Respiratory sinus arrhythmia. A phenomenon improving pulmonary gas exchange and circulatory efficiency

Quantification of physiological effect of respiration on automated measurement of blood pressure among normotensive adult individuals

BACKGROUND

Accurate blood pressure measurement necessitates meticulous methodology, as even minor variations like speaking or sitting can impact the readings. Additionally, respiration plays a role in blood pressure, exhibiting a dip during inhalation and a subsequent increase during exhalation. However, the influence of breathing patterns, duration, and rate on blood pressure remains largely unexplored.

METHODS

In this study, we have attempted to quantify the changes in blood pressure and heart rate (HR) of normotensive individuals while performing predefined respiratory patterns - slow, medium, and fast (respiratory rates of 5, 10, and 20/m, respectively). For each respiratory pattern, age-matched and gender-matched (18-40 years) volunteered normotensive individuals were selected as volunteers. Baseline readings were recorded and each volunteer was randomly allotted a respiratory pattern. The volunteers performed the assigned respiratory pattern while the BP and HR were recorded.

RESULTS

A fall in both SBP and DBP was observed in all three patterns of respiration. There was no inter-pattern difference in the blood pressure change. A novel finding in our study was a trend of respiratory rate and HR - the change in HR linearly increased with a rise in respiratory rate difference. We also proposed a linear regression equation for this increase in HR with the increase in respiratory rate which was statistically significant.

CONCLUSION

The findings suggest the decline in blood pressure is independent of the respiratory pattern employed. The study also demonstrates that the HR is a linear function of respiratory rate.

Cardiopulmonary adaptations of a diving marine mammal, the bottlenose dolphin: Physiology during anesthesia

Diving marine mammals are a diverse group of semi- to completely aquatic species. Some species are targets of conservation and rehabilitation efforts; other populations are permanently housed under human care and may contribute to clinical and biomedical investigations. Veterinary medical care for species under human care, at times, may necessitate the use of general anesthesia for diagnostic and surgical indications. However, the unique physiologic and anatomic adaptations of one representative diving marine mammal, the bottlenose dolphin, present several challenges in providing ventilatory and cardiovascular support to maintain adequate organ perfusion under general anesthesia. The goal of this review is to highlight the unique cardiopulmonary adaptations of the completely aquatic bottlenose dolphin (Tursiops truncatus), and to identify knowledge gaps in our understanding of how those adaptations influence their physiology and pose potential challenges for sedation and anesthesia of these mammals.

The contribution of granger causality analysis to our understanding of cardiovascular homeostasis: from cardiovascular and respiratory interactions to central autonomic network control

Homeostatic regulation plays a fundamental role in maintenance of multicellular life. At different scales and in different biological systems, this principle allows a better understanding of biological organization. Consequently, a growing interest in studying cause-effect relations between physiological systems has emerged, such as in the fields of cardiovascular and cardiorespiratory regulations. For this, mathematical approaches such as Granger causality (GC) were applied to the field of cardiovascular physiology in the last 20 years, overcoming the limitations of previous approaches and offering new perspectives in understanding cardiac, vascular and respiratory homeostatic interactions. In clinical practice, continuous recording of clinical data of hospitalized patients or by telemetry has opened new applicability for these approaches with potential early diagnostic and prognostic information. In this review, we describe a theoretical background of approaches based on linear GC in time and frequency domains applied to detect couplings between time series of RR intervals, blood pressure and respiration. Interestingly, these tools help in understanding the contribution of homeostatic negative feedback and the anticipatory feedforward mechanisms in homeostatic cardiovascular and cardiorespiratory controls. We also describe experimental and clinical results based on these mathematical tools, consolidating previous experimental and clinical evidence on the coupling in cardiovascular and cardiorespiratory studies. Finally, we propose perspectives allowing to complete the understanding of these interactions between cardiovascular and cardiorespiratory systems, as well as the interplay between brain and cardiac, and vascular and respiratory systems, offering a high integrative view of cardiovascular and cardiorespiratory homeostatic regulation.

A comprehensive evaluation of linear and non-linear HRV parameters between paced breathing and stressful mental state

Background

Heart rate variability (HRV) is a crucial metric that provides valuable insight into the balance between relaxation and stress. Previous research has shown that most HRV parameters improve during periods of mental relaxation, while decreasing during tasks involving cognitive workload. Although a comprehensive analysis of both linear and non-linear HRV parameters has been carried out in existing literature, there still exists a need for further research in this area. Additionally, limited knowledge exists regarding how specific interventions may influence the interpretation of these parameters and how the different parameters correlate under different interventions. This study aims to address these gaps by conducting a thorough comparison of different linear and non-linear HRV parameters under mentally relaxed versus stressful states.

Methodology

Participants were randomly and equally divided among two between-subjects groups: relaxed-stress (RS) (N = 22) and stress-relaxed (SR) (N = 22). In the RS group, a paced breathing task was given for 5 min to create relaxation, and was followed by a 5-min time-based mental calculation task to create stress. In the SR group, the order of the stress and relaxed tasks was reversed. There was a washout period of 15 min after the first task in both groups.

Results

Of the 37 HRV parameters, 33 differed significantly between the two interventions. The majority of the parameters exhibited an improving and degrading tendency of HRV parameters in the relaxed and stressed states, respectively. The correlation of the majority of HRV parameters decreases during stress, while prominent time domain and geometric domain parameters stand out in the correlation.

Conclusion

Overall, HRV parameters can be reliably used to assess a person's relaxed and stressed mental states during paced breathing and mental arithmetic task respectively. Furthermore, non-linear HRV parameters provide accurate estimators of the mental state, in addition to the commonly used linear parameters.

Tibetans exhibit lower hemoglobin concentration and decreased heart response to hypoxia during poikilocapnia at intermediate altitude relative to Han Chinese

Background

High-altitude populations exhibit distinct cellular, respiratory, and cardiovascular phenotypes, some of which provide adaptive advantages to hypoxic conditions compared to populations with sea-level ancestry. Studies performed in populations with a history of high-altitude residence, such as Tibetans, support the idea that many of these phenotypes may be shaped by genomic features that have been positively selected for throughout generations. We hypothesize that such traits observed in Tibetans at high altitude also occur in Tibetans living at intermediate altitude, even in the absence of severe sustained hypoxia.

Methodology

We studied individuals of high-altitude ancestry (Tibetans, n = 17 females; n = 12 males) and sea-level ancestry (Han Chinese, n = 6 females; n = 10 males), both who had been living at ∼1300 m (∼4327 ft) for at least 18 months. We measured hemoglobin concentration ([Hb]), hypoxic ventilatory response (HVR), and hypoxic heart rate response (HHRR) with end-tidal CO2 (PetCO2) held constant (isocapnia) or allowed to decrease with hypoxic hyperventilation (poikilocapnia). We also quantified the contribution of CO2 on ventilation and heart rate by calculating the differences of isocapnic versus poikilocapnic hypoxic conditions (Δ V ˙ I /ΔPetCO2 and ΔHR/ΔPetCO2, respectively).

Results

Male Tibetans had lower [Hb] compared to Han Chinese males (p < 0.05), consistent with reports for individuals from these populations living at high altitude and sea level. Measurements of ventilation (resting ventilation, HVR, and PetCO2) were similar for both groups. Heart rate responses to hypoxia were similar in both groups during isocapnia; however, HHRR in poikilocapnia was reduced in the Tibetan group (p < 0.03), and the heart rate response to CO2 in hypoxia was lower in Tibetans relative to Han Chinese (p < 0.01).

Conclusion

These results suggest that Tibetans living at intermediate altitude have blunted cardiac responses in the context of hypoxia. Hence, only some of the phenotypes observed in Tibetans living at high altitude are observed in Tibetans living at intermediate altitude. Whereas blunted cardiac responses to hypoxia is revealed at intermediate altitudes, manifestation of other physiological adaptations to high altitude may require exposure to more severe levels of hypoxia.

