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Mirzohreh ST, Panahi P, Heidari F. Exploring heart rate variability in polycystic ovary syndrome: implications for cardiovascular health: a systematic review and meta-analysis. Syst Rev 2024; 13:194. [PMID: 39049099 PMCID: PMC11271026 DOI: 10.1186/s13643-024-02617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. It has significant implications for female endocrine function, reproductive health, and metabolic disturbances, including insulin resistance, impaired glucose tolerance, and dyslipidemia. Studies have shown that decreased heart rate variability (HRV), a marker of autonomic dysfunction, is associated with adverse cardiovascular events. Recent research has focused on investigating autonomic function in PCOS, and some studies have suggested altered autonomic drive in these patients. The aim of this systematic review and meta-analysis was to evaluate cardiac autonomic function by analyzing HRV in women with PCOS. METHODS This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI). RESULTS Seventeen articles were included in the final analysis, varied in quality, ranging from a "low" to a "high risk of bias". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases. CONCLUSION The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group.
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Affiliation(s)
| | - Padideh Panahi
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Heidari
- Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Yu Y, Chen T, Zheng Z, Jia F, Liao Y, Ren Y, Liu X, Liu Y. The role of the autonomic nervous system in polycystic ovary syndrome. Front Endocrinol (Lausanne) 2024; 14:1295061. [PMID: 38313837 PMCID: PMC10834786 DOI: 10.3389/fendo.2023.1295061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
This article reviewed the relationship between the autonomic nervous system and the development of polycystic ovary syndrome (PCOS). PCOS is the most common reproductive endocrine disorder among women of reproductive age. Its primary characteristics include persistent anovulation, hyperandrogenism, and polycystic ovarian morphology, often accompanied by disturbances in glucose and lipid metabolism. The body's functions are regulated by the autonomic nervous system, which consists mainly of the sympathetic and parasympathetic nervous systems. The autonomic nervous system helps maintain homeostasis in the body. Research indicates that ovarian function in mammals is under autonomic neural control. The ovaries receive central nervous system information through the ovarian plexus nerves and the superior ovarian nerves. Neurotransmitters mediate neural function, with acetylcholine and norepinephrine being the predominant autonomic neurotransmitters. They influence the secretion of ovarian steroids and follicular development. In animal experiments, estrogen, androgens, and stress-induced rat models have been used to explore the relationship between PCOS and the autonomic nervous system. Results have shown that the activation of the autonomic nervous system contributes to the development of PCOS in rat. In clinical practice, assessments of autonomic nervous system function in PCOS patients have been gradually employed. These assessments include heart rate variability testing, measurement of muscle sympathetic nerve activity, skin sympathetic response testing, and post-exercise heart rate recovery evaluation. PCOS patients exhibit autonomic nervous system dysfunction, characterized by increased sympathetic nervous system activity and decreased vagal nerve activity. Abnormal metabolic indicators in PCOS women can also impact autonomic nervous system activity. Clinical studies have shown that various effective methods for managing PCOS regulate patients' autonomic nervous system activity during the treatment process. This suggests that improving autonomic nervous system activity may be an effective approach in treating PCOS.
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Affiliation(s)
- Yue Yu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Chen
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zheng Zheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fan Jia
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Yan Liao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuehan Ren
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinmin Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Shrivastava R, Pathak T, Shrivastava P, Patel S, Chouhan S, Singh R, Parashar R, Mishra S. Assessment of Cardiac Autonomic Function in Women With Polycystic Ovary Syndrome Through Ewing's Battery, Heart Rate Variability Analysis, and Composite Autonomic Symptom Score-31 Scale. Cureus 2023; 15:e45580. [PMID: 37868510 PMCID: PMC10587444 DOI: 10.7759/cureus.45580] [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] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Polycystic ovary syndrome (PCOS) is a frequently occurring endocrine condition prevalent in women of reproductive age characterized by chronic anovulation, hyperandrogenism, insulin resistance, and a low-grade inflammatory state. Patients with PCOS are more vulnerable to developing cardiac and metabolic co-morbidities. Sympathetic overactivity is also reported in PCOS patients. Objective This study aimed to assess cardiac autonomic function in PCOS by Heart Rate Variability Analysis, Ewing's Test, and Composite Autonomic Symptom Scale-31 (COMPASS-31). Methods Thirty female PCOS patients and 30 age-matched control females were enrolled in the study. Both cases and controls were subdivided into sub-groups based on body mass index (BMI) and waist-to-hip ratio (WHR). The cardiac autonomic functions were assessed by the COMPASS-31 questionnaire, Ewing's battery tests, and short-term heart rate variability analysis. Results There was no significant difference in age, BMI, and WHR of both groups. Additionally, cases had a significantly higher low frequency to high frequency (LF/HF) ratio and COMPASS-31 score and also reported more derangement in Ewing's battery test, indicating cardiac autonomic dysfunction in PCOS patients. Conclusion Patients with PCOS are more prone to developing cardiac and metabolic co-morbidities. Early assessment of cardiac autonomic function can prevent future complications with timely interventions. Altered autonomic function in PCOS patients can be due to hyperandrogenism and insulin resistance.
