF, von Känel R. Can Illness Perceptions Predict Lower Heart Rate Variability following Acute Myocardial Infarction? Front Psychol 2016; 7:1801. [PMID: 27917140 PMCID: PMC5114266 DOI: 10.3389/fpsyg.2016.01801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 11/01/2016] [Indexed: 12/19/2022] Open
Abstract
Objective: Decreased heart rate variability (HRV) has been reported to be a predictor of mortality after myocardial infarction (MI). Patients' beliefs and perceptions concerning their illness may play a role in decreased HRV. This study investigated if illness perceptions predict HRV at 3 months following acute MI. Methods: 130 patients referred to a tertiary cardiology center, were examined within 48 h and 3 months following acute MI. At admission, patients' cognitive representations of their MI were assessed using the German version of the self-rated Brief Illness Perception Questionnaire (Brief IPQ). At admission and after 3 months (follow-up), frequency and time domain measures of HRV were obtained from 5-min electrocardiogram (ECG) recordings during stable supine resting. Results: Linear hierarchical regression showed that the Brief IPQ dimensions timeline (β coefficient = 0.29; p = 0.044), personal control (β = 0.47; p = 0.008) and illness understanding (β = 0.43; p = 0.014) were significant predictors of HRV, adjusted for age, gender, baseline HRV, diabetes, beta-blockers, left ventricular ejection fraction (LVEF), attendance of cardiac rehabilitation, and depressive symptoms. Conclusions: As patients' negative perceptions of their illness are associated with lower HRV following acute MI, a brief illness perception questionnaire may help to identify patients who might benefit from a specific illness perceptions intervention.
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Affiliation(s)
- Mary Princip
- Department of Neurology, Inselspital, Bern University Hospital, and University of BernBern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of BernBern, Switzerland; Department of Cardiology, Inselspital, Bern University HospitalBern, Switzerland
| | - Marco Scholz
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern Bern, Switzerland
| | - Rebecca E Meister-Langraf
- Department of Neurology, Inselspital, Bern University Hospital, and University of BernBern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of BernBern, Switzerland; Clienia Schlössli AG, Private Psychiatric and Psychotherapy ClinicOetwil am See, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich Switzerland
| | - Hansjörg Znoj
- Division of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern Bern, Switzerland
| | - Jean-Paul Schmid
- Cardiology Clinic, Tiefenauspital, Bern University Hospital Bern, Switzerland
| | - Julian F Thayer
- Department of Psychology, Ohio State University Columbus Columbus, OH, USA
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of BernBern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of BernBern, Switzerland; Department of Psychosomatic Medicine, Clinic BarmelweidBarmelweid, Switzerland
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Tully PJ, Tzourio C. Psychiatric correlates of blood pressure variability in the elderly: The Three City cohort study. Physiol Behav 2016; 168:91-97. [PMID: 27818215 DOI: 10.1016/j.physbeh.2016.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The modifiable factors associated with blood pressure variability (BPV) are still being established and their clinical relevance is poorly understood. Generalized anxiety disorder (GAD) and depression have been implicated with higher BPV in the short term (e.g. hours, days) however their effects on BPV over longer periods are unknown. METHODS In a prospective cohort study, 1454 elderly participants (age 78.5±3.78years, 59% women) underwent structured interview for GAD and major depression. Participants performed home blood pressure monitoring (HBPM) over 3 consecutive days and underwent serial clinic BP measures on 4 separate follow-ups over an 8year period. Systolic and diastolic BPV was calculated using the coefficient of variation (CV) and standard deviation method. Generalized linear models assessed the association between GAD and depression with BPV over an 8year period. RESULTS GAD was associated with significantly increased systolic BPV over 8years in age, sex and mean systolic BP (β=0.25, SE=0.09; p=0.007) and fully adjusted models (β=0.23, SE=0.10; p=0.017). BPV from HBPM was strongly associated with 8year systolic BPV in age-sex (β=3.10, SE=0.82; p<0.001) and fully adjusted models (β=3.09, SE=0.84; p<0.001). The association between GAD and longer term BPV was consistent when analyzing morning and evening HBPM measures of BPV. There was no association between diastolic BPV over 8years with GAD or depression. CONCLUSIONS GAD but not depression was associated with increased systolic BPV over an 8year period controlling for HBPM. GAD has clinical relevance for control of systolic BPV in elderly participants.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia.
