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Sokolovskiy S, Arroyo D, Hansma P. Can Pulse Rate Variability be Used to Monitor Compliance with a Breath Pacer? Appl Psychophysiol Biofeedback 2024; 49:233-240. [PMID: 38214800 PMCID: PMC11101548 DOI: 10.1007/s10484-023-09617-y] [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] [Accepted: 12/24/2023] [Indexed: 01/13/2024]
Abstract
Slow paced breathing has been demonstrated to provide significant health benefits for a person's health, and, during breathing sessions, it is desirable to monitor that a person is actually compliant with the breath pacer. We explore the potential use of pulse rate variability to monitor compliance with a breath pacer during meditation sessions. The study involved 6 human subjects each participating in 2-3 trials, where they are asked to follow or not to follow the breath pacer, where we collected data on how the magnitude of pulse rate variability changed. Two methods, logistic regression and a running standard deviation technique, were developed to detect non-compliance with the breath pacer based on pulse rate variability metrics. Results indicate that using pulse rate variability alone may not reliably detect non-compliance with the breath pacer. Both models exhibited limitations in terms of false positives and false negatives, with accuracy ranging from 67 to 65%. Existing methods involving visual, audio, and motion signals currently perform better for monitoring compliance with the breath pacer.
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Affiliation(s)
| | | | - Paul Hansma
- University of California, Santa Barbara, USA
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2
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Respiratory patterns and baroreflex function in heart failure. Sci Rep 2023; 13:2220. [PMID: 36755066 PMCID: PMC9908869 DOI: 10.1038/s41598-023-29271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Little is known on the effects of respiratory patterns on baroreflex function in heart failure (HF). Patients with HF (n = 30, age 61.6 ± 10 years, mean ± SD) and healthy controls (CNT, n = 10, age 58.9 ± 5.6 years) having their R-R interval (RRI, EKG), systolic arterial blood pressure (SBP, Finapres) and respiratory signal (RSP, Respitrace) monitored, were subjected to three recording sessions: free-breathing, fast- (≥ 12 bpm) and slow- (6 bpm) paced breathing. Baroreflex sensitivity (BRS) and power spectra of RRI, SBP, and RSP signals were calculated. During free-breathing, compared to CNT, HF patients showed a significantly greater modulation of respiratory volumes in the very-low-frequency (< 0.04 Hz) range and their BRS was not significantly different from that of CNT. During fast-paced breathing, when very-low-frequency modulations of respiration were reduced, BRS of HF patients was significantly lower than that of CNT and lower than during free breathing. During slow-paced breathing, BRS became again significantly higher than during fast breathing. In conclusion: (1) in free-breathing HF patients is present a greater modulation of respiratory volumes in the very-low-frequency range; (2) in HF patients modulation of respiration in the very-low and low frequency (around 0.1 Hz) ranges contributes to preserve baroreflex-mediated control of heart rate.
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3
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Park C, Youn I, Han S. Single-lead ECG based autonomic nervous system assessment for meditation monitoring. Sci Rep 2022; 12:22513. [PMID: 36581715 PMCID: PMC9800362 DOI: 10.1038/s41598-022-27121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
We propose a single-lead ECG-based heart rate variability (HRV) analysis algorithm to quantify autonomic nervous system activity during meditation. Respiratory sinus arrhythmia (RSA) induced by breathing is a dominant component of HRV, but its frequency depends on an individual's breathing speed. To address this RSA issue, we designed a novel HRV tachogram decomposition algorithm and new HRV indices. The proposed method was validated by using a simulation, and applied to our experimental (mindfulness meditation) data and the WESAD open-source data. During meditation, our proposed HRV indices related to vagal and sympathetic tones were significantly increased (p < 0.000005) and decreased (p < 0.000005), respectively. These results were consistent with self-reports and experimental protocols, and identified parasympathetic activation and sympathetic inhibition during meditation. In conclusion, the proposed method successfully assessed autonomic nervous system activity during meditation when respiration influences disrupted classical HRV. The proposed method can be considered a reliable approach to quantify autonomic nervous system activity.