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Affiliation(s)
| | - Tanusha Pathak
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Shweta Patel
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, IND
| | - Sunil Chouhan
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Ruchi Singh
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rachna Parashar
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Shweta Mishra
- Yoga and Naturopathy, All India Institute of Medical Sciences, Bhopal, IND
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Ponzo S, Wickham A, Bamford R, Radovic T, Zhaunova L, Peven K, Klepchukova A, Payne JL. Menstrual cycle-associated symptoms and workplace productivity in US employees: A cross-sectional survey of users of the Flo mobile phone app. Digit Health 2022; 8:20552076221145852. [PMID: 36544535 PMCID: PMC9761221 DOI: 10.1177/20552076221145852] [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: 08/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Mood and physical symptoms related to the menstrual cycle affect women's productivity at work, often leading to absenteeism. However, employer-led initiatives to tackle these issues are lacking. Digital health interventions focused on women's health (such as the Flo app) could help fill this gap. Methods 1867 users of the Flo app participated in a survey exploring the impact of their menstrual cycle on their workplace productivity and the role of Flo in mitigating some of the identified issues. Results The majority reported a moderate to severe impact of their cycle on workplace productivity, with 45.2% reporting absenteeism (5.8 days on average in the previous 12 months). 48.4% reported not receiving any support from their manager and 94.6% said they were not provided with any specific benefit for issues related to their menstrual cycle, with 75.6% declaring wanting them. Users stated that the Flo app helped them with the management of menstrual cycle symptoms (68.7%), preparedness and bodily awareness (88.7%), openness with others (52.5%), and feeling supported (77.6%). Users who reported the most positive impact of the Flo app were 18-25% less likely to report an impact of their menstrual cycle on their productivity and 12-18% less likely to take days off work for issues related to their cycle. Conclusions Apps such as Flo could equip individuals with tools to better cope with issues related to their menstrual cycle and facilitate discussions around menstrual health in the workplace.
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Affiliation(s)
- Sonia Ponzo
- Flo Health
Inc., London, UK
- Institute of Health Informatics, University College London, London,
UK
| | | | | | - Tara Radovic
- Flo Health
Inc., London, UK
- Department of Psychology and Ergonomics,
Technische
Universitaet Berlin, Berlin, Germany
| | | | - Kimberly Peven
- Flo Health
Inc., London, UK
- London School of Hygiene & Tropical Medicine, Maternal,
Adolescent, Reproductive & Child Health (MARCH) Centre, London, UK
| | | | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences,
University of
Virginia, Charlottesville, VA, USA
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Philbois SV, Gastaldi AC, Facioli TDP, Felix ACS, Reis RMD, Fares TH, Souza HCDD. Women with Polycystic Ovarian Syndrome Exhibit Reduced Baroreflex Sensitivity That May Be Associated with Increased Body Fat. Arq Bras Cardiol 2019; 112:424-429. [PMID: 30843930 PMCID: PMC6459434 DOI: 10.5935/abc.20190031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background Polycystic ovarian syndrome (PCOS) women have a high prevalence of obesity
and alterations in cardiovascular autonomic control, mainly modifications in
heart rate variability (HRV) autonomic modulation. However, there are few
studies about other autonomic control parameters, such as blood pressure
variability (BPV) and baroreflex sensitivity (BRS). In addition, there are
still doubts about the obesity real contribution in altering autonomic
control in these women. Objective To investigate BPV and BRS autonomic modulation alterations in PCOS women, as
well as, to evaluate whether these alterations are due PCOS or increased
body fat. Methods We studied 30 eutrophic volunteers [body mass index (BMI) < 25
kg/m2] without PCOS (control group) and 60 volunteers with
PCOS divided into: eutrophic (BMI < 25 kg/m2, N = 30) and
obese women (BMI > 30 kg/m2, N = 30). All volunteers were
submitted to anthropometric evaluation, hemodynamic and cardiorespiratory
parameters record at rest and during physical exercise, analysis of HRV, BPV
and spontaneous BRS. The differences in p less than 5% (p < 0.05) were
considered statistically significant. Results Related to eutrophics groups, there were no differences in autonomic
parameters evaluated. The comparison between the PCOS groups showed that
both PCOS groups did not differ in the BPV analysis. Although, the obese
PCOS group presented lower values of spontaneous BRS and HRV, in low
frequency and high frequency oscillations in absolute units. Conclusion Our results suggest that obesity did little to alter HRV in women with PCOS,
but it may influence the spontaneous BRS.