| | - Christophe Tzourio
- Bordeaux Population Health, University of Bordeaux, France; INSERM, Neuroepidemiology, UMR897, F-33000 Bordeaux, France
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Lu WC, Tzeng NS, Kao YC, Yeh CB, Kuo TBJ, Chang CC, Chang HA. Correlation between health-related quality of life in the physical domain and heart rate variability in asymptomatic adults. Health Qual Life Outcomes 2016; 14:149. [PMID: 27765048 PMCID: PMC5073888 DOI: 10.1186/s12955-016-0555-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/14/2016] [Indexed: 01/02/2023] Open
Abstract
Background Reduced health-related quality of life in the physical domain (HRQOLphysical) has been reported to increase risks for cardiovascular disease (CVD); however, the mechanism underlying this phenomenon is still unclear. The autonomic nervous system (ANS) that connects the body and mind is a biologically plausible candidate to investigate this mechanism. The aim of our study is to examine whether the HRQOLphysical independently contributes to heart rate variability (HRV), which reflects ANS activity. Methods We recruited 329 physically and mentally healthy adults. All participants completed Beck Anxiety Inventory, Beck Depression Inventory and World Health Organization Questionnaire on Quality of Life: Short Form-Taiwanese version (WHOQOL-BREF). They were divided into groups of individuals having high or low scores of HRQOLphysical as discriminated by the quartile value of WHOQOL-BREF. We obtained the time and frequency-domain indices of HRV, namely variance (total HRV), the low-frequency power (LF; 0.05–0.15 Hz), which may reflect baroreflex function, the high-frequency power (HF; 0.15–0.40 Hz), which reflects cardiac parasympathetic activity, and the LF/HF ratio. Results There was an independent contribution of HRQOLphysical to explaining the variance in HRV after excluding potential confounding factors (gender, age, physical activity, alcohol use, depression and anxiety). Compared with the participants with high levels of HRQOLphysical, those with low levels of HRQOLphysical displayed significant reductions in variance and LF. Conclusions This study highlights the independent role of low HRQOLphysical in contributing to the reduced HRV in healthy adults and points to a potential underlying mechanism for HRQOLphysical to confer increased risks for CVD.
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Affiliation(s)
- Wan-Chun Lu
- Department of Psychiatry, Tri-Service General Hospital National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, 114, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, 114, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, 114, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, 114, Taipei, Taiwan.
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, 114, Taipei, Taiwan.
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Rice MJ, Records K. Cardiac Response Rate Variability in Physically Abused Women of Childbearing Age. Biol Res Nurs 2016; 7:204-13. [PMID: 16552948 DOI: 10.1177/1099800405283567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical abuse directly affects maternal and fetal/infant health, with documented reports of higher rates of pregnancy termination, neonatal death, and lower birth weights. Although the Centers for Disease Control and Prevention recommend repeated interviews of women of childbearing age to screen for abuse, the paper-and-pencil instruments available for such screening are adversely affected by the hesitancy of women to disclose physical abuse. Biophysical measures of physiological stress adaptations may hold potential for identifying physically abused childbearing women. This pilot investigation used a Latin square design to assess the effects of physically abusive trauma on the cardiac rate response of three clinical groups and one control group of childbearing-age women. Participants were screened using the Child-bearing Health Questionnaire. Cardiac response rates were measured during a standardized orthostatic challenge using a Tanito cardiac rate response monitor. Forty participants participated with an average age of 27. Multiple analyses of variance revealed that there were significant differences between cardiac rate responses at the 5-min interval. Post hoc testing using Dunnett’s t indicated that only the abused pregnant women had significantly higher cardiac responses to orthostatic challenges; differences were apparent at the 5-min testing period. The findings suggest that physical abuse may alter the vasovagal response beyond the attenuation associated with pregnancy. These findings support further testing with larger samples to identify vasovagal changes in abused pregnant women.
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Affiliation(s)
- Michael J Rice
- Washington State University, Intercollegiate College of Nursing, 2917 W. Ft. Wright Drive, Spokane, WA 99224, USA.
