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Vulić M, Milovanovic B, Obad A, Glavaš D, Glavicic I, Zubac D, Valic M, Valic Z. Depth of SCUBA Diving Affects Cardiac Autonomic Nervous System. PATHOPHYSIOLOGY 2024; 31:183-189. [PMID: 38651402 PMCID: PMC11036274 DOI: 10.3390/pathophysiology31020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024] Open
Abstract
The present study investigated the influence of SCUBA dives with compressed air at depths of 10 and 20 m on ECG-derived HRV parameters in apparently healthy individuals. We hypothesized that cardiac sympathetic activity (measured by HRV parameters) adapts proportionally to diving depth, and that both time- and frequency-domain parameters are sensitive enough to track changes in cardiac ANS function during diving activities and subsequently during the recovery period. Eleven healthy middle-aged recreational divers (nine men and two women, age 43 ± 8, all nonsmokers) volunteered to participate in the present study. The participants (all open-circuit divers) were equipped with dry suits and ECG Holter devices and were later randomly assigned to dive pairs and depths (10 m vs. 20 m), and each participant served as his or her own control. No interaction effects (diving depth x time epoch) were found for the most commonly used HRV markers. More precisely, in response to two different diving protocols, a significant post hoc effect of time was observed for HR and SDNN, as these parameters transiently decreased during the dives and returned to baseline after ascent (p < 0.001). The ULF, VLF (p < 0.003), TP, and LF parameters decreased significantly during the dives, while HF significantly increased (p < 0.003). SCUBA diving apparently challenges the cardiac ANS, even in healthy individuals. The observed changes reveal possible underwater methods of influencing the parasympathetic activity of the heart depending on the depth of the dive. These results identify autonomic nervous system markers to track the cardiovascular risk related to diving and point to the possibility of tracking cardiovascular system benefits during underwater activities in selected patients.
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Affiliation(s)
- Marina Vulić
- Health Centre Vračar, Department for Internal Medicine, St. Bojanska 16, 11000 Belgrade, Serbia
| | - Branislav Milovanovic
- Neurocardiology Laboratory, Institute for Cardiovascular Diseases “Dedinje”, 111040 Belgrade, Serbia;
| | - Ante Obad
- University Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Duška Glavaš
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Igor Glavicic
- University Department of Marine Studies, University of Split, 21000 Split, Croatia;
| | - Damir Zubac
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Dusseldorf, University Hospital of Cologne, 50937 Cologne, Germany;
- Science and Research Center Koper, Institute for Kinesiology Research, 6000 Koper, Slovenia
| | - Maja Valic
- Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Zoran Valic
- Department of Integrative Physiology, School of Medicine, University of Split, 21000 Split, Croatia;
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Schmidt T, Reiss N, Olbrich E, Chalabi K, Hagedorn T, Tetzlaff K. Scuba diving after a heart transplant: excessive daring or calculable risk? Am J Physiol Heart Circ Physiol 2023; 325:H569-H577. [PMID: 37477692 DOI: 10.1152/ajpheart.00332.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Over the past 50 years, outcomes after heart transplantation (HTX) have continuously and significantly improved. In the meantime, many heart transplant recipients live almost normal lives with only a few limitations. In some cases, even activities that actually seemed unreasonable for these patients turn out to be feasible. This article describes the encouraging example of a patient returning to recreational scuba diving after HTX. So far, there were no scientific experiences documented in this area. We worked out the special hemodynamic features and the corresponding risks of this sport for heart transplant recipients in an interdisciplinary manner and evaluated them using the patient as an example. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities, including scuba diving, are possible again after HTX. They illustrate again the significant development and the enormous potential of this therapy option, which is unfortunately only available to a limited extent.NEW & NOTEWORTHY Example for shared decision-making process for tricky questions: First scientific publication about heart transplantation (HTX)-recipient restarting scuba diving. As exercise physiology after HTX combined with specific diving medicine aspects is challenging, we formed a multidisciplinary team to identify, evaluate, and mitigate the risks involved. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities are possible again after HTX.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Erk Olbrich
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Khaled Chalabi
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Thorsten Hagedorn
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Kay Tetzlaff
- Department of Sports Medicine, University Hospital Tuebingen, Tuebingen, Germany