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Ji HR, Woo HL, Park YJ, Hwang DS, Lee JM, Lee CH, Jang JB, Park KS. Characteristics of heart rate variability in women with polycystic ovary syndrome: A retrospective cross-sectional study. Medicine (Baltimore) 2018; 97:e12510. [PMID: 30235765 PMCID: PMC6160158 DOI: 10.1097/md.0000000000012510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We aimed to compare the modulation of the autonomic nervous system (ANS) in women with polycystic ovary syndrome (PCOS) with that in healthy ovulatory women on the basis of heart rate variability (HRV), and to analyze the characteristics of the ANS in PCOS.In a retrospective chart review, HRV, body mass index, and physical examination data in women with PCOS and those with regular menstrual cycles were collected. Approval from the institutional review board (IRB) was obtained (IRB No. 2017-05-007-001) for this study. The mean outcomes were the values of HRV in the time [standard deviation of all normal R-R intervals (SDNN), the square root of the sum of the squares of the differences between the adjacent normal R-R intervals (rMSSD), and the mean heart rate turbulence (mean HRT)] and frequency [total power (TP), very-low-frequency power (VLF), low-frequency power (LF), normalized low-frequency power (LF norm), high-frequency power (HF), normalized high-frequency power (HF norm), and LF/HF ratio] domains. Differences between the 2 groups were analyzed by Mann-Whitney U test, using SPSS for Windows (version 22.0).There was no significant difference in the values of the time domain (SDNN, rMSSD, and mean HRT) between the groups. In the frequency domain, women with PCOS showed significantly higher LF (598.63 ± 94.38 vs 459.13 ± 163.64, P = .028), LF norm (48.64 ± 3.39 vs 36.49 ± 2.82, P = .009), and LF/HF ratio (1.49 ± 0.31 vs 0.73 ± 0.13, P = .009) than the control group. HF norm was significantly lower in the women with PCOS than in the controls (51.38 ± 3.39 vs 63.51 ± 2.82, P = .009). The TP, VLF, and HF showed no significant difference between the groups.The results of the present study indicated that PCOS is related to increased sympathetic modulation in HRV.
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Affiliation(s)
- Hae Ri Ji
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Hye Lin Woo
- Department of Korean Medicine Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Young Jae Park
- Department of Diagnosis and Biofunctional Medicine, College of Korean Medicine
| | | | - Jin Moo Lee
- Department of Korean Medicine Obstetrics and Gynecology
| | | | - Jun Bock Jang
- Department of Korean Medicine Obstetrics and Gynecology
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Gui J, Wang RH. Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biomed Online 2017; 35:113-120. [PMID: 28483340 DOI: 10.1016/j.rbmo.2017.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 02/07/2023]
Abstract
Recent studies reveal that polycystic ovary syndrome (PCOS) might be associated with cardiovascular autonomic dysfunction, but with inconsistent results. The aim of this meta-analysis was to study whether women with PCOS have cardiovascular autonomic dysfunction. PubMed, Web of Science, Cochrane Library and SCOPUS were searched for studies comparing cardiovascular function between women with PCOS and controls. A random-effects model was used to evaluate cardiac autonomic modulation and muscle sympathetic nerve activity (MSNA) between women with PCOS and controls. Eight studies were included, including 243 PCOS and 211 controls. Overall, women with PCOS had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and percentage of the number of interval differences of successive normal-to-normal RR intervals greater than 50 ms among the total number of RR intervals (pNN50), higher MSNA frequency and higher MSNA incidence than controls. Therefore, this meta-analysis provides evidence that women with PCOS might show cardiovascular autonomic dysfunction, with reduced total and parasympathetic cardiac modulation, and increased sympathetic activity.