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Affiliation(s)
- Chanki Park
- grid.36303.350000 0000 9148 4899Future and Basic Technology Research Division, ICT Creative Research Laboratory, Electronics and Telecommunications Research Institute, CybreBrain Research Section, Daejeon, 34129 Republic of Korea
| | - Inchan Youn
- grid.35541.360000000121053345Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792 Republic of Korea ,grid.35541.360000000121053345Division of Bio‑Medical Science and Technology, Korea Institute of Science and Technology School, Seoul, 02792 Republic of Korea ,grid.289247.20000 0001 2171 7818KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Seongbuk-gu 02447 Republic of Korea
| | - Sungmin Han
- grid.35541.360000000121053345Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792 Republic of Korea ,grid.35541.360000000121053345Division of Bio‑Medical Science and Technology, Korea Institute of Science and Technology School, Seoul, 02792 Republic of Korea
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4
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Ovadia-Blechman Z, Tarrasch R, Velicki M, Chalutz Ben-Gal H. Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study. Front Psychol 2022; 13:678098. [PMID: 35677145 PMCID: PMC9167931 DOI: 10.3389/fpsyg.2022.678098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Zehava Ovadia-Blechman
- School of Medical Engineering, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
- *Correspondence: Zehava Ovadia-Blechman,
| | - Ricardo Tarrasch
- School of Education, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Maria Velicki
- School of Medical Engineering, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Hila Chalutz Ben-Gal
- School of Industrial Engineering and Management, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
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Urbancsek R, Csanádi Z, Forgács IN, Papp TB, Boczán J, Barta J, Jenei C, Nagy L, Rudas L. The Feasibility of Baroreflex Sensitivity Measurements in Heart Failure Subjects: The Role of Slow-patterned Breathing. Clin Physiol Funct Imaging 2022; 42:260-268. [PMID: 35396907 DOI: 10.1111/cpf.12755] [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: 12/09/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increased muscle sympathetic nerve activity (MSNA) indicates an adverse outcome in heart failure. Decreased baroreflex modulation of MSNA is well known feature of the disease. The determinability of cardiovagal baroreflex sensitivity (BRS) in heart failure is low, however, the determinability of sympathetic BRS is not known. METHODS We have assessed the spontaneous, MSNA burst incidence-based baroreflex index (BRSsymp) in 33 stable heart failure patients and in 10 healthy controls using the traditional r≥0.5 cut-off for acceptable individual diastolic pressure-burst incidence slopes, and also a more stringent r≥0.7 cut-off. We have also assessed the influence of 6/min breathing. RESULTS The determinability of BRSsymp in heart failure patients was 64% during spontaneous breathing with r≥0.5 cut-off, and 39% using the r≥0.7 cut-off. The determinability of these indices further decreased during 6/min breathing, dropping to 29% with the r≥0.7 cut-off. In contrast, the determinability of the cardiovagal BRS indices increased significantly with 6/min breathing (from 24% to 66%; p<0.001). Patients who still had determinable BRSsymp at the r≥0.7 cut-off had a significantly lower baseline burst incidence than those with an undeterminable index (70±14 vs.89±10 burst/100 cycles; p<0.002). Neither the 6/min breathing, nor the r≥0.7 cut-off limit influenced the high availability of BRSsymp in healthy subjects. CONCLUSION The determinability of BRSsymp in heart failure patients is limited, especially with the 0.7 limit for correlation. Undeterminable BRSsymp in patients is associated with higher sympathetic activity. 6/min breathing improves the determinability of cardiovagal BRS indices, but not that of BRSsymp. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Réka Urbancsek
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Ildikó Noémi Forgács
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Tímea Bianka Papp
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Judit Boczán
- Faculty of Medicine, Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Judit Barta
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - László Nagy
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - László Rudas
- Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
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Larson M, Chantigian DP, Asirvatham-Jeyaraj N, Van de Winckel A, Keller-Ross ML. Slow-Paced Breathing and Autonomic Function in People Post-stroke. Front Physiol 2020; 11:573325. [PMID: 33192570 PMCID: PMC7662434 DOI: 10.3389/fphys.2020.573325] [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: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: To determine if acute slow breathing at 6 breaths/min would improve baroreflex sensitivity (BRS) and heart rate variability (HRV), and lower blood pressure (BP) in adults after stroke. Methods: Twelve individuals completed two randomized study visits where they performed a 15-min bout of breathing exercises at 6 breaths/min (slow) and at 12 breaths/min (control). Continuous BP and heart rate (HR) were measured throughout, and BRS, BRS response to elevations in blood pressure (BRSup), BRS response to depressions in blood pressure (BRSdown), and HRV were calculated and analyzed before (pre), during, and after (post) breathing exercises. Results: BRS increased from pre to post slow breathing by 10% (p = 0.012), whereas BRSup increased from pre to during slow breathing by 30% (p = 0.04). BRSdown increased from pre to post breathing for both breathing conditions (p < 0.05). HR (control: Δ - 4 ± 4; slow: Δ - 3 ± 4 beats/min, time, p < 0.01) and systolic BP (control: Δ - 0.5 ± 5; slow: Δ - 6.3 ± 8 mmHg, time, p < 0.01) decreased after both breathing conditions. Total power, low frequency power, and standard deviation of normal inter-beat intervals (SDNN) increased during the 6-breaths/min condition (condition × time, p < 0.001), whereas high frequency increased during both breathing conditions (time effect, p = 0.009). Conclusions: This study demonstrated that in people post-stroke, slow breathing may increase BRS, particularly BRSup, more than a typical breathing space; however, paced breathing at either a slow or typical breathing rate appears to be beneficial for acutely decreasing systolic BP and HR and increasing HRV.