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Sánchez C, Hernando A, Bolea J, Izquierdo D, Rodríguez G, Olea A, Lozano MT, Peláez-Coca MD. Enhancing Safety in Hyperbaric Environments through Analysis of Autonomic Nervous System Responses: A Comparison of Dry and Humid Conditions. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115289. [PMID: 37300016 DOI: 10.3390/s23115289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Diving can have significant cardiovascular effects on the human body and increase the risk of developing cardiac health issues. This study aimed to investigate the autonomic nervous system (ANS) responses of healthy individuals during simulated dives in hyperbaric chambers and explore the effects of the humid environment on these responses. Electrocardiographic- and heart-rate-variability (HRV)-derived indices were analyzed, and their statistical ranges were compared at different depths during simulated immersions under dry and humid conditions. The results showed that humidity significantly affected the ANS responses of the subjects, leading to reduced parasympathetic activity and increased sympathetic dominance. The power of the high-frequency band of the HRV after removing the influence of respiration, PHF⟂¯, and the number of pairs of successive normal-to-normal intervals that differ by more than 50 ms divided by the total number of normal-to-normal intervals, pNN50¯, indices were found to be the most informative in distinguishing the ANS responses of subjects between the two datasets. Additionally, the statistical ranges of the HRV indices were calculated, and the classification of subjects as "normal" or "abnormal" was determined based on these ranges. The results showed that the ranges were effective at identifying abnormal ANS responses, indicating the potential use of these ranges as a reference for monitoring the activity of divers and avoiding future immersions if many indices are out of the normal ranges. The bagging method was also used to include some variability in the datasets' ranges, and the classification results showed that the ranges computed without proper bagging represent reality and its associated variability. Overall, this study provides valuable insights into the ANS responses of healthy individuals during simulated dives in hyperbaric chambers and the effects of humidity on these responses.
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Affiliation(s)
- Carlos Sánchez
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain
| | - Alberto Hernando
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain
| | - Juan Bolea
- Departamento de Física, Centro Universitario de la Defensa de Zaragoza, Academia General Militar, 50090 Zaragoza, Spain
| | - David Izquierdo
- GTF Group, I3A Institute, University of Zaragoza, 50018 Zaragoza, Spain
| | - Germán Rodríguez
- Departamento de Ingeniería y Técnicas Aplicadas, Centro Universitario de la Defensa de San Javier, Academia General del Aire, 30729 Murcia, Spain
| | - Agustín Olea
- Centro de Buceo de la Armada de Cartagena, 30205 Murcia, Spain
| | - María Teresa Lozano
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain
- Departamento de Física, Centro Universitario de la Defensa de Zaragoza, Academia General Militar, 50090 Zaragoza, Spain
| | - María Dolores Peláez-Coca
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain
- Departamento de Física, Centro Universitario de la Defensa de Zaragoza, Academia General Militar, 50090 Zaragoza, Spain
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Ackermann SP, Raab M, Backschat S, Smith DJC, Javelle F, Laborde S. The diving response and cardiac vagal activity: A systematic review and meta-analysis. Psychophysiology 2023; 60:e14183. [PMID: 36219506 DOI: 10.1111/psyp.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023]
Abstract
This article aimed to synthesize the various triggers of the diving response and to perform a meta-analysis assessing their effects on cardiac vagal activity. The protocol was preregistered on PROSPERO (CRD42021231419; 01.07.2021). A systematic and meta-analytic review of cardiac vagal activity was conducted, indexed with the root mean square of successive differences (RMSSD) in the context of the diving response. The search on MEDLINE (via PubMed), Web of Science, ProQuest and PsycNet was finalized on November 6th, 2021. Studies with human participants were considered, measuring RMSSD pre- and during and/or post-exposure to at least one trigger of the diving response. Seventeen papers (n = 311) met inclusion criteria. Triggers examined include face immersion or cooling, SCUBA diving, and total body immersion into water. Compared to resting conditions, a significant moderate to large positive effect was found for RMSSD during exposure (Hedges' g = 0.59, 95% CI 0.36 to 0.82, p < .001), but not post-exposure (g = 0.11, 95% CI -0.14 to 0.36, p = .34). Among the considered moderators, total body immersion had a significantly larger effect than forehead cooling (QM = 23.46, df = 1, p < .001). No further differences were detected. Limitations were the small number of studies included, heterogenous triggers, few participants and low quality of evidence. Further research is needed to investigate the role of cardiac sympathetic activity and of the moderators.