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Affiliation(s)
- Juan Gui
- Department of Obstetrics, Gynecology, Renmin Hospital of Wuhan University, Wuhan, China; Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China.
| | - Rui-Hao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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Abstract
Objective: Polycystic ovary syndrome (PCOS) is an endocrine disease closely related to several risk factors of cardiovascular disease. Obese women with PCOS show altered autonomic modulation. The results of studies investigating cardiac autonomic functions of normal-weight women with PCOS are conflicting. The aim of the study was to assess the reactivity of cardiac sympathovagal balance in normal-weight women with PCOS by heart rate variability analysis. Methods: We examined the heart rate variability in 60 normal-weight women with PCOS and compared them with that in 60 age-matched healthy women having a similar metabolic profile. Time and frequency domain parameters of heart rate variability were analyzed based on 5-min-long continuous electrocardiography recordings for the following 3 periods: (1) during rest in supine position, (2) during controlled breathing, and (3) during isometric handgrip exercise. Results: Time and frequency domain parameters of heart rate variability for the 3 periods assessed were similar in the two groups. Although modified Ferriman–Gallwey score and serum testosterone and luteinizing hormone levels were significantly higher in women with PCOS, homeostatic model assessment-insulin resistance (HOMA-IR) was not different the between the PCOS and control groups. There were no significant correlations between serum testosterone levels and heart rate variability parameters among the study population. Conclusion: The findings of this study suggest that the reactivity of cardiac sympathovagal balance is not altered in normal-weight women with PCOS having a normal HOMA-IR.
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Dag ZO, Alpua M, Turkel Y, Isik Y. Autonomic dysfunction in patients with polycystic ovary syndrome. Taiwan J Obstet Gynecol 2016; 54:381-4. [PMID: 26384054 DOI: 10.1016/j.tjog.2015.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To assess the autonomic system in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS Thirty-seven adult patients with PCOS and 33 healthy controls were enrolled in the study. The electrophysiological assessments of the autonomic nervous system function were performed using sympathetic skin response and R-R interval variation tests. RESULTS The mean latency of sympathetic skin response in PCOS patients was significantly delayed compared with the controls (p = 0.001). The mean amplitude of sympathetic skin response was significantly lower in comparison with the controls (p = 0.01). Mean R-R interval variation during deep breathing was also significantly delayed (p = 0.04). CONCLUSION There are parasympathetic dysfunction and sympathetic dysfunction in patients with PCOS. This may be easily demonstrated with sympathetic skin response and R-R interval variation tests.
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Affiliation(s)
- Zeynep Ozcan Dag
- Kirikkale University, Faculty of Medicine, Department of Obstetrics and Gynecology, Kirikkale, Turkey.