From Psychostasis to the Discovery of Cardiac Nerves: The Origins of the Modern Cardiac Neuromodulation Concept

This review explores the historical development of cardiology knowledge, from ancient Egyptian psychostasis to the modern comprehension of cardiac neuromodulation. In ancient Egyptian religion, psychostasis was the ceremony in which the deceased was judged before gaining access to the afterlife. This ritual was also known as the "weighing of the heart" or "weighing of the soul". The Egyptians believed that the heart, not the brain, was the seat of human wisdom, emotions, and memory. They were the first to recognize the cardiocentric nature of the body, identifying the heart as the center of the circulatory system. Aristotle (fourth century BC) considered the importance of the heart in human physiology in his philosophical analyses. For Galen (third century AD), the heart muscle was the site of the vital spirit, which regulated body temperature. Cardiology knowledge advanced significantly in the 15th century, coinciding with Leonardo da Vinci and Vesalius's pioneering anatomical and physiological studies. It was William Harvey, in the 17th century, who introduced the concept of cardiac circulation. Servet's research and Marcello Malpighi's discovery of arterioles and capillaries provided a more detailed understanding of circulation. Richard Lower emerged as the foremost pioneer of experimental cardiology in the late 17th century. He demonstrated the heart's neural control by tying off the vagus nerve. In 1753, Albrecht von Haller, a professor at Göttingen, was the first to discover the heart's automaticity and the excitation of muscle fibers. Towards the end of the 18th century, Antonio Scarpa challenged the theories of Albrecht von Haller and Johann Bernhard Jacob Behrends, who maintained that the myocardium possessed its own "irritability", on which the heartbeat depended, and was independent of neuronal sensitivity. Instead, Scarpa argued that the heart required innervation to maintain life, refuting Galenic notions. In contemporary times, the study of cardiac innervation has regained prominence, particularly in understanding the post-acute sequelae of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (PASC), which frequently involves cardiorespiratory symptoms and dysregulation of the intrinsic cardiac innervation. Recently, it has been recognized that post-acute sequelae of acute respiratory infections (ARIs) due to other pathogens can also be a cause of long-term vegetative and somatic symptoms. Understanding cardiac innervation and modulation can help to recognize and treat long COVID and long non-COVID-19 (coronavirus disease 2019) ARIs. This analysis explores the historical foundations of cardiac neuromodulation and its contemporary relevance. By focusing on this concept, we aim to bridge the gap between historical understanding and modern applications. This will illuminate the complex interplay between cardiac function, neural modulation, cardiovascular health, and disease management in the context of long-term cardiorespiratory symptoms and dysregulation of intrinsic cardiac innervations.

Apneustic anesthesia ventilation improves pulmonary function in anesthetized bottlenose dolphins (Tursiops truncatus)

Introduction

Use of mechanical ventilation during general anesthesia is a necessary practice in the anesthetization of small cetaceans as spontaneous ventilation fails to provide adequate gas exchange. Currently available methods of ventilation do not account for the intermittent breathing strategy of representative species within this infraorder of fully aquatic mammals and may have a significant effect on cardiac and respiratory physiology.

Methods

To understand the impact of mechanical ventilation on cardiopulmonary function in one small species of cetacean, the bottlenose dolphin (Tursiops truncatus), we compared controlled mechanical ventilation (CMV) to a novel ventilation method known as apneustic anesthesia ventilation (AAV). AAV simulates the normal inspiratory breath-hold pattern of dolphins. Ten anesthetic procedures (dental procedure, n = 9; bronchoscopy, n = 2) were performed on nine dolphins (age range: 10-42 years; mean = 32 years; median = 37 years; female = 3, 40%; male = 6, 60%). In a cross-over study design, dolphins were instrumented and randomly assigned to AAV or CMV as the initial mode of ventilation, then switched to the alternate mode. Baseline cardiopulmonary data were collected and again after 30 min on each mode of ventilation. Cardiac index, stroke volume index, systemic vascular resistance, alveolar dead space, alveolar-arterial oxygen tension gradient, arterial oxygen content, oxygen delivery index, and dynamic respiratory system compliance index were calculated at each of the four time points.

Results

During AAV, dolphins had higher arterial oxygen tension, higher mean airway pressure, reduced alveolar dead space ventilation and lower alveolar-arterial oxygen difference. Cardiovascular performance was not statistically different between the two modes.

Discussion

Our study suggests AAV, which more closely resembles the conscious intermittent respiratory pattern phenotype of dolphins, improves ventilation and pulmonary function in the anesthetized dolphin. Future studies should evaluate the cardiopulmonary effects of neutral buoyancy and cardiopulmonary sparing drug protocols to reduce the need for hemodynamic support of current protocols.

Scan-associated anxiety (scanxiety): the enigma of emotional breathing oscillations at 0.32 Hz (19 bpm)

MRI-related anxiety in healthy participants is often characterized by a dominant breathing frequency at around 0.32 Hz (19 breaths per minute, bpm) at the beginning but in a few cases also at the end of scanning. Breathing waves at 19 bpm are also observed in patients with anxiety independently of the scanned body part. In patients with medically intractable epilepsy and intracranial electroencephalography (iEEG), spontaneous breathing through the nose varied between 0.24 and 0.37 Hz (~19 bpm). Remarkable is the similarity of the observed breathing rates at around 0.32 Hz during different types of anxiety states (e.g., epilepsy, cancer, claustrophobia) with the preferred breathing frequency of 0.32 Hz (19 bpm), which is predicted by the binary hierarchy model of Klimesch. This elevated breathing frequency most likely reflects an emotional processing state, in which energy demands are minimized due to a harmonic coupling ratio with other brain-body oscillations.

Cardiorespiratory coupling is associated with exercise capacity in athletes: A cross-sectional study

PURPOSE

To determine the association between exercise capacity based on peak oxygen uptake (VO2peak) and resting cardiorespiratory coupling (CRC) levels in athletes and non-athletes' subjects.

METHODS

A cross-sectional study was carried out in 42 apparently healthy male subjects, aged between 20 and 40 years old. The participants were allocated into athletes (n = 21) and non-athletes (n = 21) groups. Resting electrocardiogram and respiratory movement (RESP) were simultaneously acquired during 15 min in supine position and quiet breathing. The beat-to-beat heart period (HP) and RESP series were determined from the recorded signals. Traditional analysis of HP based on frequency domain indexes was performed considering the high-frequency (0.15 - 0.45 Hz) components. To compute the CRC, the linear association between HP and RESP series was determined via squared coherence function and directionality of interaction was investigated through the causal extension of this approach. The exercise capacity was assessed through incremental cardiopulmonary exercise testing in order to determine the VO2peak.

RESULTS

Traditional analysis of HP based on high-frequency index was not correlated with exercise capacity in the athletes (r = -0.1, p = 0.5) and non-athletes (r = -0.1, p = 0.3) cohorts. However, resting CRC values was associated with exercise capacity in athletes (r = 0.4, p = 0.03), but not in the non-athletes group (r = -0.2, p = 0.3).

CONCLUSION

These results suggest that improved resting values of CRC is associated with higher exercise capacity (VO2peak) in endurance athletes. Moreover, frequency domain of HP was not sensitive to identifying this relationship, probably because effects of training on parasympathetic modulation might be affected by respiratory dynamics, and this influence has a directionality (i.e., from RESP to HP).

Putting back respiration into respiratory sinus arrhythmia or high-frequency heart rate variability: Implications for interpretation, respiratory rhythmicity, and health

Research on respiratory sinus arrhythmia, or high-frequency heart rate variability (its frequency-domain equivalent), has been popular in psychology and the behavioral sciences for some time. It is typically interpreted as an indicator of cardiac vagal activity. However, as research has shown for decades, the respiratory pattern can influence the amplitude of these noninvasive measures substantially, without necessarily reflecting changes in tonic cardiac vagal activity. Although changes in respiration are systematically associated with experiential and behavioral states, this potential confound in the interpretation of RSA, or HF-HRV, is rarely considered. Interpretations of within-individual changes in these parameters are therefore only conclusive if undertaken relative to the breathing pattern. The interpretation of absolute levels of these parameters between individuals is additionally burdened with the problem of residual inspiratory cardiac vagal activity in humans. Furthermore, multiple demographic, anthropometric, life-style, health, and medication variables can act as relevant third variables that might explain associations of RSA or HF-HRV with experiential and behavioral variables. Because vagal activity measured by these parameters only represents the portion of cardiac vagal outflow that is modulated by the respiratory rhythm, alternative interpretations beyond cardiac vagal activity should be considered. Accumulating research shows that activity of multiple populations of neurons in the brain and the periphery, and with that organ activity and function, are modulated rhythmically by respiratory activity. Thus, observable health benefits ascribed to the cardiac vagal system through RSA or HF-HRV may actually reflect beneficial effects of respiratory modulation. Respiratory rhythmicity may ultimately provide the mechanism that integrates central, autonomic, and visceral activities.