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Affiliation(s)
- Mia Larson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Daniel P. Chantigian
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ninitha Asirvatham-Jeyaraj
- Indian Institute of Science, Bangalore, India
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ann Van de Winckel
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Manda L. Keller-Ross
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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7
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Gholamrezaei A, Van Diest I, Aziz Q, Vlaeyen JWS, Van Oudenhove L. Psychophysiological responses to various slow, deep breathing techniques. Psychophysiology 2020; 58:e13712. [PMID: 33111377 DOI: 10.1111/psyp.13712] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
Deep breathing exercises are commonly used for several health conditions including pain and hypertension. Various techniques are available to practice deep breathing, whereas possible differential psychophysiological effects have not been investigated. We compared four deep breathing techniques and examined outcomes in blood pressure variability, respiratory sinus arrhythmia, baroreflex function, and emotional state. Healthy adult volunteers performed pursed-lips breathing, left and right unilateral nostril breathing, and deep breathing with an inspiratory threshold load (loaded breathing), all at a frequency of 0.1 Hz (i.e., controlled breathing) and for three minutes each. Results showed that blood pressure variability was higher during loaded breathing versus other conditions and higher during pursed-lips breathing versus left and right unilateral nostril breathing. Respiratory sinus arrhythmia was higher during loaded breathing versus other conditions and higher during pursed-lips breathing versus left unilateral nostril breathing. The effect of breathing condition on respiratory sinus arrhythmia was mediated by alterations in blood pressure variability. There was no difference between the breathing conditions in baroreflex sensitivity or effectiveness. Participants rated pursed-lips breathing as more calming and pleasant and with more sense of control (vs. other conditions). Overall, among the four tested deep breathing techniques, loaded breathing was associated with enhanced cardiovascular effects and pursed-lips breathing with better emotional responses, while also enhancing cardiovascular effects (albeit less than loaded breathing). These findings can be informative in applying deep breathing techniques as self-management interventions for health conditions, in which baroreceptors stimulation and autonomic and emotional modulations can be beneficial, such as pain and hypertension.
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Affiliation(s)
- Ali Gholamrezaei
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroeneterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Johan W S Vlaeyen
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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8
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Harada D, Asanoi H, Noto T, Takagawa J. The impact of right ventricular dysfunction on the effectiveness of beta-blockers in heart failure with preserved ejection fraction. J Cardiol 2020; 76:325-334. [DOI: 10.1016/j.jjcc.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 01/01/2023]
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9
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Fonkoue IT, Hu Y, Jones T, Vemulapalli M, Sprick JD, Rothbaum B, Park J. Eight weeks of device-guided slow breathing decreases sympathetic nervous reactivity to stress in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2020; 319:R466-R475. [PMID: 32847397 DOI: 10.1152/ajpregu.00079.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by increased risk for developing hypertension and cardiovascular disease. We recently showed that device-guided slow breathing (DGB) acutely lowers blood pressure (BP) and muscle sympathetic activity (MSNA) and improves baroreflex sensitivity (BRS) in PTSD. The aim of this study was to assess the long-term benefits of DGB on autonomic function at rest and during stress. We hypothesized that long-term DGB improves arterial BRS and lowers BP and MSNA in PTSD. Twenty-five veterans with PTSD were studied and randomized to either 8 wk of daily DGB (n = 12) or 8 wk of sham device (Sham; n = 13). BP, heart rate (HR), and MSNA were measured at rest and during mental math. Arterial BRS was assessed using the modified Oxford technique. Resting MSNA, BP, and heart rate (HR) remained comparable before and after 8 wk in both groups (DGB and Sham). Likewise, the change in sympathetic and cardiovagal BRS was not different between the groups. Interestingly, DGB significantly decreased MSNA reactivity to mental math when expressed as burst frequency (P = 0.012) or burst incidence (P = 0.008) compared with Sham, suggesting a sustained effect of DGB on sympathetic reactivity to stress in PTSD. Contrary to our hypothesis, long-term DGB did not lower systolic BP, diastolic BP, or HR responses to stress compared with Sham. Likewise, pulse pressure reactivity after 8 wk (P = 0.121) was also comparable. In summary, these data suggest that long-term use of DGB may lead to a sustained dampening of sympathetic reactivity to mental stress in PTSD.