| | - Murat Alpua
- Kirikkale University, Faculty of Medicine, Department of Neurology, Kirikkale, Turkey
| | - Yakup Turkel
- Kirikkale University, Faculty of Medicine, Department of Neurology, Kirikkale, Turkey
| | - Yuksel Isik
- Kirikkale University, Faculty of Medicine, Department of Obstetrics and Gynecology, Kirikkale, Turkey
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Sá JC, Costa EC, da Silva E, Tamburús NY, Porta A, Medeiros LF, Lemos TM, Soares EM, Azevedo GD. Aerobic exercise improves cardiac autonomic modulation in women with polycystic ovary syndrome. Int J Cardiol 2016; 202:356-61. [DOI: 10.1016/j.ijcard.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/09/2015] [Accepted: 09/19/2015] [Indexed: 02/01/2023]
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Özkeçeci G, Ünlü BS, Dursun H, Akçi Ö, Köken G, Onrat E, Avşar A. Heart rate variability and heart rate turbulence in patients with polycystic ovary syndrome. Anatol J Cardiol 2015; 16:323-7. [PMID: 26488379 PMCID: PMC5336779 DOI: 10.5152/anatoljcardiol.2015.6307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Cardiac autonomic dysfunction may develop in patients with polycystic ovary syndrome (PCOS). Heart rate variability (HRV) and heart rate turbulence (HRT) are used in assessing cardiac autonomic functions. The goal of this study was to compare the cardiac autonomic functions in patients with PCOS and healthy controls. To our knowledge, this is the first study evaluating cardiac autonomic functions in patients with PCOS with respect to both HRV and HRT. METHODS Twenty-three patients with PCOS (mean age 22.8±3.9 years) and 25 healthy female volunteers who were matched for age and body mass index (BMI) (mean age 23.5±6.2 years) were enrolled in this as case-control study. Twenty-four hour ambulatory electrocardiogram recordings of all participants were taken using Pathfinder software. The time domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope, were calculated. Diagnosis of PCOS was made with physical and laboratory findings of hirsutism or biochemical hyperandrogenism and chronic anovulation. Diabetes mellitus, other hormon disorders or hormon therapy, pregnancy, atrial fibrilation, obesite, chronic diseases, disorders of the autonomic nervous system, a history of drug use affecting the autonomic nervous system were excluded. RESULTS There were no significant differences in HRV and HRT parameters between the two groups. Cardiovascular risk factors, such as BMI, blood pressure, fasting blood glucose, and lipid parameters, were also similar. Triangular index measure of HRV was negatively correlated with high density lipoprotein cholesterol levels (r=-0.47, p<0.05), while age and BMI were significantly correlated with TO (r=0.31 and 0.47, respectively; p<0.05 for all). CONCLUSION Cardiac autonomic functions were not found to be altered in patients with PCOS in comparison with healthy controls. These results may be explained with the absence of concomitant cardiovascular risk factors with the patients being in the early stage of the disease.
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Affiliation(s)
- Gülay Özkeçeci
- Department of Cardiology, Faculty of Medicine, Afyon University; Afyonkarahisar-Turkey.
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Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, Diamanti-Kandarakis E. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 2015; 18:57-66. [PMID: 25287137 DOI: 10.3109/10253890.2014.974030] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with a significant psychological burden throughout the life course of affected women. Thus, use of mindful awareness may be beneficial as an adjunct to conventional medical management of women with PCOS. A randomized, controlled trial was conducted at the Evgenideion Hospital of the Athens University Medical School to explore the impact of an 8-week mindfulness stress management program on measures of depression, anxiety and stress as well as on the quality of life in reproductive age women with PCOS. The study was approved by the Research Ethics Committee. Twenty-three and 15 women with PCOS were randomly allocated to the intervention or control group, respectively. All participants were administered DASS21, PSS-14, PCOSQ, Daily Life and General Life Satisfaction Questionnaires and provided three-timed daily samples of salivary cortisol, before and after the intervention. Intervention group participants were provided with the Credibility/Expectancy Questionnaire at the day of enrolment, to check for possible placebo effect on the outcome. Post-intervention, between-group results revealed statistically significant reductions in stress, depressive and anxiety symptoms, as well as in salivary cortisol concentrations, along with an increase in Life Satisfaction and Quality of Life scores in the intervention group only. There was no significant "placebo" effect on the outcome measures. Mindfulness techniques seem promising in ameliorating stress, anxiety, depression and the quality of life in women with PCOS and could be used as an adjunct method to the conventional management of these women.