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Affiliation(s)
- Stefan Peter Ackermann
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Markus Raab
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Applied Sciences, London South Bank University, London, UK
| | - Serena Backschat
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - David John Charles Smith
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Florian Javelle
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,UFR STAPS, EA 4260, Cesams, Normandie Université, Caen, France
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Pulmonary Effects of One Week of Repeated Recreational Closed-Circuit Rebreather Dives in Cold Water. Medicina (B Aires) 2022; 59:medicina59010081. [PMID: 36676705 PMCID: PMC9864030 DOI: 10.3390/medicina59010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives: The use of closed-circuit rebreathers (CCRs) in recreational diving is gaining interest. However, data regarding its physiological effects are still scarce. Immersion, cold water, hyperoxia, exercise or the equipment itself could challenge the cardiopulmonary system. The purpose of this study was to examine the impact of CCR diving on lung function and autonomous cardiac activity after a series of CCR dives in cold water. Materials and Methods: Eight CCR divers performed a diving trip (one week) in the Baltic Sea. Spirometry parameters, SpO2, and the lung ultrasonography score (LUS) associated with hydration monitoring by bioelectrical impedance were assessed at the end of the week. Heart rate variability (HRV) was recorded during the dives. Results: No diver declared pulmonary symptoms. The LUS increased after dives combined with a slight non-pathological decrease in SpO2. Spirometry was not altered, and all body water compartments were increased. Global HRV decreased during diving with a predominant increase in sympathetic tone while the parasympathetic tone decreased. All parameters returned to baseline 24 h after the last dive. Conclusions: The lung aeration disorders observed seem to be transient and not associated with functional spirometry alteration. The HRV dynamics highlighted physiological constraints during the dive as well as environmental-stress-related stimulation that may influence pulmonary changes. The impact of these impairments is unknown but should be taken into account, especially when considering long and repetitive CCR dives.
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Tso JV, Powers JM, Kim JH. Response to: Correspondence on 'Cardiovascular considerations for scuba divers' by Wilmshurst et al. Heart 2022; 108:1416-1418. [PMID: 35853685 PMCID: PMC10511218 DOI: 10.1136/heartjnl-2022-321527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jason V Tso
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua M Powers
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan H Kim
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Kelly KR, Arrington LJ, Bernards JR, Jensen AE. Prolonged Extreme Cold Water Diving and the Acute Stress Response During Military Dive Training. Front Physiol 2022; 13:842612. [PMID: 35874531 PMCID: PMC9304957 DOI: 10.3389/fphys.2022.842612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cold water exposure poses a unique physiological challenge to the human body. Normally, water submersion increases activation of parasympathetic tone to induce bradycardia in order to compensate for hemodynamic shifts and reduce oxygen consumption by peripheral tissues. However, elevated stress, such as that which may occur due to prolonged cold exposure, may shift the sympatho-vagal balance towards sympathetic activation which may potentially negate the dive reflex and impact thermoregulation. Objective: To quantify the acute stress response during prolonged extreme cold water diving and to determine the influence of acute stress on thermoregulation. Materials and Methods: Twenty-one (n = 21) subjects tasked with cold water dive training participated. Divers donned standard diving equipment and fully submerged to a depth of ≈20 feet, in a pool chilled to 4°C, for a 9-h training exercise. Pre- and post-training measures included: core and skin temperature; salivary alpha amylase (AA), cortisol (CORT), osteocalcin (OCN), testosterone (TEST) and dehydroepiandosterone (DHEA); body weight; blood glucose, lactate, and ketones. Results: Core, skin, and extremity temperature decreased (p < 0.001) over the 9-h dive; however, core temperature was maintained above the clinical threshold for hypothermia and was not correlated to body size (p = 0.595). There was a significant increase in AA (p < 0.001) and OCN (p = 0.021) and a significant decrease in TEST (p = 0.003) over the duration of the dive. An indirect correlation between changes in cortisol concentrations and changes in foot temperature (ρ = -0.5,p = 0.042) were observed. There was a significant positive correlation between baseline OCN and change in hand temperature (ρ = 0.66, p = 0.044) and significant indirect correlation between changes in OCN concentrations and changes in hand temperature (ρ = -0.59, p = 0.043). Conclusion: These data suggest that long-duration, cold water diving initiates a stress response—as measurable by salivary stress biomarkers—and that peripheral skin temperature decreases over the course of these dives. Cumulatively, these data suggest that there is a relationship between the acute stress response and peripheral thermoregulation.