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Kao LC, Liu YW, Tzeng NS, Kuo TBJ, Huang SY, Chang CC, Chang HA. Linking an Anxiety-Related Personality Trait to Cardiac Autonomic Regulation in Well-Defined Healthy Adults: Harm Avoidance and Resting Heart Rate Variability. Psychiatry Investig 2016; 13:397-405. [PMID: 27482240 PMCID: PMC4965649 DOI: 10.4306/pi.2016.13.4.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/19/2015] [Accepted: 10/24/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Anxiety trait, anxiety and depression states have all been reported to increase risks for cardiovascular disease (CVD), possibly through altering cardiac autonomic regulation. Our aim was to investigate whether the relationship between harm avoidance (HA, an anxiety-related personality trait) and cardiac autonomic regulation is independent of anxiety and depression states in healthy adults. METHODS We recruited 535 physically and mentally healthy volunteers. Participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Tri-dimensional Personality Questionnaire. Participants were divided into high or low HA groups as discriminated by the quartile value. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV). We obtained the time and frequency-domain indices of HRV including variance (total HRV), the low-frequency power (LF; 0.05-0.15 Hz), which may reflect baroreflex function, the high-frequency power (HF; 0.15-0.40 Hz), which reflects cardiac parasympathetic activity, as well as the LF/HF ratio. RESULTS The BDI and HA scores showed associations with HRV parameters. After adjustment for the BDI scores and other control variables, HA is still associated with reduced variance, LF and HF power. Compared with the participants with low HA, those with high HA displayed significant reductions in variance, LF and HF power and a significant increase in their LF/HF ratio. CONCLUSION This study highlights the independent role of HA in contributing to decreased autonomic cardiac regulation in healthy adults and provides a potential underlying mechanism for anxiety trait to confer increased risk for CVD.
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Affiliation(s)
- Lien-Cheng Kao
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Wen Liu
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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The Effect of Hostility Reduction on Autonomic Control of the Heart and Vasculature: A Randomized Controlled Trial. Psychosom Med 2016; 78:481-91. [PMID: 26867075 PMCID: PMC5020896 DOI: 10.1097/psy.0000000000000296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hostility is associated with coronary artery disease. One candidate mechanism may be autonomic nervous system (ANS) dysregulation. In this study, we report the effect of cognitive behavioral treatment on ANS regulation. METHODS Participants were 158 healthy young adults, high in hostility measured by the Cook-Medley Hostility and Spielberger Trait Anger scales. Participants were also interviewed using the Interpersonal Hostility Assessment Technique. They were randomized to a 12-week cognitive behavioral treatment program for reducing hostility or a wait-list control group. The outcome measures were preejection period, low-frequency blood pressure variability, and high-frequency heart rate variability measured at rest and in response to and recovery from cognitive and orthostatic challenge. Linear-mixed models were used to examine group by session and group by session by period interactions while controlling for sex and age. Contrasts of differential group and session effects were used to examine reactivity and recovery from challenge. RESULTS After Bonferroni correction, two-way and three-way interactions failed to achieve significance for preejection period, low-frequency blood pressure variability, or high-frequency heart rate variability (p > .002), indicating that hostility reduction treatment failed to influence ANS indices. CONCLUSIONS Reduction in anger and hostility failed to alter ANS activity at rest or in response to or recovery from challenge. These findings raise questions about whether autonomic dysregulation represents a pathophysiological link between hostility and heart disease.
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Sex differences in healthy human heart rate variability: A meta-analysis. Neurosci Biobehav Rev 2016; 64:288-310. [PMID: 26964804 DOI: 10.1016/j.neubiorev.2016.03.007] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/04/2016] [Indexed: 12/17/2022]
Abstract
The present meta-analysis aimed to quantify current evidence on sex differences in the autonomic control of the heart, indexed by measures of heart rate variability (HRV) in healthy human subjects. An extensive search of the literature yielded 2020 titles and abstracts, of which 172 provided sufficient reporting of sex difference in HRV. Data from 63,612 participants (31,970 females) were available for analysis. Meta-analysis yielded a total of 1154 effect size estimates (k) across 50 different measures of HRV in a cumulated total of 296,247 participants. Females showed a significantly lower mean RR interval and standard deviation of RR intervals (SDNN). The power spectral density of HRV in females is characterized by significantly less total power that contains significantly greater high- (HF) and less low-frequency (LF) power. This is further reflected by a lower LF/HF ratio. Meta-regression revealed significant effects of age, respiration control and the length of recording available for analysis. Although women showed greater mean heart rate, they showed greater vagal activity indexed by HF power of HRV. Underlying mechanisms of these findings are discussed.