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Affiliation(s)
- Charikleia Stefanaki
- Division of Endocrinology, Metabolism and Diabetes, Evgenideion Hospital, Athens University Medical School , Athens , Greece
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Kuppusamy S, Pal GK, Habeebullah S, Ananthanarayanan PH, Pal P. Association of sympathovagal imbalance with cardiovascular risks in patients with polycystic ovary syndrome. Endocr Res 2015; 40:37-43. [PMID: 24866562 DOI: 10.3109/07435800.2014.920350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Polycystic ovary syndrome (PCOS) is associated with cardiovascular risks like obesity, insulin resistance, dyslipidemia that can lead to sympathovagal imbalance (SVI). The study was designed to assess the cardiovascular risk in PCOS and link of metabolic derangements to SVI. Thirty-five newly diagnosed PCOS patients and 32 age-matched controls were recruited. Waist-hip ratio, body mass index (BMI), basal cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product (RPP) were recorded. Autonomic functions were assessed using short-term heart rate variability (HRV) analysis, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBPihg). Fasting plasma glucose, insulin, lipid profile and testosterone were assayed. Insulin resistance (HOMA-IR) and lipid risk factors were calculated. The cases had increased BHR, BMI, SBP, DBP, MAP and RPP. The ratio of low-frequency to high-frequency (LF-HF) of HRV, the marker of SVI was significantly increased in cases. 30:15 ratio and ΔDBPihg were increased and E:I ratio was decreased in the cases. HOMA-IR, lipid risk factors and testosterone were significantly elevated in cases. There was a significant correlation of LF-HF with BMI, BHR, RPP, insulin resistance and lipid risk factors. On regression analysis, insulin resistance and lipid risk factors had independent association with LF-HF. PCOS patients have SVI, decreased HRV and increased RPP and the potential cardiovascular risks. The insulin resistance and dyslipidemia contribute to SVI and cardiovascular risks in PCOS patients.
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Cho YH, Craig ME, Srinivasan S, Benitez-Aguirre P, Mitchell P, Jopling T, Donaghue KC. Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycaemic control, insulin resistance and hyperandrogenism. Clin Endocrinol (Oxf) 2014; 80:818-24. [PMID: 23650970 DOI: 10.1111/cen.12238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/01/2013] [Accepted: 05/03/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between glycaemic control, insulin resistance and hyperandrogenism on cardiac autonomic function in peripubertal girls with type 1 diabetes. DESIGN Prospective, clinic-based study of 125 girls with diabetes and 46 age-matched nondiabetic girls. MEASUREMENTS Heart rate variability (HRV) parameters derived from a 10-min ECG recording using LabChart Pro were as follows: standard deviation of mean NN intervals (SDNN), where NN = adjacent QRS complexes; root mean squared difference of successive NN intervals (RMSSD) - estimates of overall HRV; and low-/high-frequency (LF:HF) ratio - an estimate of the sympathovagal balance. Androgens and sex hormone binding globulin (SHBG) were measured in girls with diabetes, and free androgen index (FAI) calculated. HRV and anthropometry were measured in nondiabetic controls. RESULTS Adolescents with diabetes (median age 15·1 years [13·3-16·0], diabetes duration 7·0 years [4·6-10·0] and median HbA1c 8·4% [7·5-9·3]) had higher HR and lower HRV compared with controls. Using multivariate models in the diabetes group, higher HR was associated with higher HbA1c, total daily dose insulin/kg body weight and systolic BP standard deviation scores (SDS), whilst reduced HRV was associated with higher HbA1c (SDNN, RMSSD and LF:HF ratio), lower SHBG (SDNN and RMSSD) and higher weight SDS (LF:HF ratio). Higher FAI was associated with higher HR and reduced HRV measures in the univariate analyses only. CONCLUSIONS In adolescent girls with diabetes, reduced HRV parameters are associated with worse glycaemic control, lower SHBG and higher weight SDS. SHBG should be considered in the cardiac risk models for this population.
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Affiliation(s)
- Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health & Department of Ophthalmology, University of Sydney, Sydney, NSW, Australia
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Saranya K, Pal GK, Habeebullah S, Pal P. Assessment of cardiovascular autonomic function in patients with polycystic ovary syndrome. J Obstet Gynaecol Res 2013; 40:192-9. [PMID: 24102794 DOI: 10.1111/jog.12154] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/16/2013] [Indexed: 01/25/2023]
Abstract
AIM The study was conducted to assess the sympathovagal balance in patients with polycystic ovary syndrome (PCOS) using short-term heart rate variability (HRV) analysis and conventional autonomic function tests (CAFT). METHODS Thirty-one newly diagnosed patients with PCOS and 30 age-matched controls were recruited. Body mass index (BMI), waist : hip ratio (WHR), cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate-pressure product (RPP), and fasting blood glucose (FBG) were measured in both groups. Cardiovascular autonomic functions assessed were spectral analysis of HRV, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBP(ihg)). RESULTS The cases had significantly increased BMI, WHR, BHR, SBP, DBP and RPP. Ratio of low-frequency to high-frequency power of HRV (LF-HF ratio), the marker of sympathovagal balance was significantly increased in cases compared to controls. Time-domain indices of HRV and E:I ratio were decreased, and 30:15 ratio, ΔDBP(ihg) and FBG were increased in cases. Though there was a significant correlation of LF-HF ratio with BMI, WHR, BHR, RPP and FBG, only BHR and RPP had independent contribution to LF-HF ratio. CONCLUSION We conclude that PCOS patients have altered autonomic modulation in the form of increased sympathetic and decreased parasympathetic reactivity and HRV. The sympathovagal imbalance exposes them to cardiovascular morbidities.