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Affiliation(s)
- Karen R. Kelly
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- *Correspondence: Karen R. Kelly,
| | - Laura J. Arrington
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | - Jake R. Bernards
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | - Andrew E. Jensen
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
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Hernando A, Posada-Quintero H, Peláez-Coca MD, Gil E, Chon KH. Autonomic Nervous System characterization in hyperbaric environments considering respiratory component and non-linear analysis of Heart Rate Variability. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106527. [PMID: 34879328 DOI: 10.1016/j.cmpb.2021.106527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES an evaluation of Principal Dynamic Mode (PDM) and Orthogonal Subspace Projection (OSP) methods to characterize the Autonomic Nervous System (ANS) response in three different hyperbaric environments was performed. METHODS ECG signals were recorded in two different stages (baseline and immersion) in three different hyperbaric environments: (a) inside a hyperbaric chamber, (b) in a controlled sea immersion, (c) in a real reservoir immersion. Time-domain parameters were extracted from the RR series of the ECG. From the Heart Rate Variability signal (HRV), classic Power Spectral Density (PSD), PDM (a non-linear analysis of HRV which is able to separate sympathetic and parasympathetic activities) and OSP (an analysis of HRV which is able to extract the respiratory component) methods were used to assess the ANS response. RESULTS PDM and OSP parameters follows the same trend when compared to the PSD ones for the hyperbaric chamber dataset. Comparing the three hyperbaric scenarios, significant differences were found: i) heart rate decreased and RMSSD increased in the hyperbaric chamber and the controlled dive, but they had the opposite behavior during the uncontrolled dive; ii) power in the OSP respiratory component was lower than power in the OSP residual component in cases a and c; iii) PDM and OSP methods showed a significant increase in sympathetic activity during both dives, but parasympathetic activity increased only during the uncontrolled dive. CONCLUSIONS PDM and OSP methods could be used as an alternative measurement of ANS response instead of the PSD method. OSP results indicate that most of the variation in the heart rate variability cannot be described by changes in the respiration, so changes in ANS response can be assigned to other factors. Time-domain parameters reflect vagal activation in the hyperbaric chamber and in the controlled dive because of the effect of pressure. In the uncontrolled dive, sympathetic activity seems to be dominant, due to the effects of other factors such as physical activity, the challenging environment, and the influence of breathing through the scuba mask during immersion. In sum, a careful description of the changes in all the possible factors that could affect the ANS response between baseline and immersion stages in hyperbaric environments is needed for better interpretation of the results.
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Affiliation(s)
- Alberto Hernando
- Centro Universitario de Defensa (CUD), Academia General Militar (AGM), Zaragoza, Spain; BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain.