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Affiliation(s)
- Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Toure Jones
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Monica Vemulapalli
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Justin D Sprick
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Barbara Rothbaum
- Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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Pagaduan J, Wu SSX, Kameneva T, Lambert E. Acute effects of resonance frequency breathing on cardiovascular regulation. Physiol Rep 2019; 7:e14295. [PMID: 31782265 PMCID: PMC6882954 DOI: 10.14814/phy2.14295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute slow breathing may have beneficial effects on cardiovascular regulation by affecting hemodynamics and the autonomic nervous system. Whether breathing at the resonance frequency (RF), a breathing rate that maximizes heart rate oscillations, induces differential effects to that of slow breathing is unknown. We compared the acute effects of breathing at either RF and RF + 1 breaths per minute on muscle sympathetic nervous activity (MSNA) and baroreflex function. Ten healthy men underwent MSNA, blood pressure (BP), and heart rate (HR) recordings while breathing for 10 min at their spontaneous breathing (SB) rate followed by 10 min at both RF and RF + 1 randomly assigned and separated by a 10-min recovery. Breathing at either RF or RF + 1 induced similar changes in HR and HR variability, with increased low frequency and decreased high frequency oscillations (p < .001 for both). Both respiration rates decreased MSNA (-5.6 and -7.3 bursts per min for RF and RF + 1 p < .05), with the sympathetic bursts occurring more often during mid-inspiration to early expiration (+57% and + 80%) and longer periods of silence between bursts were seen (p < .05 for RF + 1). Systolic BP was decreased only during RF (-4.6 mmHg, p < .05) but the decrease did not differ to that seen during RF + 1 (-3.1 mmHg). The sympathetic baroreflex function remained unchanged at either breathing rates. The slope of the cardiac baroreflex function was unaltered but the cardiac baroreflex efficiency was improved during both RF and RF + 1. Acute breathing at either RF or RF + 1 has similar hemodynamic and sympatho-inhibitory effects in healthy men.
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Affiliation(s)
- Jeffrey Pagaduan
- School of Health SciencesCollege of Health and MedicineUniversity of TasmaniaTasmaniaAustralia
| | - Sam SX Wu
- School of Health SciencesCollege of Health and MedicineUniversity of TasmaniaTasmaniaAustralia
- School of Health SciencesDepartment of Health and Medical SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - Tatiana Kameneva
- Faculty of Science, Engineering and TechnologySwinburne University of TechnologyHawthornVictoriaAustralia
- Iverson Health Innovation Research InstituteSchool of Health Sciences Faculty of Health, Arts and DesignSwinburne University of TechnologyHawthornVictoriaAustralia
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleAustralia
| | - Elisabeth Lambert
- School of Health SciencesDepartment of Health and Medical SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- Iverson Health Innovation Research InstituteSchool of Health Sciences Faculty of Health, Arts and DesignSwinburne University of TechnologyHawthornVictoriaAustralia
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11
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Liu B, Yan S, Wang X, Xie L, Tong J, Zhao F, Di X, Yan X, Zhang J. An improved method to evaluate heart rate variability based on time-variant cardiorespiratory relation. J Appl Physiol (1985) 2019; 127:320-327. [PMID: 31219773 DOI: 10.1152/japplphysiol.00125.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Frequency domain analysis of heart rate variability (HRV) is a noninvasive method to evaluate the autonomic nervous system (ANS), but the traditional parameters of HRV, i.e., the power spectra of the high-frequency (HF) and low-frequency bands (LF), cannot estimate the activity of the parasympathetic (PNS) and sympathetic nervous systems (SNS) well. The aim of our study was to provide a corrected method to better distinguish the contributions of the PNS and SNS in the HRV spectrum. Respiration has a gating effect on cardiac vagal efferent activity, which induces respiration-locked heart rate (HR) changes because of the fast effect of the PNS. So the respiration-related heart rate (HRr) is closely related to PNS activity. In this study, HR was decomposed into HRr and the respiration-unrelated component (HRru) based on empirical mode decomposition (EMD) and the relationship between HR and respiration. Time-frequency analysis of HRr and HRru was defined as HFr and LFru, respectively, with specific adaptive bands for every signal. Two experimental data sets, representing SNS and PNS activation, respectively, were used for efficiency analysis of our method. Our results show that the corrected HRV predicted ANS activity well. HFr could be an index of PNS activity, LFru mainly reflected SNS activity, and LFru/HFr could be more accurate in representing the sympathovagal balance.NEW & NOTEWORTHY This study includes the time-varying relationship between respiration and heart rate in the analysis of heart rate variability. Correction for low-frequency and high-frequency components based on respiration significantly improved evaluation of the sympathetic and parasympathetic nervous systems.