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Affiliation(s)
- Kuppusamy Saranya
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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16
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Di Domenico K, Wiltgen D, Nickel FJ, Magalhães JA, Moraes RS, Spritzer PM. Cardiac autonomic modulation in polycystic ovary syndrome: does the phenotype matter? Fertil Steril 2012; 99:286-292. [PMID: 23025880 DOI: 10.1016/j.fertnstert.2012.08.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/19/2012] [Accepted: 08/22/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether heart rate variability (HRV) at rest and during sympathetic stimulation is disturbed in patients with different polycystic ovary syndrome (PCOS) phenotypes in comparison to healthy controls. DESIGN Cross-sectional study. SETTING University hospital. PATIENT(S) Thirty women with classic, anovulatory PCOS, 16 women with ovulatory PCOS, and 23 age-paired women with regular and proven ovulatory cycles. INTERVENTION(S) Anthropometric and hormonal evaluation and analysis of HRV (time and frequency domain HRV indices) at rest and after a mental stress test. MAIN OUTCOME MEASURE(S) Difference between HRV components during rest and stress. RESULT(S) Mean age was 22.80 ± 5.80 years in patients with classic PCOS, 19.81 ± 6.43 years in ovulatory PCOS, and 22.65 ± 5.89 years in controls. During mental stress, patients with classic PCOS showed lower HRV response when compared with the control group, even after adjustment for body mass index (BMI) and age. When patients with classic and ovulatory PCOS were considered together, total T levels were inversely associated with the low frequency component, low frequency/high frequency ratio, and the difference between high frequency response at rest and after the stress test. CONCLUSION(S) Young patients with the classic PCOS phenotype have an impaired autonomic modulation in response to sympathetic stimulation that is typical of considerably older women, or of advanced age.
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Affiliation(s)
- Kristhiane Di Domenico
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denusa Wiltgen
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fabian J Nickel
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jose Antonio Magalhães
- Division of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ruy Silveira Moraes
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Laboratory of Molecular Endocrinology, Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; National Institute of Hormones and Women's Health, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, Brazil.
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Kamata N, Tanaka K, Morita S, Tagaya H, Kawashima M, Shichiri M, Miyaoka H. Relationship between autonomic nervous system activity during sleep and fasting glucose in Japanese workers. INDUSTRIAL HEALTH 2011; 49:427-433. [PMID: 21697626 DOI: 10.2486/indhealth.ms1257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although autonomic nervous system activity is reportedly related to diurnal glucose tolerance impairment, the relationship with glucose tolerance during sleep is unclear. Since work styles have recently diversified, it is important to assess the effect of sleep on workers' health. Elucidation of the relationship between autonomic nervous system activity during sleep and glucose tolerance in workers may facilitate preventive measures against diabetes using non-pharmacological means (e.g., sleep hygiene education, relaxation techniques and stress management). We examined whether autonomic nervous system activity during sleep is related to fasting glucose or glycated hemoglobin (HbA1c) in individuals with either normal or impaired fasting glucose tolerance. The subjects were 77 apparently healthy Japanese workers with normal or impaired fasting glucose. We used high frequency (HF) and the ratio of low frequency to high frequency (LF/HF) obtained by pulse wave analysis to estimate autonomic nervous system activity. The data were analyzed using a generalized estimating equation adjusted for potential confounders (age, gender, engagement in shift work, sleep duration, and body mass index). Fasting glucose was significantly negatively related to HF, the parasympathetic component during sleep. Our results suggest that parasympathetic activity during sleep is associated with fasting glucose in apparently healthy Japanese workers.
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Affiliation(s)
- Naoki Kamata
- Department of Psychiatry, Graduate School of Medical Sciences, Kitasato University, 1–15–1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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