| | | | - María Dolores Peláez-Coca
- Centro Universitario de Defensa (CUD), Academia General Militar (AGM), Zaragoza, Spain; BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Eduardo Gil
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs CT, USA
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Dugrenot E, Balestra C, Gouin E, L'Her E, Guerrero F. Physiological effects of mixed-gas deep sea dives using a closed-circuit rebreather: a field pilot study. Eur J Appl Physiol 2021; 121:3323-3331. [PMID: 34435274 DOI: 10.1007/s00421-021-04798-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Deep diving using mixed gas with closed-circuit rebreathers (CCRs) is increasingly common. However, data regarding the effects of these dives are still scarce. This preliminary field study aimed at evaluating the acute effects of deep (90-120 msw) mixed-gas CCR bounce dives on lung function in relation with other physiological parameters. METHODS Seven divers performed a total of sixteen open-sea CCR dives breathing gas mixture of helium, nitrogen and oxygen (trimix) within four days at 2 depths (90 and 120 msw). Spirometric parameters, SpO2, body mass, hematocrit, short term heart rate variability (HRV) and critical flicker fusion frequency (CFFF) were measured at rest 60 min before the dive and 120 min after surfacing. RESULTS The median [1st-3rd quartile] of the forced vital capacity was lower (84% [76-93] vs 91% [74-107] of predicted values; p = 0.029), whereas FEV1/FVC was higher (98% [95-99] vs 95% [89-99]; p = 0.019) after than before the dives. The other spirometry values and SpO2 were unchanged. Body mass decreased from 73.5 kg (72.0-89.6) before the dives to 70.0 kg (69.2-85.8) after surfacing (p = 0.001), with no change of hematocrit or CFFT. HRV was increased as indicated by the higher SDNN, RMSSD and pNN50 after than before dives. CONCLUSION The present observation represents the first original data regarding the effects of deep repeated CCR dives. The body mass loss and decrease of FVC after bounce dives at depth of about 100 msw may possibly impose an important physiological stress for the divers.
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Affiliation(s)
- Emmanuel Dugrenot
- TEK diving SAS, F-29200, Brest, France
- Univ Brest, ORPHY, IBSAM, 6 avenue Le Gorgeu, F-29200, Brest, France
| | - Costantino Balestra
- Environmental and Occupational Physiology Laboratory, (ISEK), Haute Ecole Bruxelles-Brabant (HE2B), 1160, Brussels, Belgium
| | | | - Erwan L'Her
- Médecine Intensive et Réanimation, CHRU de Brest, Brest, NA, France
| | - François Guerrero
- Univ Brest, ORPHY, IBSAM, 6 avenue Le Gorgeu, F-29200, Brest, France.
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Lundell RV, Tuominen L, Ojanen T, Parkkola K, Räisänen-Sokolowski A. Diving Responses in Experienced Rebreather Divers: Short-Term Heart Rate Variability in Cold Water Diving. Front Physiol 2021; 12:649319. [PMID: 33897457 PMCID: PMC8058382 DOI: 10.3389/fphys.2021.649319] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Technical diving is very popular in Finland throughout the year despite diving conditions being challenging, especially due to arctic water and poor visibility. Cold water, immersion, submersion, hyperoxia, as well as psychological and physiological stress, all have an effect on the autonomic nervous system (ANS). Materials and methods To evaluate divers' ANS responses, short-term (5 min) heart rate variability (HRV) during dives in 2-4°C water was measured. HRV resting values were evaluated from separate measurements before and after the dives. Twenty-six experienced closed circuit rebreather (CCR) divers performed an identical 45-meter decompression dive with a non-physical task requiring concentration at the bottom depth. Results Activity of the ANS branches was evaluated with the parasympathetic (PNS) and sympathetic (SNS) indexes of the Kubios HRV Standard program. Compared to resting values, PNS activity decreased significantly on immersion with face out of water. From immersion, it increased significantly with facial immersion, just before decompression and just before surfacing. Compared to resting values, SNS activity increased significantly on immersion with face out of water. Face in water and submersion measures did not differ from the immersion measure. After these measurements, SNS activity decreased significantly over time. Conclusion Our study indicates that the trigeminocardiac part of the diving reflex causes the strong initial PNS activation at the beginning of the dive but the reaction seems to decrease quickly. After this initial activation, cold seemed to be the most prominent promoter of PNS activity - not pressure. Also, our study showed a concurrent increase in both SNS and PNS branches, which has been associated with an elevated risk for arrhythmia. Therefore, we recommend a short adaptation phase at the beginning of cold-water diving before physical activity.