Cardiorespiratory dynamics during respiratory maneuver in athletes

Introduction: The modern practice of sports medicine and medical rehabilitation requires the search for subtle criteria for the development of conditions and recovery of the body after diseases, which would have a prognostic value for the prevention of negative effects of training and rehabilitation tools, and also testify to the development and course of mechanisms for counteracting pathogenetic processes in the body. The purpose of this study was to determine the informative directions of the cardiorespiratory system parameters dynamics during the performing a maneuver with a change in breathing rate, which may indicate the body functional state violation.

Methods: The results of the study of 183 healthy men aged 21.2 ± 2.3 years who regularly engaged in various sports were analyzed. The procedure for studying the cardiorespiratory system included conducting combined measurements of indicators of activity of the respiratory and cardiovascular systems in a sitting position using a spiroarteriocardiograph device. The duration of the study was 6 min and involved the sequential registration of three measurements with a change in breathing rate (spontaneous breathing, breathing at 0.1 Hz and 0.25 Hz).

Results: Performing a breathing maneuver at breathing 0.1 Hz and breathing 0.25 Hz in comparison with spontaneous breathing leads to multidirectional significant changes in heart rate variability indicators–TP (ms2), LF (ms2), LFHF (ms2/ms2); of blood pressure variability indicators–TPDBP (mmHg2), LFSBP (mmHg2), LFDBP (mmHg2), HFSBP (mmHg2); of volume respiration variability indicators - LFR, (L×min-1)2; HFR, (L×min-1)2; LFHFR, (L×min-1)2/(L×min-1)2; of arterial baroreflex sensitivity indicators - BRLF (ms×mmHg-1), BRHF (ms×mmHg-1). Differences in indicators of systemic hemodynamics and indicators of cardiovascular and respiratory systems synchronization were also informative.

Conclusion: According to the results of the study, it is shown that during performing a breathing maneuver with a change in the rate of breathing, there are significant changes in cardiorespiratory parameters, the analysis of which the increments made it possible to determine of the changes directions dynamics, their absolute values and informative limits regarding the possible occurrence of the cardiorespiratory interactions dysregulation.

Cardiorespiratory dynamics during respiratory maneuver in athletes

Introduction: The modern practice of sports medicine and medical rehabilitation requires the search for subtle criteria for the development of conditions and recovery of the body after diseases, which would have a prognostic value for the prevention of negative effects of training and rehabilitation tools, and also testify to the development and course of mechanisms for counteracting pathogenetic processes in the body. The purpose of this study was to determine the informative directions of the cardiorespiratory system parameters dynamics during the performing a maneuver with a change in breathing rate, which may indicate the body functional state violation. Methods: The results of the study of 183 healthy men aged 21.2 ± 2.3 years who regularly engaged in various sports were analyzed. The procedure for studying the cardiorespiratory system included conducting combined measurements of indicators of activity of the respiratory and cardiovascular systems in a sitting position using a spiroarteriocardiograph device. The duration of the study was 6 min and involved the sequential registration of three measurements with a change in breathing rate (spontaneous breathing, breathing at 0.1 Hz and 0.25 Hz). Results: Performing a breathing maneuver at breathing 0.1 Hz and breathing 0.25 Hz in comparison with spontaneous breathing leads to multidirectional significant changes in heart rate variability indicators-TP (ms2), LF (ms2), LFHF (ms2/ms2); of blood pressure variability indicators-TPDBP (mmHg2), LFSBP (mmHg2), LFDBP (mmHg2), HFSBP (mmHg2); of volume respiration variability indicators - LFR, (L×min-1)2; HFR, (L×min-1)2; LFHFR, (L×min-1)2/(L×min-1)2; of arterial baroreflex sensitivity indicators - BRLF (ms×mmHg-1), BRHF (ms×mmHg-1). Differences in indicators of systemic hemodynamics and indicators of cardiovascular and respiratory systems synchronization were also informative. Conclusion: According to the results of the study, it is shown that during performing a breathing maneuver with a change in the rate of breathing, there are significant changes in cardiorespiratory parameters, the analysis of which the increments made it possible to determine of the changes directions dynamics, their absolute values and informative limits regarding the possible occurrence of the cardiorespiratory interactions dysregulation.

Cardiorespiratory coupling in the bottlenose dolphin (Tursiops truncatus)

Introduction: The bottlenose dolphin (Tursiops truncatus) is an intermittent breather, where the breath begins with an exhalation followed by inhalation and an extended inter-breath interval ranging from 10 to 40 s. Breathing has been shown to alter both the instantaneous heart rate (if H) and stroke volume (iSV) in the bottlenose dolphin, with a transitory ventilatory tachycardia following the breath, and an exponential decrease to a stable if H around 40 beats • min-1 during the inter-breath period. As the total breath duration in the dolphin is around 1 s, it is not possible to assess the contribution of exhalation and inhalation to these changes in cardiac function during normal breathing. Methods: In the current study, we evaluated the if H response by separating expiration and inspiration of a breath, which allowed us to distinguish their respective contribution to the changes in if H. We studied 3 individual male bottlenose dolphins trained to hold their breath between the different respiratory phases (expiration and inhalation). Results: Our data show that inspiration causes an increase in if H, while expiration appears to result in a decrease in if H. Discussion: These data provide improved understanding of the cardiorespiratory coupling in dolphins, and show how both exhalation and inhalation alters if H.

Assessing cardiorespiratory interactions via lagged joint symbolic dynamics during spontaneous and controlled breathing

Introduction: Joint symbolic analysis (JSA) can be utilized to describe interactions between time series while accounting for time scales and nonlinear features. JSA is based on the computation of the rate of occurrence of joint patterns built after symbolization. Lagged JSA (LJSA) is obtained from the more classical JSA by introducing a delay/lead between patterns built over the two series and combined to form the joint scheme, thus monitoring coordinated patterns at different lags. Methods: In the present study, we applied LJSA for the assessment of cardiorespiratory coupling (CRC) from heart period (HP) variability and respiratory activity (R) in 19 healthy subjects (age: 27-35 years; 8 males, 11 females) during spontaneous breathing (SB) and controlled breathing (CB). The R rate of CB was selected to be indistinguishable from that of SB, namely, 15 breaths·minute-1 (CB15), or slower than SB, namely, 10 breaths·minute-1 (CB10), but in both cases, very rapid interactions between heart rate and R were known to be present. The ability of the LJSA approach to follow variations of the coupling strength was tested over a unidirectionally or bidirectionally coupled stochastic process and using surrogate data to test the null hypothesis of uncoupling. Results: We found that: i) the analysis of surrogate data proved that HP and R were significantly coupled in any experimental condition, and coupling was not more likely to occur at a specific time lag; ii) CB10 reduced CRC strength at the fastest time scales while increasing that at intermediate time scales, thus leaving the overall CRC strength unvaried; iii) despite exhibiting similar R rates and respiratory sinus arrhythmia, SB and CB15 induced different cardiorespiratory interactions; iv) no dominant temporal scheme was observed with relevant contributions of HP patterns either leading or lagging R. Discussion: LJSA is a useful methodology to explore HP-R dynamic interactions while accounting for time shifts and scales.

Cardiorespiratory coupling as an early marker of cardiac autonomic dysfunction in type 2 diabetes mellitus patients

The aim of this study was to assess cardiorespiratory coupling (CRC) in type 2 diabetes mellitus patients (T2DM) and apparently healthy individuals, in order to test the hypothesis that this method can provide additional knowledge to the information obtained through the heart rate variability (HRV). A cross-sectional study was conducted in T2DM patients(T2DMG=32) and health controls (CON=32). For CRC analysis, the electrocardiogram, arterial pressure, and thoracic respiratory movement were recorded at rest in supine position and during active standing. Beat-to-beat series of heart period and systolic arterial pressure were analyzed with the respiratory movement signal via a traditional non-causal approach, such as squared coherence function. In this sample of T2DM, no differences in HRV were observed when compared to the CON, but the T2DMG showed a reduction in resting CRC. We conclude that in CRC in T2DM, reflected by the squared coherence may already be compromised even before HRV changes.