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Affiliation(s)
- Binbin Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Saisai Yan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoni Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lin Xie
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jie Tong
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Fadong Zhao
- Equipment Management and Support College, Engineering University of People's Armed Police, Xi'an, China
| | - Xiaohui Di
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiangguo Yan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jianbao Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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12
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Gholamrezaei A, Van Diest I, Aziz Q, Vlaeyen JWS, Van Oudenhove L. Influence of inspiratory threshold load on cardiovascular responses to controlled breathing at 0.1 Hz. Psychophysiology 2019; 56:e13447. [DOI: 10.1111/psyp.13447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/06/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ali Gholamrezaei
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Qasim Aziz
- Centre for Neuroscience and Trauma Blizard Institute, Wingate Institute of Neurogastroeneterology, Queen Mary University of London London UK
| | - Johan W. S. Vlaeyen
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
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Kaufmann D, Raczak G, Szwoch M, Kozłowski D, Kwiatkowska J, Lewicka E, Daniłowicz-Szymanowicz L. Could autonomic nervous system parameters be still helpful in identifying patients with left ventricular systolic dysfunction at the highest risk of all-cause mortality? Cardiol J 2019; 28:914-922. [PMID: 31257569 PMCID: PMC8747825 DOI: 10.5603/cj.a2019.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Autonomic imbalance is associated with poor prognosis of patients with systolic dysfunction. Most of the previous data were written several years ago and constituted to cardiovascular or arrhythmic mortality. The current treatment of these patients has improved substantially over the last decades, and thus, the population at risk of death may have altered as well. Consequently, data on high-risk patients with systolic dysfunction in the modern era are sparse and those from previous trials may no longer be applicable. The aim herein, was to verify whether well-known autonomic indices - baroreflex sensitivity (BRS) and heart rate variability (HRV) - remain accurate predictors of mortality in patients with systolic dysfunction. METHODS Non-invasively obtained BRS and HRV were analyzed in 205 clinically stable patients with left ventricular ejection fraction (LVEF) ≤ 40%. 28 patients died within 28 ± 9 month follow-up. RESULTS Baroreflex sensitivity, low-frequency (LF) in normalized units, LF to high-frequency ratio and standard deviation of average R-R intervals were significantly associated with mortality; cut-off values of the highest discriminatory power for abovementioned parameters were ≤ 3.0 ms/mmHg, ≤ 41, ≤ 0.7 and ≤ 25 ms, respectively. In bivariate Cox analyses (adjusted for LVEF, New York Heart Association [NYHA] or absence of implantable cardioverter-defibrillator [ICD]) autonomic indices remain significant predictors of death. CONCLUSIONS Baroreflex sensitivity and HRV - may still be helpful in identifying patients with left ventricular systolic dysfunction at the highest risk of all-cause mortality, independently of LVEF, NYHA class, and ICD implantation.
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Affiliation(s)
- Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Małgorzata Szwoch
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Defect, Medical University of Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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Takagawa J, Asanoi H, Tobushi T, Kumagai N, Kadokami T, Dohi K, Joho S, Wada O, Koyama T, Haruki N, Ando SI, Momomura SI. Multicenter, Prospective Study on Respiratory Stability During Recovery From Deterioration of Chronic Heart Failure. Circ J 2018; 83:164-173. [PMID: 30429428 DOI: 10.1253/circj.cj-18-0519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The respiratory instability frequently observed in advanced heart failure (HF) is likely to mirror the clinical status of worsening HF. The present multicenter study was conducted to examine whether the noble respiratory stability index (RSI), a quantitative measure of respiratory instability, reflects the recovery process from HF decompensation. Methods and Results: Thirty-six of 44 patients hospitalized for worsening HF completed all-night measurements of RSI both at deterioration and recovery phases. Based on the signs, symptoms, and laboratory data during hospitalization, the Central Adjudication Committee identified 22 convalescent patients and 14 patients with less extent of recovery in a blinded manner without any information on RSI or other respiratory variables. The all-night RSI in the convalescent patients was increased from 27.8±18.4 to 34.6±15.8 (P<0.05). There was no significant improvement of RSI, however, in the remaining patients with little clinical improvement. Of the clinical and laboratory variables, on stepwise linear regression modeling, body weight, peripheral edema, and lung congestion were closely related to the RSI of recovered patients and accounted for 56% of the changes in RSI (coefficient of determination, R2=0.56). CONCLUSIONS All-night RSI, a quantitative measure of respiratory instability, could faithfully reflect congestive signs and clinical status of HF during the recovery process from acute decompensation.