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Affiliation(s)
| | - Laura Tuominen
- Department of Anaestesia, Tampere University Hospital, Tampere, Finland
| | - Tommi Ojanen
- Finnish Defence Research Agency, Finnish Defence Forces, Tuusula, Finland
| | - Kai Parkkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Anne Räisänen-Sokolowski
- Diving Medical Centre, Finnish Defence Forces, Helsinki, Finland.,Department of Pathology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
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11
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Zenske A, Koch A, Kähler W, Oellrich K, Pepper C, Muth T, Schipke JD. Assessment of a dive incident using heart rate variability. Diving Hyperb Med 2020; 50:157-163. [PMID: 32557418 DOI: 10.28920/dhm50.2.157-163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 02/23/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Scuba diving likely has an impact on the autonomic nervous system (ANS). In the course of conducting trials of underwater ECG recording for measurement of heart rate variability, there was an unexpected stressful event; one participant's regulator iced and began to free-flow. METHODS A custom-made, water- and pressure-tight aluminum housing was used to protect a portable Holter monitor. ECGs were recorded in three experienced divers who witnessed an unplanned moderately stressful incident during diving. The ECG signals were analysed for measures of heart rate variability (HRV). RESULTS Analysis for different short-term HRV measures provided consistent results if periods of interest were appropriately time-aligned. There was improvement in sympatho-vagal balance. One diver unexpectedly exhibited an increase in both sympathetic and vagal activity shortly after the incident. CONCLUSIONS A conventional open-water dive affected the ANS of experienced recreational divers as measured by HRV which provides a global evaluation of the ANS and alterations in its two branches. The heart rate variability data gathered from several participating divers around the time of this event illustrate the potential utility of this variable in quantifying stress during diving. HRV data may be useful in addressing relevant diving related questions such as effects of cold, exercise or different breathing gases on ANS function.
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Affiliation(s)
| | - Andreas Koch
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Wataru Kähler
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Kerstin Oellrich
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Clark Pepper
- Johanna Etienne Hospital, Dept. of Anaesthesiology, Neuss, Germany
| | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Jochen D Schipke
- Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum, Düsseldorf, Germany.,Corresponding author: Professor Jochen D Schipke, c/o Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf, DE, Moorenstrasse 5, D-40225 Düsseldorf,
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12
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Vinetti G, Lopomo NF, Taboni A, Fagoni N, Ferretti G. The current use of wearable sensors to enhance safety and performance in breath-hold diving: A systematic review. Diving Hyperb Med 2020; 50:54-65. [PMID: 32187619 DOI: 10.28920/dhm50.1.54-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/19/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Measuring physiological parameters at depth is an emergent challenge for athletic training, diver's safety and biomedical research. Recent advances in wearable sensor technology made this challenge affordable; however, its impact on breath-hold diving has never been comprehensively discussed. METHODS We performed a systematic review of the literature in order to assess what types of sensors are available or suitable for human breath-hold diving, within the two-fold perspective of safety and athletic performance. RESULTS In the 52 studies identified, sensed physiological variables were: electrocardiogram, body temperature, blood pressure, peripheral oxygen saturation, interstitial glucose concentration, impedance cardiography, heart rate, body segment inertia and orientation. CONCLUSIONS Limits and potential of each technology are separately reviewed. Inertial sensor technology and transmission pulse oximetry could produce the greatest impact on breath-hold diving performances in the future.
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Affiliation(s)
- Giovanni Vinetti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Information Engineering, University of Brescia, Brescia, Italy.,Corresponding author: Dr Giovanni Vinetti, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11-25123, Brescia, Italy,
| | - Nicola F Lopomo
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Anna Taboni
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergencies, University of Geneva, Geneva, Switzerland
| | - Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Guido Ferretti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Anesthesiology, Pharmacology, Intensive Care and Emergencies, University of Geneva, Geneva, Switzerland
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13
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Schirato SR, El-Dash I, El-Dash V, Bizzarro B, Marroni A, Pieri M, Cialoni D, Chaui-Berlinck JG. Association Between Heart Rate Variability and Decompression-Induced Physiological Stress. Front Physiol 2020; 11:743. [PMID: 32714210 PMCID: PMC7351513 DOI: 10.3389/fphys.2020.00743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to analyze the correlation between decompression-related physiological stress markers, given by inflammatory processes and immune system activation and changes in Heart Rate Variability, evaluating whether Heart Rate Variability can be used to estimate the physiological stress caused by the exposure to hyperbaric environments and subsequent decompression. A total of 28 volunteers participated in the experimental protocol. Electrocardiograms were performed; blood samples were obtained for the quantification of red cells, hemoglobin, hematocrit, neutrophils, lymphocytes, platelets, aspartate transaminase (AST), alanine aminotransferase (ALT), and for immunophenotyping and microparticles (MP) research through Flow Cytometry, before and after each experimental protocol from each volunteer. Also, myeloperoxidase (MPO) expression and microparticles (MPs) deriving from platelets, neutrophils and endothelial cells were quantified. Negative associations between the standard deviation of normal-to-normal intervals (SDNN) in the time domain, the High Frequency in the frequency domain and the total number of circulating microparticles was observed (p-value = 0.03 and p-value = 0.02, respectively). The pre and post exposure ratio of variation in the number of circulating microparticles was negatively correlated with SDNN (p-value = 0.01). Additionally, a model based on the utilization of Radial Basis Function Neural Networks (RBF-NN) was created and was able to predict the SDNN ratio of variation based on the variation of specific inflammatory markers (RMSE = 0.06).