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

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

Blue Light-Ocular and Systemic Damaging Effects: A Narrative Review

Light is a fundamental aspect of our lives, being involved in the regulation of numerous processes in our body. While blue light has always existed in nature, with the ever-growing number of electronic devices that make use of short wavelength (blue) light, the human retina has seen increased exposure to it. Because it is at the high-energy end of the visible spectrum, many authors have investigated the theoretical harmful effects that it poses to the human retina and, more recently, the human body, given the discovery and characterization of the intrinsically photosensitive retinal ganglion cells. Many approaches have been explored, with the focus shifting throughout the years from examining classic ophthalmological parameters, such as visual acuity, and contrast sensitivity to more complex ones seen on electrophysiological assays and optical coherence tomographies. The current study aims to gather the most recent relevant data, reveal encountered pitfalls, and suggest future directions for studies regarding local and/or systemic effects of blue light retinal exposures.

Exploring the use of Granger causality for the identification of chemical exposure based on physiological data

Wearable sensors offer new opportunities for the early detection and identification of toxic chemicals in situations where medical evaluation is not immediately possible. We previously found that continuously recorded physiology in guinea pigs can be used for early detection of exposure to an opioid (fentanyl) or a nerve agent (VX), as well as for differentiating between the two. Here, we investigated how exposure to these different chemicals affects the interactions between ECG and respiration parameters as determined by Granger causality (GC). Features reflecting such interactions may provide additional information and improve models differentiating between chemical agents. Traditional respiration and ECG features, as well as GC features, were extracted from data of 120 guinea pigs exposed to VX (n = 61) or fentanyl (n = 59). Data were divided in a training set (n = 99) and a test set (n = 21). Minimum Redundancy Maximum Relevance (mRMR) and Support Vector Machine (SVM) algorithms were used to, respectively, perform feature selection and train a model to discriminate between the two chemicals. We found that ECG and respiration parameters are Granger-related under healthy conditions, and that exposure to fentanyl and VX affected these relationships in different ways. SVM models discriminated between chemicals with accuracy of 95% or higher on the test set. GC features did not improve the classification compared to traditional features. Respiration features (i.e., peak inspiratory and expiratory flow) were the most important to discriminate between different chemical’s exposure. Our results indicate that it may be feasible to discriminate between chemical exposure when using traditional physiological respiration features from wearable sensors. Future research will examine whether GC features can contribute to robust detection and differentiation between chemicals when considering other factors, such as generalizing results across species.

Respiratory patterns and baroreflex function in heart failure

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.

Heart rate variability during mindful breathing meditation

We discuss Heart Rate Variability (HRV) measured during mindful breathing meditation. We provide a pedagogical computation of two commonly used heart rate variability metrics, i.e. the root mean square of successive differences (RMSSD) and the standard deviation of RR intervals (SDRR), in terms of Fourier components. It is shown that the root mean square of successive differences preferentially weights higher frequency Fourier modes, making it unsuitable as a biosignal for mindful breathing meditation which encourages slow breathing. We propose a new metric called the autonomic balance index (ABI) which uses Respiratory Sinus Arrhythmia to quantify the fraction of heart rate variability contributed by the parasympathetic nervous system. We apply this metric to heart rate variability data collected during two different meditation techniques, and show that the autonomic balance index is significantly elevated during mindful breathing, making it a good signal for biofeedback during meditation sessions.

Age-dependent cardiorespiratory directional coupling in wake-resting state

Objective.Cooperation in the cardiorespiratory system helps maintain internal stability. Various types of system interactions have been investigated; however, the characteristics of the interactions have mostly been studied using data collected in well-defined physiological states, such as sleep. Furthermore, most analyses provided general information about the interaction, making it difficult to quantify how the systems influenced one another.Approach.Cardiorespiratory directional coupling was investigated in different age groups (20 young and 19 elderly subjects) in a wake-resting state. The directionality index (DI) was calculated using instantaneous phases from the heartbeat interval and respiratory signal to provide information about the strength and direction of interaction between the systems. Statistical analysis was performed between the groups on the DI and independent measures of directionality (nc_r: influence from cardiac system to respiratory system, and nc_c: influence from the respiratory system to the cardiac system).Main results.The values of DI were -0.52 and -0.17 in the young and elderly groups, respectively (p< 0.001). Furthermore, the values of nc_rand nc_cwere found to be significantly different between the groups (p< 0.001), respectively.Significance.Changes in both directions between the systems influence different aspects of cardiorespiratory coupling between the groups. This observation could be linked to different levels of autonomic modulation associated with ageing. Our approach could aid in quantitatively tracking and comprehending how systems interact in response to physiological and environmental changes. It could also be used to understand how abnormal interaction characteristics influence physiological system dysfunctions and disorders.

Breathing is coupled with voluntary initiation of mental imagery

Previous research has suggested that bodily signals from internal organs are associated with diverse cortical and subcortical processes involved in sensory-motor functions, beyond homeostatic reflexes. For instance, a recent study demonstrated that the preparation and execution of voluntary actions, as well as its underlying neural activity, are coupled with the breathing cycle. In the current study, we investigated whether such breathing-action coupling is limited to voluntary motor action or whether it is also present for mental actions not involving any overt bodily movement. To answer this question, we recorded electroencephalography (EEG), electromyography (EMG), and respiratory signals while participants were conducting a voluntary action paradigm including self-initiated motor execution (ME), motor imagery (MI), and visual imagery (VI) tasks. We observed that the voluntary initiation of ME, MI, and VI are similarly coupled with the respiration phase. In addition, EEG analysis revealed the existence of readiness potential (RP) waveforms in all three tasks (i.e., ME, MI, VI), as well as a coupling between the RP amplitude and the respiratory phase. Our findings show that the voluntary initiation of both imagined and overt action is coupled with respiration, and further suggest that the breathing system is involved in preparatory processes of voluntary action by contributing to the temporal decision of when to initiate the action plan, regardless of whether this culminates in overt movements.

Pulmonary Oxygen Exchange in a Rhythmically Expanding–Contracting Alveolus–Capillary Model

Pulmonary gas exchanges are vital to human health, and disruptions to this process have been associated with many respiratory diseases. Previous gas exchange studies have predominately relied on whole-body testing and theoretical analysis with 1D or static models. However, pulmonary gas exchanges are inherently a dynamic process in 3D spaces with instantaneous interactions between air, blood, and tissue. This study aimed to develop a computational model for oxygen exchange that considered all factors mentioned above. Therefore, an integrated alveolus–membrane–capillary geometry was developed with prescribed rhythmic expansion/contraction. Airflow ventilation, blood perfusion, and oxygen diffusion were simulated using COMSOL. The temporal and spatial distribution of blood flow and oxygen within the capillaries were simulated under varying breathing depths and cardiac outputs. The results showed highly nonuniform blood flow distributions in the capillary network, while the rhythmic oscillation further increased this nonuniformity, leading to stagnant blood flow in the distal vessels. A static alveolus–capillary geometry underestimated perfusion by 11% for normal respirations, and the deviation grew with breathing depth. The rhythmic motion caused a phase lag in the blood flow. The blood PO2 reached equilibrium with the alveolar air after traveling 1/5–1/3 of the capillary network. The time to reach this equilibrium was significantly influenced by the air–blood barrier diffusivity, while it was only slightly affected by the perfusion rate. The computational platform in this study could be instrumental in obtaining refined knowledge of pulmonary O2 exchanges.

Cardiorespiratory coupling strength in athletes and non-athletes

PURPOSE

Despite the relevant presence of nonlinear components on heart period (HP) likely due to cardiorespiratory coupling (CRC), the HP is frequently analyzed in absence of concomitant recordings of respiratory movements (RESP). This study aims to assess the cardiovascular dynamics and CRC during postural challenge in athletes and non-athletes via joint symbolic analysis (JSA).

METHODS

A cross-sectional study was conducted in 50 men, aged between 20 and 40 yrs, divided into athletes (n = 25) and non-athletes (n = 25) groups. The electrocardiogram, blood pressure and RESP signals were recorded during 15 min in both supine position (REST) and after active postural maneuver (STAND). From the beat-to-beat series of HP, systolic arterial pressure (SAP) and RESP, we computed the time and frequency domain indexes and baroreflex sensitivity. The JSA was based on the definition of symbolic HP and RESP patterns and on the evaluation of the rate of their simultaneous occurrence in both HP and RESP series.

RESULTS

The JSA analysis was able to identify higher CRC strength at REST in athletes. Moreover, the response of CRC to STAND depended on the time scales of the analysis and was much more evident in athletes than in non-athletes, thus indicating a more reactive autonomic control in athletes.

CONCLUSION

Assessing CRC in athletes via JSA provides additional information compared to standard linear time and frequency domain tools likely due to the more relevant presence of nonlinearities in HP-RESP variability relationship.