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Karukivi M, Jula A, Hutri-Kähönen N, Juonala M, Raitakari O. Is alexithymia associated with metabolic syndrome? A study in a healthy adult population. Psychiatry Res 2016; 236:58-63. [PMID: 26747214 DOI: 10.1016/j.psychres.2015.12.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/10/2015] [Accepted: 12/25/2015] [Indexed: 11/16/2022]
Abstract
Metabolic syndrome (MetS) is a constellation of risk factors for, in particular, cardiovascular diseases and increased mortality, and it constitutes a major clinical challenge affecting millions of lives. Alexithymia is a condition that has been linked with several mental diseases and symptoms, as well as somatic illnesses, including essential hypertension and diabetes mellitus. However, there is limited research on the association of alexithymia and MetS. The aim of the present study was to comprehensively explore this association in a large (n=1648) non-clinical sample of adults. Logistic regression analyses were applied to the five separate MetS components as well as the MetS diagnosis, and the analyses included a number of sociodemographic variables and depressive symptoms as covariates. The results confirmed the previous finding of alexithymic features being independently and significantly associated with hypertension. As a new finding, this association appears to be related to two particular dimensions of alexithymia, namely difficulty describing feelings and externally oriented thinking. Interestingly, alexithymic features were also separately significantly associated with waist circumference and triglycerides as well as the MetS diagnosis. Depressive symptoms did not have any significant effect on the relations of alexithymia and MetS.
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Affiliation(s)
- Max Karukivi
- Department of Psychiatry, University of Turku, Turku, Finland; Psychiatric Care Division, Satakunta Hospital District, Harjavalta, Finland.
| | - Antti Jula
- Department of Health, National Institute for Health and Welfare, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Cardiovascular and single-unit responses to L-glutamate injection into the posterior insular cortex in rat. Neuroscience 2015; 306:63-73. [PMID: 26297894 DOI: 10.1016/j.neuroscience.2015.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 11/20/2022]
Abstract
The insular cortex in rat is a longitudinal strip that runs along the rostral half of the rhinal fissure. The previous studies showed connections between the posterior insular cortex (PIC) and some major cardiovascular centers. Based on the stimulation site, electrical or chemical stimulation of the PIC induced an increase or a decrease in blood pressure (BP) and heart rate (HR). There is no report of simultaneous cardiovascular and single-unit recording microinjection of Glut in the PIC. In this study, L-glutamate was microinjected into the PIC of urethane anesthetized rats and arterial pressure, HR and single-unit responses were recorded simultaneously. Also the response of the neurons to baroreceptor activation was explored. Glut produced five types of long oscillatory, pressor, depressor, bradycardic and tachycardic cardiovascular responses, with no association between pressure and HR responses. We also observed five single-unit responses, consisting of short excitatory, long oscillatory, excitatory, inhibitory and mixed responses. There was an association between oscillation in BP and in single-unit response. There were some differences between the two sides especially for single-unit responses. In conclusion, there were five types of cardiovascular and five types of single-unit responses, to Glut microinjection into PIC, from which three types were correlated. The left side of the PIC is involved more in the cardiovascular functions. These data along with the fact that most recorded neurons responded to baroreceptor activation, might imply the presence of feedback systems in the PIC, producing irregularity in BP and HR.
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Mann SL, Selby EA, Bates ME, Contrada RJ. Integrating affective and cognitive correlates of heart rate variability: A structural equation modeling approach. Int J Psychophysiol 2015; 98:76-86. [PMID: 26168884 PMCID: PMC4980075 DOI: 10.1016/j.ijpsycho.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 12/19/2022]
Abstract
High frequency heart rate variability (HRV) is a measure of neurocardiac communication thought to reflect predominantly parasympathetic cardiac regulation. Low HRV has been associated empirically with clinical and subclinical levels of anxiety and depression and, more recently, high levels of HRV have been associated with better performance on some measures of executive functioning (EF). These findings have offered support for theories proposing HRV as an index measure of a broad, self-regulatory capacity underlying aspects of emotion regulation and executive control. This study sought to test that proposition by using a structural equation modeling approach to examine the relationships of HRV to negative affect (NA) and EF in a large sample of U.S. adults ages 30s-80s. HRV was modeled as a predictor of an NA factor (self-reported trait anxiety and depression symptoms) and an EF factor (performance on three neuropsychological tests tapping facets of executive abilities). Alternative models also were tested to determine the utility of HRV for predicting NA and EF, with and without statistical control of demographic and health-related covariates. In the initial structural model, HRV showed a significant positive relationship to EF and a nonsignificant relationship to NA. In a covariate-adjusted model, HRV's associations with both constructs were nonsignificant. Age emerged as the only significant predictor of NA and EF in the final model, showing inverse relationships to both. Findings may reflect population and methodological differences from prior research; they also suggest refinements to the interpretations of earlier findings and theoretical claims regarding HRV.