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Affiliation(s)
- Sergio Rhein Schirato
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ingrid El-Dash
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Vivian El-Dash
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Bruna Bizzarro
- Peter Murányi Experimental Research Center, Albert Einstein Hospital, São Paulo, Brazil
| | | | - Massimo Pieri
- DAN Europe Research Division, Roseto degli Abruzzi, Italy
| | - Danilo Cialoni
- DAN Europe Research Division, Roseto degli Abruzzi, Italy
- Environmental Physiology and Medicine Laboratory, Department of Biomedical Sciences, University of Padova, Padua, Italy
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14
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Lundell RV, Räisänen-Sokolowski AK, Wuorimaa TK, Ojanen T, Parkkola KI. Diving in the Arctic: Cold Water Immersion's Effects on Heart Rate Variability in Navy Divers. Front Physiol 2020; 10:1600. [PMID: 32082177 PMCID: PMC7005786 DOI: 10.3389/fphys.2019.01600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Diving close to the Arctic circle means diving in cold water regardless of the time of year. The human body reacts to cold through autonomous nervous system (ANS)-mediated thermoregulatory mechanisms. Diving also induces ANS responses as a result of the diving reflex. Materials and Methods In order to study ANS responses during diving in Arctic water temperatures, we retrospectively analyzed repeated 5-min heart rate variability (HRV) measures and the mean body temperature from dives at regular intervals using naval diving equipment measurement tests in 0°C water. Three divers performed seven dives without physical activity (81–91 min), and two divers performed four dives with physical activity after 10 min of diving (0–10 min HRV recordings were included in the study). Results Our study showed a significant increase in parasympathetic activity (PNS) at the beginning of the dives, after which PNS activity decreased significantly (measure 5–10 min). Subsequent measurements (15–20 min and onward) showed a significant increase in PNS activity over time. Conclusion Our results suggest that the first PNS responses of the human diving reflex decrease quickly. Adverse effects of PNS activity should be considered on long and cold dives. To avoid concurrent sympathetic (SNS) and PNS activity at the beginning of dives, which in turn may increase the risk of arrhythmia in cold water, we suggest a short adaptation phase before physical activity. Moreover, we suggest it is prudent to give special attention to cardiovascular risk factors during pre-dive examinations for cold water divers.