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Affiliation(s)
| | | | | | - Naoto Kumagai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Shuji Joho
- Second Department of Internal Medicine, Toyama University Hospital
| | - Osamu Wada
- Cardiovascular Medicine, Japan Community Health Care Organization Takaoka Fushiki Hospital
| | | | - Nobuhiko Haruki
- Cardiovascular Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
| | | | - Shin-Ichi Momomura
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
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15
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Fonkoue IT, Marvar PJ, Norrholm SD, Kankam ML, Li Y, DaCosta D, Rothbaum BO, Park J. Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 2018; 315:H141-H149. [PMID: 29652544 DOI: 10.1152/ajpheart.00098.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) have elevated sympathetic nervous system reactivity and impaired sympathetic and cardiovagal baroreflex sensitivity (BRS). Device-guided slow breathing (DGB) has been shown to lower blood pressure (BP) and sympathetic activity in other patient populations. We hypothesized that DGB acutely lowers BP, heart rate (HR), and improves BRS in PTSD. In 23 prehypertensive veterans with PTSD, we measured continuous BP, ECG, and muscle sympathetic nerve activity (MSNA) at rest and during 15 min of DGB at 5 breaths/min ( n = 13) or identical sham device breathing at normal rates of 14 breaths/min (sham; n = 10). Sympathetic and cardiovagal BRS was quantified using pharmacological manipulation of BP via the modified Oxford technique at baseline and during the last 5 min of DGB or sham. There was a significant reduction in systolic BP (by -9 ± 2 mmHg, P < 0.001), diastolic BP (by -3 ± 1 mmHg, P = 0.019), mean arterial pressure (by -4 ± 1 mmHg, P = 0.002), and MSNA burst frequency (by -7.8 ± 2.1 bursts/min, P = 0.004) with DGB but no significant change in HR ( P > 0.05). Within the sham group, there was no significant change in diastolic BP, mean arterial pressure, HR, or MSNA burst frequency, but there was a small but significant decrease in systolic BP ( P = 0.034) and MSNA burst incidence ( P = 0.033). Sympathetic BRS increased significantly in the DGB group (-1.08 ± 0.25 to -2.29 ± 0.24 bursts·100 heart beats-1·mmHg-1, P = 0.014) but decreased in the sham group (-1.58 ± 0.34 to -0.82 ± 0.28 bursts·100 heart beats-1·mmHg-1, P = 0.025) (time × device, P = 0.001). There was no significant difference in the change in cardiovagal BRS between the groups (time × device, P = 0.496). DGB acutely lowers BP and MSNA and improves sympathetic but not cardiovagal BRS in prehypertensive veterans with PTSD. NEW & NOTEWORTHY Posttraumatic stress disorder is characterized by augmented sympathetic reactivity, impaired baroreflex sensitivity, and an increased risk for developing hypertension and cardiovascular disease. This is the first study to examine the potential beneficial effects of device-guided slow breathing on hemodynamics, sympathetic activity, and arterial baroreflex sensitivity in prehypertensive veterans with posttraumatic stress disorder.
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Affiliation(s)
- Ida T Fonkoue
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Dana DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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16
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Cardiorespiratory optimization during improvised singing and toning. Sci Rep 2017; 7:8113. [PMID: 28808334 PMCID: PMC5556092 DOI: 10.1038/s41598-017-07171-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/21/2017] [Indexed: 12/01/2022] Open
Abstract
We evaluated the effect of different forms of singing on cardiorespiratory physiology, and we aimed at disentangling the role of breathing from that of vocal production. Cardiorespiratory recordings were obtained from 20 healthy adults at rest and during: a) singing of familiar slow songs as in the standard form of Western culture; b) improvised vocalization of free vowel sounds, known as toning. To disentangle the role of breathing from that of vocal production, we compared the vocal conditions with matched breathing-only conditions. Toning significantly improved heart rate variability, ventilatory efficiency and slowed respiration to almost exactly six breaths per minute (p < 0.001), a pattern that is known to optimize cardiovascular function and that coincides with the period of endogenous circulatory rhythms. Singing songs also positively impacted cardiorespiratory function, although to a lesser extent. The breathing pattern imposed upon participants in the absence of vocal production was sufficient to generate the physiological benefits. The effects of toning are similar to what has been previously described as a result of engaging in formal breathing exercises. Toning and singing may offer an engaging and cost effective tool to trigger beneficial respiratory patterns and the related cardiovascular benefits.