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Affiliation(s)
- Sarah L Mann
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Marsha E Bates
- Center of Alcohol Studies, Smithers Hall, Busch Campus, 607 Allison Road, Piscataway, NJ 08854-8001, USA; Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Richard J Contrada
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
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Abstract
OBJECTIVE Hostility is associated with cardiovascular mortality and morbidity, and one of the mechanisms may involve heightened reactivity to mental stress. However, little research has been conducted in populations at high risk for cardiovascular disease. The aim of the present study was to assess the relationship between hostility and acute stress responsivity in individuals with Type 2 diabetes. METHODS A total of 140 individuals (median age [standard deviation] 63.71 [7.00] years) with Type 2 diabetes took part in laboratory-based experimental stress testing. Systolic blood pressure, diastolic blood pressure, heart rate, plasma interleukin-6 (IL-6), and salivary cortisol were assessed at baseline, during two stress tasks, and 45 and 75 minutes later. Cynical hostility was assessed using the Cook Medley Cynical Hostility Scale. RESULTS Participants with greater hostility scores had heightened increases in IL-6 induced by the acute stress tasks (B = 0.082, p = .002), independent of age, sex, body mass index, smoking, household income, time of testing, medication, and baseline IL-6. Hostility was inversely associated with cortisol output poststress (B = -0.017, p = .002), independent of covariates. No associations between hostility and blood pressure or heart rate responses were observed. CONCLUSIONS Hostile individuals with Type 2 diabetes may be susceptible to stress-induced increases in inflammation. Further research is needed to understand if such changes increase the risk of cardiovascular disease in this population.
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Nardelli M, Valenza G, Cristea IA, Gentili C, Cotet C, David D, Lanata A, Scilingo EP. Characterizing psychological dimensions in non-pathological subjects through autonomic nervous system dynamics. Front Comput Neurosci 2015; 9:37. [PMID: 25859212 PMCID: PMC4373375 DOI: 10.3389/fncom.2015.00037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/06/2015] [Indexed: 11/17/2022] Open
Abstract
The objective assessment of psychological traits of healthy subjects and psychiatric patients has been growing interest in clinical and bioengineering research fields during the last decade. Several experimental evidences strongly suggest that a link between Autonomic Nervous System (ANS) dynamics and specific dimensions such as anxiety, social phobia, stress, and emotional regulation might exist. Nevertheless, an extensive investigation on a wide range of psycho-cognitive scales and ANS non-invasive markers gathered from standard and non-linear analysis still needs to be addressed. In this study, we analyzed the discerning and correlation capabilities of a comprehensive set of ANS features and psycho-cognitive scales in 29 non-pathological subjects monitored during resting conditions. In particular, the state of the art of standard and non-linear analysis was performed on Heart Rate Variability, InterBreath Interval series, and InterBeat Respiration series, which were considered as monovariate and multivariate measurements. Experimental results show that each ANS feature is linked to specific psychological traits. Moreover, non-linear analysis outperforms the psychological assessment with respect to standard analysis. Considering that the current clinical practice relies only on subjective scores from interviews and questionnaires, this study provides objective tools for the assessment of psychological dimensions.
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Affiliation(s)
- Mimma Nardelli
- Department of Information Engineering & Research Centre E. Piaggio, Faculty of Engineering, University of PisaPisa, Italy
| | - Gaetano Valenza
- Department of Information Engineering & Research Centre E. Piaggio, Faculty of Engineering, University of PisaPisa, Italy
| | - Ioana A. Cristea
- Section of Psychology, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of PisaPisa, Italy
- Department of Clinical Psychology and Pychotherapy, Babes-Bolyai UniversityCluj-Napoca, Romania
| | - Claudio Gentili
- Section of Psychology, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of PisaPisa, Italy
| | - Carmen Cotet
- Department of Clinical Psychology and Pychotherapy, Babes-Bolyai UniversityCluj-Napoca, Romania
| | - Daniel David
- Department of Clinical Psychology and Pychotherapy, Babes-Bolyai UniversityCluj-Napoca, Romania
| | - Antonio Lanata
- Department of Information Engineering & Research Centre E. Piaggio, Faculty of Engineering, University of PisaPisa, Italy
| | - Enzo P. Scilingo
- Department of Information Engineering & Research Centre E. Piaggio, Faculty of Engineering, University of PisaPisa, Italy
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Goldstein DS. Concepts of scientific integrative medicine applied to the physiology and pathophysiology of catecholamine systems. Compr Physiol 2014; 3:1569-610. [PMID: 24265239 DOI: 10.1002/cphy.c130006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review presents concepts of scientific integrative medicine and relates them to the physiology of catecholamine systems and to the pathophysiology of catecholamine-related disorders. The applications to catecholamine systems exemplify how scientific integrative medicine links systems biology with integrative physiology. Concepts of scientific integrative medicine include (i) negative feedback regulation, maintaining stability of the body's monitored variables; (ii) homeostats, which compare information about monitored variables with algorithms for responding; (iii) multiple effectors, enabling compensatory activation of alternative effectors and primitive specificity of stress response patterns; (iv) effector sharing, accounting for interactions among homeostats and phenomena such as hyperglycemia attending gastrointestinal bleeding and hyponatremia attending congestive heart failure; (v) stress, applying a definition as a state rather than as an environmental stimulus or stereotyped response; (vi) distress, using a noncircular definition that does not presume pathology; (vii) allostasis, corresponding to adaptive plasticity of feedback-regulated systems; and (viii) allostatic load, explaining chronic degenerative diseases in terms of effects of cumulative wear and tear. From computer models one can predict mathematically the effects of stress and allostatic load on the transition from wellness to symptomatic disease. The review describes acute and chronic clinical disorders involving catecholamine systems-especially Parkinson disease-and how these concepts relate to pathophysiology, early detection, and treatment and prevention strategies in the post-genome era.