Respiratory Sinus Arrhythmia is Mainly Driven by Central Feedforward Mechanisms in Healthy Humans

Heart rate variability (HRV) has prognostic and diagnostic potential, however, the mechanisms behind respiratory sinus arrhythmia (RSA), a main short-term HRV, are still not well understood. We investigated if the central feedforward mechanism or pulmonary stretch reflex contributed most to RSA in healthy humans. Ventilatory support reduces the centrally mediated respiratory effort but remains the inspiratory stretch of the pulmonary receptors. We aimed to quantify the difference in RSA between spontaneous breathing and ventilatory support. Nineteen healthy, young subjects underwent spontaneous breathing and non-invasive intermittent positive pressure ventilation (NIV) while we recorded heart rate (HR, from ECG), mean arterial pressure (MAP) and stroke volume (SV) estimated from the non-invasive finger arterial pressure curve, end-tidal CO2 (capnograph), and respiratory frequency (RF) with a stretch band. Variability was quantified by an integral between 0.15–0.4 Hz calculated from the power spectra. Median and 95% confidence intervals (95%CI) were calculated as Hodges–Lehmann’s one-sample estimator. Statistical difference was calculated by the Wilcoxon matched-pairs signed-rank test. RF and end-tidal CO2 were unchanged by NIV. NIV reduced HR by 2 bpm, while MAP and SV were unchanged in comparison to spontaneous breathing. Variability in both HR and SV was reduced by 60% and 75%, respectively, during NIV as compared to spontaneous breathing, but their interrelationship with respiration was maintained. NIV reduced RSA through a less central respiratory drive, and pulmonary stretch reflex contributed little to RSA. RSA is mainly driven by a central feedforward mechanism in healthy humans. Peripheral reflexes may contribute as modifiers of RSA.

Respiratory and heart rate dynamics during peripheral chemoreceptor deactivation compared to targeted sympathetic and sympathetic/parasympathetic (co-)activation

BACKGROUND

The importance of peripheral chemoreceptors for cardiorespiratory neural control is known for decades. Pure oxygen inhalation deactivates chemoreceptors and increases parasympathetic outflow. However, the relationship between autonomic nervous system (ANS) activation and resulting respiratory as well as heart rate (HR) dynamics is still not fully understood.

METHODS

In young adults the impact of (1) 100 % pure oxygen inhalation (hyperoxic cardiac chemoreflex sensitivity (CHRS) testing), (2) the cold face test (CFT) and (3) the cold pressor test (CPT) on heart rate variability (HRV), hemodynamics and respiratory rate was investigated in randomized order. Baseline ANS outflow was determined assessing respiratory sinus arrhythmia via deep breathing, baroreflex sensitivity and HRV.

RESULTS

Baseline ANS outflow was normal in all participants (23 ± 1 years, 7 females, 3 males). Hyperoxic CHRS testing decreased HR (after 60 ± 3 vs before 63 ± 3 min^-1, p = 0.004), while increasing total peripheral resistance (1053 ± 87 vs 988 ± 76 dyne*s + m²/cm⁵, p = 0.02) and mean arterial blood pressure (93 ± 4 vs 91 ± 4 mm Hg, p = 0.02). HRV indicated increased parasympathetic outflow after hyperoxic CHRS testing accompanied by a decrease in respiratory rate (15 ± 1vs 19 ± 1 min^-1, p = 0.001). In contrast, neither CFT nor CPT altered the respiratory rate (18 ± 1 vs 18 ± 2 min^-1, p = 0.38 and 18 ± 1 vs 18 ± 1 min^-1, p = 0.84, respectively).

CONCLUSION

Changes in HR characteristics during deactivation of peripheral chemoreceptors but not during the CFT and CPT are related with a decrease in respiratory rate. This highlights the need of respiratory rate assessment when evaluating adaptations of cardiorespiratory chemoreceptor control.

Dynamic Phase Extraction: Applications in Pulse Rate Variability

Pulse rate variability is a physiological parameter that has been extensively studied and correlated with many physical ailments. However, the phase relationship between inter-beat interval, IBI, and breathing has very rarely been studied. Develop a technique by which the phase relationship between IBI and breathing can be accurately and efficiently extracted from photoplethysmography (PPG) data. A program based on Lock-in Amplifier technology was written in Python to implement a novel technique, Dynamic Phase Extraction. It was tested using a breath pacer and a PPG sensor on 6 subjects who followed a breath pacer at varied breathing rates. The data were then analyzed using both traditional methods and the novel technique (Dynamic Phase Extraction) utilizing a breath pacer. Pulse data was extracted using a PPG sensor. Dynamic Phase Extraction (DPE) gave the magnitudes of the variation in IBI associated with breathing [Formula: see text] measured with photoplethysmography during paced breathing (with premature ventricular contractions, abnormal arrhythmias, and other artifacts edited out). [Formula: see text] correlated well with two standard measures of pulse rate variability: the Standard Deviation of the inter-beat interval (SDNN) (ρ = 0.911) and with the integrated value of the Power Spectral Density between 0.04 and 0.15 Hz (Low Frequency Power or LF Power) (ρ = 0.885). These correlations were comparable to the correlation between the SDNN and the LF Power (ρ = 0.877). In addition to the magnitude [Formula: see text], Dynamic Phase Extraction also gave the phase between the breath pacer and the changes in the inter-beat interval (IBI) due to respiratory sinus arrythmia (RSA), and correlated well with the phase extracted using a Fourier transform (ρ = 0.857). Dynamic Phase Extraction can extract both the phase between the breath pacer and the changes in IBI due to the respiratory sinus arrhythmia component of pulse rate variability ([Formula: see text], but is limited by needing a breath pacer.

Evaluation of Heart Rate Variability and Application of Heart Rate Variability Biofeedback: Toward Further Research on Slow-Paced Abdominal Breathing in Zen Meditation

This review summarizes my own involvement in heart rate variability (HRV) and HRV biofeedback studies, as a tribute to the late Dr. Evgeny Vaschillo. I first review psychophysiological studies on behavioral stress and relaxation performed in my laboratory using an assessment of cardiac parasympathetic activity. Although magnitude of high-frequency (HF) component of HRV corresponding respiratory sinus arrhythmia (RSA) is widely used as an index of cardiac parasympathetic function, a respiratory confound during stress or relaxation may have interfered with the proper assessment of the HF HRV. An enhanced method under frequency-controlled respiration at 0.25 Hz provided a reliable assessment of cardiac parasympathetic activity. I then review findings from HRV biofeedback research in my laboratory. Based on the hypothesis that RSA measured as an HF component of HRV represents cardiorespiratory resting function, it was demonstrated that HRV biofeedback before sleep enhanced the magnitude of HF HRV during sleep, a cardiorespiratory resting function. Moreover, by focusing on the spectral peak of the low-frequency (LF) component of HRV, paced breathing at the LF-peak frequency was shown to increase baroreflex sensitivity. Finally, I describe the potential of slow-paced abdominal breathing (i.e., Tanden breathing) performed in Zen meditation. The concept of Tanden breathing as described in a regimen from early modern Japan is introduced, and recent research findings on slow-paced abdominal breathing are summarized. Future research directions of slow-paced abdominal breathing are also discussed.

The effects of a respiratory training mask on steady-state oxygen consumption at rest and during exercise

No studies have directly measured ventilatory and metabolic responses while wearing a respiratory training mask (RTM) at rest and during exercise. Eleven aerobically fit adults (age: 21 ± 1 years) completed a randomized cross-over study while wearing an RTM or control mask during cycling at 50% Wmax. An RTM was retrofitted with a gas collection tube and set to the manufacturer's "altitude resistance" setting of 6,000 ft (1,800 m). Metabolic gas analysis, ratings of perceived exertion, and oxygen saturation (SpO2) were measured during rest and cycling exercise. The RTM did not affect metabolic, ventilation, and SpO2 at rest compared to the control mask (all, effect of condition: P > 0.05). During exercise, the RTM blunted respiratory rate and minute ventilation (effect of condition: P < 0.05) compared to control. Similar increases in VO2 and VCO2 were observed in both conditions (both, effect of condition: P > 0.05). However, the RTM led to decreased fractional expired O2 and increased fractional expired CO2 (effect of condition: P < 0.05) compared to the control mask. In addition, the RTM decreased SpO2 and increased RPE (both, effect of condition: P < 0.05) during exercise. Despite limited influence on ventilation and metabolism at rest, the RTM reduces ventilation and disrupts gas concentrations during exercise leading to modest hypoxemia.