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18
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Asanoi H, Harada D, Oda Y, Ueno H, Takagawa J, Ishise H, Goso Y, Joho S, Inoue H. Independent prognostic importance of respiratory instability and sympathetic nerve activity in patients with chronic heart failure. J Cardiol 2017; 70:476-483. [PMID: 28438369 DOI: 10.1016/j.jjcc.2017.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/20/2017] [Accepted: 02/28/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Respiratory instability in chronic heart failure (CHF) is characterized by irregularly rapid respiration or non-periodic breathing rather than by Cheyne-Stokes respiration. We developed a new quantitative measure of respiratory instability (RSI) and examined its independent prognostic impact upon CHF. METHODS In 87 patients with stable CHF, respiratory flow and muscle sympathetic nerve activity (MSNA) were simultaneously recorded. RSI was calculated from the frequency distribution of respiratory spectral components and very low frequency components. RESULTS During a mean follow-up of 85±38 months, 24 patients died. Sixteen patients who died of cardiac causes had a lower RSI (16±6 vs. 30±21, p<0.01), a lower specific activity scale (4.3±1.4 Mets vs. 5.7±1.4 Mets, p<0.005), a higher MSNA burst area (16±5% vs. 11±4%, p<0.001), and a higher brain natriuretic peptide (BNP) level (514±559pg/ml vs. 234±311pg/ml, p<0.05) than 71 patients who did not die of cardiac causes. Multivariate analysis revealed that RSI (p=0.015), followed by MSNA burst area (p=0.033), was an independent predictor of subsequent all-cause deaths and that RSI (p=0.026), MSNA burst area (p=0.001), and BNP (p=0.048) were independent predictors of cardiac deaths. Patients at very high risk of fatal outcome could be identified by an RSI<20. CONCLUSIONS The daytime respiratory instability quantified by a new measure of RSI has prognostic importance independent of sympathetic nerve activation in patients with clinically stable CHF. An RSI of <20 identifies patients at very high risk for subsequent all-cause and cardiovascular death.
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Affiliation(s)
- Hidetsugu Asanoi
- The Cardiology Division, Imizu Municipal Hospital, Imizu City, Toyama, Japan.
| | - Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Imizu City, Toyama, Japan
| | - Yoshitaka Oda
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Hiroshi Ueno
- The Cardiology Division, Imizu Municipal Hospital, Imizu City, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Imizu City, Toyama, Japan
| | - Hisanari Ishise
- The Cardiology Division, Imizu Municipal Hospital, Imizu City, Toyama, Japan
| | - Yukiko Goso
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Shuji Joho
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Hiroshi Inoue
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama City, Toyama, Japan
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19
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Floras JS, Zamel N. Complexity of Sympathetic Nerve Traffic in Human Heart Failure: Seeking Inspiration. J Card Fail 2016; 23:104-106. [PMID: 27908780 DOI: 10.1016/j.cardfail.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 11/18/2022]
Affiliation(s)
- John S Floras
- University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Noe Zamel
- University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Joho S, Ushijima R, Akabane T, Hirai T, Inoue H. Restrictive Lung Function Is Related to Sympathetic Hyperactivity in Patients With Heart Failure. J Card Fail 2016; 23:96-103. [PMID: 27288844 DOI: 10.1016/j.cardfail.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sympathoexcitation and impaired lung function are common in patients with severe heart failure (HF). However, the association between impaired lung function and sympathoexcitation remains unknown. METHODS AND RESULTS Muscle sympathetic nerve activity (MSNA) and clinical variables were determined in 83 HF patients with left ventricular ejection fraction (LVEF) <0.45. Restrictive and obstructive changes on spirometry were defined as reduced forced vital capacity (FVC) of <80% of predicted and a ratio of forced expiratory volume in the first second to FVC of <70%, respectively. Restrictive and obstructive changes were identified in 17 and 21 patients, respectively. MSNA was higher in patients with restrictive changes than in those without restrictive changes (84 vs 66 bursts per 100 beats; P < .01), but was similar in those with and without obstructive changes. Univariate analyses showed that FVC, estimated glomerular filtration rate (eGFR), specific activity scale, B-type natriuretic peptide level, LVEF, age, and use of aldosterone receptor blockers were significant predictors of MSNA burst incidence. Multivariate analysis revealed that FVC, LVEF, and eGFR were independent factors for increased burst incidence. Changes in FVC during follow-up negatively correlated with changes in burst rate (n = 11; P < .01). CONCLUSION Restrictive lung function was associated with increased sympathetic nerve activity independently from HF severity.