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Affiliation(s)
- David S Goldstein
- Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Trait anxiety mimics age-related cardiovascular autonomic modulation in young adults. J Hum Hypertens 2014; 29:274-80. [DOI: 10.1038/jhh.2014.72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022]
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Carnevali L, Trombini M, Graiani G, Madeddu D, Quaini F, Landgraf R, Neumann ID, Nalivaiko E, Sgoifo A. Low vagally-mediated heart rate variability and increased susceptibility to ventricular arrhythmias in rats bred for high anxiety. Physiol Behav 2014; 128:16-25. [PMID: 24518868 DOI: 10.1016/j.physbeh.2014.01.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/15/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
In humans, there is a documented association between anxiety disorders and cardiovascular disease. Putative underlying mechanisms may include an impairment of the autonomic nervous system control of cardiac function. The primary objective of the present study was to characterize cardiac autonomic modulation and susceptibility to arrhythmias in genetic lines of rats that differ largely in their anxiety level. To reach this goal, electrocardiographic recordings were performed in high-anxiety behavior (HAB, n=10) and low-anxiety behavior (LAB, n=10) rats at rest, during stressful stimuli and under autonomic pharmacological manipulations, and analyzed by means of time- and frequency-domain indexes of heart rate variability. During resting conditions, HAB rats displayed a reduced heart rate variability, mostly in terms of lower parasympathetic (vagal) modulation compared to LAB rats. In HAB rats, this relatively low cardiac vagal control was associated with smaller heart rate responsiveness to acute stressors compared to LAB counterparts. In addition, beta-adrenergic pharmacological stimulation induced a larger incidence of ventricular tachyarrhythmias in HABs compared to LABs. At sacrifice, a moderate increase in heart-body weight ratio was observed in HAB rats. We conclude that high levels of anxiety-related behavior in rats are associated with signs of i) impaired autonomic modulation of heart rate (low vagally-mediated heart rate variability), ii) poor adaptive heart rate responsiveness to stressful stimuli, iii) increased arrhythmia susceptibility, and iv) cardiac hypertrophy. These results highlight the utility of the HAB/LAB model for investigating the mechanistic basis of the comorbidity between anxiety disorders and cardiovascular disease.
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Affiliation(s)
| | | | - Gallia Graiani
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Denise Madeddu
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Federico Quaini
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | | | - Inga D Neumann
- Department of Behavioural and Molecular Neurobiology, University of Regensburg, Germany
| | - Eugene Nalivaiko
- School of Biomedical Sciences and Pharmacy, University of Newcastle, New South Wales, Australia
| | - Andrea Sgoifo
- Department of Neuroscience, University of Parma, Italy
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Proneness to worry is negatively associated with blood pressure and baroreflex sensitivity: Further evidence of the blood pressure emotional dampening hypothesis. Biol Psychol 2014; 96:20-7. [DOI: 10.1016/j.biopsycho.2013.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022]
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50
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Koutnik AP, Sanchez-Gonzalez MA, May RW, Hughes RM, Fincham FD. Impact of psychological distress on cardiovagal reactivation after a speech task. J Hum Hypertens 2013; 28:399-401. [DOI: 10.1038/jhh.2013.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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