Rhythmic Skeletal Muscle Tension Increases Heart Rate Variability at 1 and 6 Contractions Per Minute

Breathing at the resonance frequency (~ 6 breaths per min) produces resonance effects on baroreflex gain, blood pressure, vascular tone, and therapeutic benefits. Evgeny Vaschillo and Paul Lehrer have emphasized that the stimulation frequency is critical for producing resonance effects in the cardiorespiratory system. Although clinicians overwhelmingly use paced breathing to increase HRV, other promising methods exist. Vaschillo, Lehrer, and colleagues have shown that presenting non-respiratory stimulation at 0.1 Hz-pictures with an emotional valence or rhythmical muscle tensing-amplifies oscillations in heart rate, blood pressure, and vascular tone. Participants in the present study included 49 undergraduate students randomly assigned to one of six different orders of 5-min trials of 1, 6, and 12 muscle contractions per min (cpm), separated by 3-min buffer periods intended to minimize carryover. This randomized controlled trial replicated the Vaschillo et al. (Psychophysiology 48:927-936, 2011. https://doi.org/10.1111/j.1469-8986.2010.01156.x ) finding that 6-cpm RSMT can produce a PkFreq of ~ 0.10 Hz, similar to 6-bpm RF breathing. RSMT at 1 and 6 cpm increased five time-domain metrics (HR Max-HR Min, RMSSD, SDNN, TI, and TINN), one frequency-domain metric (LF power), and three non-linear metrics (D2, SD1, SD2) significantly more than RSMT at 12 cpm. There were no differences between 1 and 6 cpm on these measures. The 1-cpm rate (~ 0.02 Hz) may have stimulated the hypothesized vascular tone baroreflex between 0.02 and 0.055 Hz. RSMT at 1 or 6 cpm provides clients with an alternative exercise for increasing HRV for patients who find slow-paced breathing challenging or medically unsafe.

My Life in HRV Biofeedback Research

This paper reviews the published work of me along with my students and close colleagues on the topic of heart rate variability biofeedback (HRVB). It includes early research by Vaschillo documenting resonance characteristics of the baroreflex system that causes large oscillations in heart rate when breathing at resonance frequency, research on heart rate variability as a marker of parasympathetic stress response in asthma, and HRVB as a treatment for asthma and depression. Many questions about HRVB remain unresolved, and important questions for future research are listed.

Influence of Spontaneous and Mechanical Ventilation on Frequency-Based Measures of Heart Rate Variability

Frequency-based measures of heart rate variability have been shown to be a useful physiological marker in both clinical and research settings providing insight into the functioning of the autonomic nervous system. Ongoing interactions between the autonomic nervous system control of the heart and lung occurs during each ventilation cycle because of their anatomical position within the closed thoracic cavity. Mechanical ventilation and subsequent removal change the normal ventilator mechanics producing alterations in the tidal volume, intrathoracic pressure, and oxygen delivery. A noninvasive method called heart rate variability (HRV) can be used to evaluate this interaction during ventilation and can be quantified by applying frequency-based measures of the variability between heartbeats. Although HRV is a reliable method to measure alteration of the autonomic nervous system (ANS) function and cardiopulmonary interaction, there have been limited reports concerning the changes in the frequency-based measure of HRV during both spontaneous and mechanical ventilation. The purpose of this methodological study is therefore to describe the physiological influence of both spontaneous and mechanical ventilation on frequency-based measures of HRV.

Respiratory-cardiovascular interactions

Much of biology is rhythmical and comprises oscillators that can couple. These have optimized energy efficiency and have been preserved during evolution. The respiratory and cardiovascular systems contain numerous oscillators, and importantly, they couple. This coupling is dynamic but essential for an efficient transmission of neural information critical for the precise linking of breathing and oxygen delivery while permitting adaptive responses to changes in state. The respiratory pattern generator and the neural network responsible for sympathetic and cardiovagal (parasympathetic) tone generation interact at many levels ensuring that cardiac output and regional blood flow match oxygen delivery to the lungs and tissues efficiently. The most classic manifestations of these interactions are respiratory sinus arrhythmia and the respiratory modulation of sympathetic nerve activity. These interactions derive from shared somatic and cardiopulmonary afferent inputs, reciprocal interactions between brainstem networks and inputs from supra-pontine regions. Disrupted respiratory-cardiovascular coupling can result in disease, where it may further the pathophysiological sequelae and be a harbinger of poor outcomes. This has been well documented by diminished respiratory sinus arrhythmia and altered respiratory sympathetic coupling in animal models and/or patients with myocardial infarction, heart failure, diabetes mellitus, and neurological disorders as stroke, brain trauma, Parkinson disease, or epilepsy. Future research needs to assess the therapeutic potential for ameliorating respiratory-cardiovascular coupling in disease.

Reverse re-modelling chronic heart failure by reinstating heart rate variability

Heart rate variability (HRV) is a crucial indicator of cardiovascular health. Low HRV is correlated with disease severity and mortality in heart failure. Heart rate increases and decreases with each breath in normal physiology termed respiratory sinus arrhythmia (RSA). RSA is highly evolutionarily conserved, most prominent in the young and athletic and is lost in cardiovascular disease. Despite this, current pacemakers either pace the heart in a metronomic fashion or sense activity in the sinus node. If RSA has been lost in cardiovascular disease current pacemakers cannot restore it. We hypothesized that restoration of RSA in heart failure would improve cardiac function. Restoration of RSA in heart failure was assessed in an ovine model of heart failure with reduced ejection fraction. Conscious 24 h recordings were made from three groups, RSA paced (n = 6), monotonically paced (n = 6) and heart failure time control (n = 5). Real-time blood pressure, cardiac output, heart rate and diaphragmatic EMG were recorded in all animals. Respiratory modulated pacing was generated by a proprietary device (Ceryx Medical) to pace the heart with real-time respiratory modulation. RSA pacing substantially increased cardiac output by 1.4 L/min (20%) compared to contemporary (monotonic) pacing. This increase in cardiac output led to a significant decrease in apnoeas associated with heart failure, reversed cardiomyocyte hypertrophy, and restored the T-tubule structure that is essential for force generation. Re-instating RSA in heart failure improves cardiac function through mechanisms of reverse re-modelling; the improvement observed is far greater than that seen with current contemporary therapies. These findings support the concept of re-instating RSA as a regime for patients who require a pacemaker.

Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study

Aim

It remains unclear how autonomic regulation modulates pathophysiological changes of sepsis. This study aims to analyze and clarify those in patients with suspected sepsis.

Methods

In this single‐centered, prospective, observational study, adult patients who had an infection, a quick Sequential Organ Failure Assessment score of 2 or more at the emergency department, and underwent intensive care were screened. Heart rate variability (HRV) and serum adrenaline were measured immediately after arrival. The primary outcome was defined as vasopressor dependence during 48 h after arrival.

Results

A total of 63 patients were included. All the patients had SOFA score of 2 or more on admission. Vasopressor dependence, renal replacement therapy, and in‐hospital mortality were associated with higher adrenaline (which reflects sympathetic adrenergic system activity). Bacteremia was associated with lower high‐frequency components of HRV (parasympathetic nerve activity). The HRV parameter of sympathetic nerve activity had no significant association with the outcomes. In the multivariate logistic regression model adjusted for age and sex, vasopressor dependence remained associated with higher adrenaline (cut‐off 0.11 ng/mL, odds ratio 9.71, 95% confidence interval 2.55–37; P = 0.000874), and lower high‐frequency components with bacteremia (17.2 ms², odds ratio 4.86, 95% confidence interval 1.36–17.4; P = 0.0152). There were no significant correlations between parameters of HRV and serum adrenaline.

Conclusion

Hypoperfusion, organ dysfunction, and in‐hospital mortality were associated with an increased sympathetic adrenergic activity. Bacteremia was associated with decreased parasympathetic nerve activity. The autonomic regulator may involve a multilayered and differentiated modulating process for sepsis.

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

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

Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease

Objectives

The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Background

Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom.

Methods

The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO₂), slope of minute ventilation to CO₂ production (VE/VCO₂ slope), and end tidal pressure of CO₂ (PetCO₂) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing.