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Affiliation(s)
- Shuji Joho
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
| | - Ryuichi Ushijima
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Takashi Akabane
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Tadakazu Hirai
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
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21
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Mind-Body Approaches in Heart Failure Prevention. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Drozdz T, Bilo G, Debicka-Dabrowska D, Klocek M, Malfatto G, Kielbasa G, Styczkiewicz K, Bednarek A, Czarnecka D, Parati G, Kawecka-Jaszcz K. Blood pressure changes in patients with chronic heart failure undergoing slow breathing training. Blood Press 2015; 25:4-10. [PMID: 26513698 DOI: 10.3109/08037051.2016.1099800] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Slow breathing training (SBT) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure (CHF). However, no information is available regarding its effects on orthostatic blood pressure (BP) changes in these patients, an issue of practical relevance given the reported BP-lowering effect of SBT. The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients. METHODS The analysis was performed as part of an ongoing crossover open trial aimed at assessing the clinical effectiveness of SBT in treated patients with CHF. The patients underwent 10-12 weeks of SBT with the RESPeRATE device and 10-12 week follow-up under usual care. Patients were randomly divided into two groups: group I began with SBT, followed by usual care; group II began with usual care, followed by SBT. Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min. In all patients, before the enrollment and after each study phase, clinical data collection and BP measurements in sitting, supine and standing position were performed. OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure (SBP) or ≥ 10 mmHg in diastolic blood pressure (DBP) within 3 min of standing. QoL was assessed three times at the beginning, and after each phase of the study by the Minnesota Living with Heart Failure (MLHF) questionnaire. RESULTS Forty patients (two equal groups) completed the study, with the following baseline characteristics: 32 males/eight females, age 63.3 ± 13.4 years, 25 with ischemic CHF, 37 in New York Heart Association class II and three in class III, left ventricular ejection fraction 30.8 ± 6.7%, mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg, 23 with arterial hypertension and four with a history of stroke. There were no significant differences between the groups in clinical characteristics, SBP and DBP at rest, while seated and before and after standing up. OH prevalence was low and did not change during the study (10% vs 10%). No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases. Decrease in MLHF score was observed in group I during SBT (p = 0.002), but not in group II. CONCLUSIONS Our data indicate that SBT is safe, does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF.
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Affiliation(s)
- Tomasz Drozdz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Grzegorz Bilo
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Dorota Debicka-Dabrowska
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Marek Klocek
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Gabriella Malfatto
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Grzegorz Kielbasa
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Styczkiewicz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Agnieszka Bednarek
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Danuta Czarnecka
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Gianfranco Parati
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy.,c Department of Health Sciences , University of Milano-Bicocca , Milan , Italy
| | - Kalina Kawecka-Jaszcz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
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Abstract
Breathing exercises (BE) and inspiratory muscle training (IMT) have been demonstrated to improve ventilation and ventilation-to-perfusion matching, and to improve exercise, functional performance, and many pathophysiologic manifestations of heart failure (HF). This article provides an extensive review of BE and IMT in patients with HF and identifies several key areas in need of further investigation, including the role of expiratory muscle training, IMT targeted at various locations of inspiration (early, mid, or late inspiration), and alteration of the ratio of inspiratory time to total breath time, all of which have substantial potential to improve many pathophysiologic manifestations of HF.
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Affiliation(s)
- Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, 5915 Ponce de Leon Boulevard, Coral Gables, FL 33146-2435, USA.
| | - Ross A Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 459, Chicago, IL 60612, USA
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24
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Jouett NP, Watenpaugh DE, Dunlap ME, Smith ML. Interactive effects of hypoxia, hypercapnia and lung volume on sympathetic nerve activity in humans. Exp Physiol 2015; 100:1018-29. [DOI: 10.1113/ep085092] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/24/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Noah P. Jouett
- Department of Integrative Physiology and Anatomy; University of North Texas Health Science Center; Fort Worth TX USA
| | - Donald E. Watenpaugh
- Department of Integrative Physiology and Anatomy; University of North Texas Health Science Center; Fort Worth TX USA
- Sleep Consultants of Texas; Fort Worth TX USA
| | - Mark E. Dunlap
- Department of Medicine; Metro Health System; Case Western Reserve University; Cleveland OH USA
| | - Michael L. Smith
- Department of Integrative Physiology and Anatomy; University of North Texas Health Science Center; Fort Worth TX USA
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25
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Dick TE, Mims JR, Hsieh YH, Morris KF, Wehrwein EA. Increased cardio-respiratory coupling evoked by slow deep breathing can persist in normal humans. Respir Physiol Neurobiol 2014; 204:99-111. [PMID: 25266396 DOI: 10.1016/j.resp.2014.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Abstract
Slow deep breathing (SDB) has a therapeutic effect on autonomic tone. Our previous studies suggested that coupling of the cardiovascular to the respiratory system mediates plasticity expressed in sympathetic nerve activity. We hypothesized that SDB evokes short-term plasticity of cardiorespiratory coupling (CRC). We analyzed respiratory frequency (fR), heart rate and its variability (HR&HRV), the power spectral density (PSD) of blood pressure (BP) and the ventilatory pattern before, during, and after a 20-min epoch of SDB. During SDB, CRC and the relative PSD of BP at fR increased; mean arterial pressure decreased; but HR varied; increasing (n = 3), or decreasing (n = 2) or remaining the same (n = 5). After SDB, short-term plasticity was not apparent for the group but for individuals differences existed between baseline and recovery periods. We conclude that a repeated practice, like pranayama, may strengthen CRC and evoke short-term plasticity effectively in a subset of individuals.
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Affiliation(s)
- Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States; Department of Neurosciences, Case Western Reserve University, Cleveland, OH, United States.
| | - Joseph R Mims
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Kendall F Morris
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Erica A Wehrwein
- Department of Physiology, Michigan State University, East Lansing, MI, United States
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