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Affiliation(s)
- Richard V Lundell
- Diving Medical Centre, Centre for Military Medicine, The Finnish Defence Forces, Helsinki, Finland.,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Anne K Räisänen-Sokolowski
- Department of Pathology, HUSLAB, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Centre for Military Medicine, The Finnish Defence Forces, Kirkkonummi, Finland
| | - Tomi K Wuorimaa
- Diving Medical Centre, Centre for Military Medicine, The Finnish Defence Forces, Kirkkonummi, Finland
| | - Tommi Ojanen
- Human Performance Division, Finnish Defence Research Agency, The Finnish Defence Forces, Tuusula, Finland
| | - Kai I Parkkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,National Defence University, Helsinki, Finland
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15
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Perez-Martinez C, Pelaez-Coca MD, Hernando A, Gil E, Sanchez C. Multivariable relationships between autonomic nervous system related indices in hyperbaric environments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6789-6793. [PMID: 31947399 DOI: 10.1109/embc.2019.8856374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The main aim of this work is to model the relationships between parameters extracted from the heart rate variability (HRV) signal, which is derived from the electrocardiogram (ECG), at different stages of a simulated immersion in a hyperbaric chamber. The response of the Autonomic Nervous System is known to be affected by changes in atmospheric pressure, reflected in changes in the HRV signal. A dataset consisting of ECG signals from 17 subjects exposed to a controlled hyperbaric environment, simulating depths from 0 m to 40 m, was used. Both linear and nonlinear dependences of HRV parameters were analysed using linear regression and Mutual Information (entropy-based) techniques. Furthermore, relationships between parameters of the HRV signals, biophysical variables of the subjects, and atmospheric pressure changes were characterized by artificial neural networks. In particular, self-organizing maps (SOM) were trained for modelling and clustering all the data. In the mid-term, these models could be the basis to create predictive models of HRV parameters at high depths in order to increase the safety for divers by warning them if some abnormal body response could be expected just by processing the ECG signal at sea level before immersion.
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16
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Zenske A, Kähler W, Koch A, Oellrich K, Pepper C, Muth T, Schipke JD. Does oxygen-enriched air better than normal air improve sympathovagal balance in recreational divers?An open-water study. Res Sports Med 2019; 28:397-412. [PMID: 31762338 DOI: 10.1080/15438627.2019.1694930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Effects of the hyperbaric environment on the autonomic nervous system (ANS) in recreational divers are not firmly settled. Aim of this exploratory study was to (1) assess ANS changes during scuba diving via recordings of electrocardiograms (ECG) and to (2) study whether nitrox40 better improves sympathovagal balance over air. 13 experienced divers (~40yrs) performed two open-water dives each breathing either air or nitrox40 (25m/39min). 3-channel ECGs were recorded using a custom-made underwater Holter-monitor. The underwater Holter system proved to be safe. Air consumption exceeded nitrox40 consumption by 12% (n = 13; p < 0.05). Both air and nitrox40 dives reduced HR (10 vs 13%; p < 0.05). The overall HRV (pNN50: 82 vs 126%; p < 0.05) and its vagal proportion (RMSSD: 33 vs 50%; p < 0.05) increased during the dive. Moreover, low (LF: 61 vs 47%) and high (HF: 71 vs 140%) frequency power were increased (all p < 0.05), decreasing the ratio of LF to HF (22 vs 34%). : Conventional open-water dives distinctly affect the ANS in experienced recreational divers, with sympathetic activation less pronounced than vagal activation thereby improving the sympathovagal balance. Nitrox40 delivered two positive results: nitrox40 consumption was lower than air consumption, and nitrox40 better improved the sympathovagal balance over air.
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Affiliation(s)
- André Zenske
- Department of Anaesthesiology, Operative Intensive Medicine, and Pain Medicine, Klinikum St. Elisabeth Straubing , Straubing, Germany
| | - Wataru Kähler
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | - Andreas Koch
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | - Kerstin Oellrich
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | | | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine , Düsseldorf, Heinrich Heine University, Germany
| | - Jochen D Schipke
- Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf , Düsseldorf, Germany
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Anderson W, Murray P, Hertweck K. Dive Medicine: Current Perspectives and Future Directions. Curr Sports Med Rep 2019; 18:129-135. [PMID: 30969238 DOI: 10.1249/jsr.0000000000000583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As SCUBA diving continues to rapidly grow in the United States and worldwide, physicians should have a fundamental working knowledge to provide care for an injured diver. SCUBA divers are faced with many hazards at depths that are normally well compensated for at sea level. Pressure gradients, changes in the partial pressure of inhaled gases and gas solubility can have disastrous effects to the diver if not managed properly. Many safety measures in SCUBA diving are governed by the laws of physics, but some have come under scrutiny. This has prompted increased research concerning in water recompression and flying after diving. This article will give physicians an understanding of the dangers divers encounter and the current treatment recommendations. We will also explore some controversies in diving medicine.
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Affiliation(s)
- Wayne Anderson
- Morton Plant Mease Family Medicine Residency Program, Department of Family Medicine, University of South Florida College of Medicine, Tampa, FL
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