Results

Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO₂ averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO₂). VE/VCO₂ slope was 30 ± 7. PetCO₂ at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO₂ <80% predicted. All patients with peak VO₂ <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO₂ had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO₂ (n = 17), and/or hypocapnia PetCO₂ <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS.

Conclusions

Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.

Ivabradine increases the high frequency gain ratio in the vagal heart rate transfer function via an interaction with muscarinic potassium channels

Muscarinic potassium channels (IK,ACh ) are thought to contribute to the high frequency (HF) dynamic heart rate (HR) response to vagal nerve stimulation (VNS) because they act faster than the pathway mediated by hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. However, the interactions between the two pathways have not yet been fully elucidated. We previously demonstrated that HCN channel blockade by ivabradine (IVA) increased the HF gain ratio of the transfer function from VNS to HR. To test the hypothesis that IVA increases the HF gain ratio via an interaction with IK,ACh , we examined the dynamic HR response to VNS under conditions of control (CNT), IK,ACh blockade by tertiapin-Q (TQ, 50 nM/kg), and TQ plus IVA (2 mg/kg) (TQ + IVA) in anesthetized rats (n = 8). In each condition, the right vagal nerve was stimulated for 10 min with binary white noise signals between 0-10, 0-20, and 0-40 Hz. On multiple regression analysis, the HF gain ratio positively correlated with the VNS rate with a coefficient of 1.691 ± 0.151 (×0.01) (p < 0.001). TQ had a negative effect on the HF gain ratio with a coefficient of -1.170 ± 0.214 (×0.01) (p < 0.001). IVA did not significantly increase the HF gain ratio in the presence of TQ. The HF gain ratio remained low under the TQ + IVA condition compared to controls. These results affirm that the IVA-induced increase in the HF gain ratio is dependent on the untethering of the hyperpolarizing effect of IK,ACh .

Assessment of autonomic function by long-term heart rate variability: beyond the classical framework of LF and HF measurements

In the assessment of autonomic function by heart rate variability (HRV), the framework that the power of high-frequency component or its surrogate indices reflects parasympathetic activity, while the power of low-frequency component or LF/HF reflects sympathetic activity has been used as the theoretical basis for the interpretation of HRV. Although this classical framework has contributed greatly to the widespread use of HRV for the assessment of autonomic function, it was obtained from studies of short-term HRV (typically 5‑10 min) under tightly controlled conditions. If it is applied to long-term HRV (typically 24 h) under free-running conditions in daily life, erroneous conclusions could be drawn. Also, long-term HRV could contain untapped useful information that is not revealed in the classical framework. In this review, we discuss the limitations of the classical framework and present studies that extracted autonomic function indicators and other useful biomedical information from long-term HRV using novel approaches beyond the classical framework. Those methods include non-Gaussianity index, HRV sleep index, heart rate turbulence, and the frequency and amplitude of cyclic variation of heart rate.

Novel 3D-printed Electrodes for Implantable Biopotential Monitoring

A major bottleneck in the manufacturing process of a medical implant capable of biopotential measurements is the design and assembly of a conductive electrode interface. This paper presents the use of a novel 3D-printing process to integrate conductive metal surfaces on a low-temperature co-fired ceramic base to be deployed as electrodes for electrocardiography (ECG) implants for small animals. In order to fit the ECG sensing system within the size of an injectable microchip implant, the electronics along with a pin-type lithium-ion battery are inserted into a cylindrical glass tube with both ends sealed by these 3D printed composite electrode discs using biomedical epoxy. In the scope of this paper, we present a proof-of-concept in vivo experiment for recording ECG from an avian animal model under local anesthesia to verify the electrode performance. Simultaneous recording with a commercial device validated the measurements, demonstrating promising accuracy in heart rate and breathing rate monitoring. This novel technology could open avenues for the mass manufacturing of miniaturized ECG implants.Clinical relevance- A novel manufacturing process and an implantable system are presented for continuous physiological monitoring of animals to be used by veterinarians, animal scientists, and biomedical researchers with potential future applications in human health monitoring.

A Method for More Accurate Determination of Resonance Frequency of the Cardiovascular System, and Evaluation of a Program to Perform It

This study validated a more exact automated method of determining cardiovascular resonance frequency (RF) against the "stepped" protocol described by Lehrer et al. (Appl Psychophysiol Biofeedback 25(3):177-191, https://doi.org/10.1023/a:1009554825745 , 2000; in Foundations of heart rate variability biofeedback: A book of readings, The Association for Applied Psychophysiology and Biofeedback, pp 9-19, 2016). Thirteen participants completed a 15-min RF determination session by each method. The "stepped" protocol assesses HRV in five 3-min stationary windows from 4.5 to 6.5 breaths per minute (bpm), decreasing in 0.5 bpm steps. Multiple criteria, subjectively weighted by the clinician, determines RF. For this study, the proposed method used a sliding window with a fixed rate of change (67.04 ms per breath) at each of 78 breath cycles ranging from 4.25 to 6.75 bpm. Its algorithm analyzes IBI to locate the midpoint of the 1-min region of stable maximum peak-trough variability. RF is quantified from breath duration at that point. The software generates a visual display of superimposed HR and breathing data. Thus, the new method fully automates RF determination. Eleven of the 13 matched pairs fell within the 0.5 bpm resolution of the stepped method. Comparisons of LF power generated by the autoregressive (AR) spectral method showed a strong correlation in LF power production by the stepped and sliding methods (R = 0.751, p = 0.000). The "sliding" pacing protocol was favored by 69% of participants (p < 0.02). The new, fully-automated, method may facilitate both in-person and remote HRV biofeedback training. Software is available open-source.

Measurement of respiratory rate using wearable devices and applications to COVID-19 detection

We show that heart rate enabled wearable devices can be used to measure respiratory rate. Respiration modulates the heart rate creating excess power in the heart rate variability at a frequency equal to the respiratory rate, a phenomenon known as respiratory sinus arrhythmia. We isolate this component from the power spectral density of the heart beat interval time series, and show that the respiratory rate thus estimated is in good agreement with a validation dataset acquired from sleep studies (root mean squared error = 0.648 min^-1, mean absolute error = 0.46 min^-1, mean absolute percentage error = 3%). We use this respiratory rate algorithm to illuminate two potential applications (a) understanding the distribution of nocturnal respiratory rate as a function of age and sex, and (b) examining changes in longitudinal nocturnal respiratory rate due to a respiratory infection such as COVID-19. 90% of respiratory rate values for healthy adults fall within the range 11.8-19.2 min^-1 with a mean value of 15.4 min^-1. Respiratory rate is shown to increase with nocturnal heart rate. It also varies with BMI, reaching a minimum at 25 kg/m², and increasing for lower and higher BMI. The respiratory rate decreases slightly with age and is higher in females compared to males for age <50 years, with no difference between females and males thereafter. The 90% range for the coefficient of variation in a 14 day period for females (males) varies from 2.3-9.2% (2.3-9.5%) for ages 20-24 yr, to 2.5-16.8% (2.7-21.7%) for ages 65-69 yr. We show that respiratory rate is often elevated in subjects diagnosed with COVID-19. In a 7 day window from D_-1 to D₊₅ (where D₀ is the date when symptoms first present, for symptomatic individuals, and the test date for asymptomatic cases), we find that 36.4% (23.7%) of symptomatic (asymptomatic) individuals had at least one measurement of respiratory rate 3 min^-1 higher than the regular rate.

Response of heart rate variability and cardiorespiratory phase synchronization to routine bronchodilator test in patients with asthma

Heart rate variability (HRV) and cardiorespiratory phase synchronization (CRPS) were employed to study the cardio- and respiratory interactions in patients with asthma receiving inhalation of beta2-agonist (Berotec 200 mcg) for routine bronchodilator test. Both time- and frequency-domain parameters were used to analyze the HRV. A weighted G-index was introduced to study the quality of the CRPS. The HRV parameters, in both the time and frequency domains, exhibited significant changes pointing to a sympathetic activation of the autonomic balance immediately after the inhalation. On the other hand, the CRPS index barely changed throughout the entire process. This indicates that inhalation of beta2-agonist does not alter the CRPS appreciably, and that the CRPS, in contrast to HRV, is relatively stable in response to the inhalation of beta2-agonist in patients with asthma.

Breath-by-breath analysis of respiratory sinus arrhythmia in dogs

Dogs differ greatly in size, heart (HR) and breathing rates (BR). In addition, they have a clear Respiratory Sinus Arrhythmia (RSA) at rest. Therefore, better than any other mammalian species, dogs offer an opportunity to test whether resting RSA varies with body weight, HR or BR. Sequences of inter-beat-intervals (IBI, ms) a few-minutes long were collected in twenty-three resting dogs of different sizes, together with pneumograms. IBI variability was quantified by standard time-domain criteria. From beat-to-beat instantaneous heart rate (hR, beats/min), RSA was the difference between inspiratory peak (hR-peak) and expiratory trough (hR-trough), in percent of mean HR. RSA averaged 40.1 % ±4.5, or more than three times that of humans, with large inter-animal variability. On average, RSA contributed 38 % of the total IBI variability. RSA did not differ between sexes and did not correlate with body weight. It had modest negative correlations with HR (P < 0.05) and BR (P < 0.05), and a very strong negative correlation with hR-trough (P < 0.001). In two separate dogs, during panting, RSA was absent. In the transition from resting to panting, RSA continued like at rest for several breaths, despite the tachypnea, underlying the importance of central mechanisms in the origin of RSA. In conclusion, RSA in dogs is very large and explains less than half of their sinus arrhythmia. Rather than HR, BR or hR-peak, changes in the vago-sympathetic control, represented by hR-trough, are the most likely source of variability of RSA among subjects.

Scaling of heart rate with breathing frequency and body mass in cetaceans

Plasticity in the cardiac function of a marine mammal facilitates rapid adjustments to the contrasting metabolic demands of breathing at the surface and diving during an extended apnea. By matching their heart rate (fH) to their immediate physiological needs, a marine mammal can improve its metabolic efficiency and maximize the proportion of time spent underwater. Respiratory sinus arrhythmia (RSA) is a known modulation of fH that is driven by respiration and has been suggested to increase cardiorespiratory efficiency. To investigate the presence of RSA in cetaceans and the relationship between fH, breathing rate (fR) and body mass (Mb), we measured simultaneous fH and fR in five cetacean species in human care. We found that a higher fR was associated with a higher mean instantaneous fH (ifH) and minimum ifH of the RSA. By contrast, fH scaled inversely with Mb such that larger animals had lower mean and minimum ifHs of the RSA. There was a significant allometric relationship between maximum ifH of the RSA and Mb, but not fR, which may indicate that this parameter is set by physical laws and not adjusted dynamically with physiological needs. RSA was significantly affected by fR and was greatly reduced with small increases in fR. Ultimately, these data show that surface fHs of cetaceans are complex and the fH patterns we observed are controlled by several factors. We suggest the importance of considering RSA when interpreting fH measurements and particularly how fR may drive fH changes that are important for efficient gas exchange. This article is part of the theme issue 'Measuring physiology in free-living animals (Part I)'.

Cardiovascular Physiotherapy on Respiratory Sinus Arrhythmia of Patients Undergoing Coronary Artery Bypass Grafting

Introduction: Patients in the postoperative period of coronary artery bypass grafting (CABG) present respiratory and autonomic dysfunctions. In this sense, cardiovascular physiotherapy has been offered as an indispensable differential for the improvement of the prognosis of this population. Heart rate variability is a simple, noninvasive method to analyze autonomic modulation, as well as the accentuation maneuver of respiratory sinus arrhythmia, which demonstrates the parasympathetic autonomic control over the heart. Five patients undergoing cardiac surgery performed a protocol of cardiovascular physiotherapy in the postoperative period and had their data referring to the preoperative period, the 1st and 4th postoperative days analyzed.

Model-Based Evaluation of Methods for Respiratory Sinus Arrhythmia Estimation

OBJECTIVE

Respiratory sinus arrhythmia (RSA) refers to heart rate oscillations synchronous with respiration, and it is one of the major representations of cardiorespiratory coupling. Its strength has been suggested as a biomarker to monitor different conditions, and diseases. Some approaches have been proposed to quantify the RSA, but it is unclear which one performs best in specific scenarios. The main objective of this study is to compare seven state-of-the-art methods for RSA quantification using data generated with a model proposed to simulate, and control the RSA. These methods are also compared, and evaluated on a real-life application, for their ability to capture changes in cardiorespiratory coupling during sleep.

METHODS

A simulation model is used to create a dataset of heart rate variability, and respiratory signals with controlled RSA, which is used to compare the RSA estimation approaches. To compare the methods objectively in real-life applications, regression models trained on the simulated data are used to map the estimates to the same measurement scale. Results, and conclusion: RSA estimates based on cross entropy, time-frequency coherence, and subspace projections showed the best performance on simulated data. In addition, these estimates captured the expected trends in the changes in cardiorespiratory coupling during sleep similarly.

SIGNIFICANCE

An objective comparison of methods for RSA quantification is presented to guide future analyses. Also, the proposed simulation model can be used to compare existing, and newly proposed RSA estimates. It is freely accessible online.

Heightened respiratory-parasympathetic coupling to airways in the spontaneously hypertensive rat

KEY POINTS

Carotid body (CB) chemoreceptors are hyperactive in hypertension, and their acute activation produces bronchoconstriction. We show that the respiratory-modulated bronchiolar tone, pulmonary parasympathetic efferent activity, and the firing frequency and synaptic excitation of bronchoconstrictor motoneurones in the nucleus ambiguus were all enhanced in spontaneous hypertensive (SH) rats. In SH rats, CB denervation reduced the respiratory-related parasympathetic-mediated bronchoconstrictor tone to levels seen in normotensive rats. Chemoreflex evoked bronchoconstrictor tone was heightened in SH versus normotensive rats. The intrinsic electrophysiological properties and morphology of bronchoconstrictor motoneurones were similar across rat strains. The heightened respiratory modulation of parasympathetic-mediated bronchoconstrictor tone to the airways in SH rats is caused by afferent drive from the CBs.

ABSTRACT

Much research has described heightened sympathetic activity in hypertension and diminished parasympathetic tone, especially to the heart. The carotid body (CB) chemoreceptors exhibit hyperreflexia and are hyperactive, providing excitatory drive to sympathetic networks in hypertension. Given that acute CB activation produces reflex evoked bronchoconstriction via activation of parasympathetic vagal efferents, we hypothesised that the parasympathetic bronchoconstrictor activity is enhanced in spontaneously hypertensive (SH) rats and that this is dependent on CB inputs. In situ preparations of Wistar and SH rats were used in which bronchiolar tone, the pulmonary branch of the vagus (pVN) and phrenic nerves were recorded simultaneously; whole cell patch clamp recordings of bronchoconstrictor vagal motoneurones were also made from the nucleus ambiguus. Bronchiolar tone, pVN and bronchoconstrictor motoneurones were respiratory modulated and this modulation was enhanced in SH rats. These differences were all eliminated after CB denervation. Stimulation of the CBs increased the phrenic frequency that caused a summation of the respiratory-related increases in pVN, resulting in the development of bronchoconstrictor tone. This tone was exaggerated in SH rats. The enhanced respiratory-parasympathetic coupling to airways in SH rats was not due to differences in the intrinsic electrophysiological properties of bronchoconstrictor motoneurones but reflected heightened pre-inspiratory- and inspiratory-related synaptic drive. In summary, in SH rats the phasic respiratory modulation of parasympathetic tone to the airways is elevated and the greater development of this bronchoconstrictor tone is caused by the heightened afferent drive originating from the CBs. Thus, targeting the CBs may prove effective for increasing lower airway patency.

Can HRV Biofeedback Improve Short-Term Effort Recovery? Implications for Intermittent Load Sports

As intensity and physical demands continue to rise in sport competition, faster and better recovery becomes essential. The aim of this study was to assess the effects of HRV biofeedback (HRVB) while recovering from a submaximal aerobic exercise. Ten physically-active graduate students participated in the study, which was conducted in four sessions: exercise with free-breathing recovery, first resonance frequency (RF) detection, second RF detection, and exercise applying HRVB during recovery. Measurements included time spent running and recovering, HRV parameters, and recovery/exertion perceptions. The results indicate that using HRVB during recovery improves cardiac variability (RRmean, SDNN, RMSSD and LF; p < 0.01). HRVB also lowers recovery time (p < 0.05) and seems to be improving the perception of recovery (p = 0.087). Moreover, time spent exercising (p < 0.01) and perceived physical exertion (p < 0.05) were higher when applying HRVB. The improvement in the psychophysiological adaptation after intensive aerobic exercise provided by the HRVB is a valuable benefit, not only for competition-driven athletes, but also for the general population.