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Samejima S, Shackleton C, Miller T, Moritz CT, Kessler TM, Krogh K, Sachdeva R, Krassioukov AV. Mapping the Iceberg of Autonomic Recovery: Mechanistic Underpinnings of Neuromodulation following Spinal Cord Injury. Neuroscientist 2024; 30:378-389. [PMID: 36631741 PMCID: PMC11107126 DOI: 10.1177/10738584221145570] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Spinal cord injury leads to disruption in autonomic control resulting in cardiovascular, bowel, and lower urinary tract dysfunctions, all of which significantly reduce health-related quality of life. Although spinal cord stimulation shows promise for promoting autonomic recovery, the underlying mechanisms are unclear. Based on current preclinical and clinical evidence, this narrative review provides the most plausible mechanisms underlying the effects of spinal cord stimulation for autonomic recovery, including activation of the somatoautonomic reflex and induction of neuroplastic changes in the spinal cord. Areas where evidence is limited are highlighted in an effort to guide the scientific community to further explore these mechanisms and advance the clinical translation of spinal cord stimulation for autonomic recovery.
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Affiliation(s)
- Soshi Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Tiev Miller
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Chet T. Moritz
- Departments of Electrical and Computer Engineering, Rehabilitation Medicine, and Physiology and Biophysics and the Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Thomas M. Kessler
- Department of Neuro-urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Klaus Krogh
- Department of Clinical Medicine and Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
- Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
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Ryan DJ, De Looze C, McGarrigle CA, Scarlett S, Kenny RA. Examining mental health and autonomic function as putative mediators of the relationship between sleep and trajectories of cognitive function: findings from the Irish longitudinal study on ageing (TILDA). Aging Ment Health 2024:1-8. [PMID: 38709667 DOI: 10.1080/13607863.2024.2345133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES This study investigates the mediating roles of autonomic function and mental health in the association between sleep and cognitive decline in adults aged 50 and above. METHOD A total of 2,697 participants with observations on sleep and mediators at baseline and repeated measures of cognitive function (MMSE) were included. Clusters of individuals with similar cognitive trajectories (high-stable, mid-stable and low-declining) were identified. Multinomial logistic regressions were used to estimate the likelihood of membership to each trajectory group based on sleep duration and disturbance. Finally, mediation analysis tested potential mediating effects of autonomic function and mental health underpinning the sleep-cognition relationship. RESULTS Short (p = .028), long (p =.019), and disturbed sleep (p =.008) increased the likelihood of a low-declining cognitive trajectory. Mental health measures fully attenuated relationships between cognitive decline and short or disturbed sleep but not long sleep. No autonomic function mediation was observed. CONCLUSION Older adults with short or disturbed sleep are at risk of cognitive decline due to poor mental health. Individuals with long sleep are also at risk, however, the acting pathways remain to be identified. These outcomes have clinical implications, potentially identifying intervention strategies targeting mental health and sleep as prophylactic measures against dementia.
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Affiliation(s)
- David J Ryan
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Céline De Looze
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Christine A McGarrigle
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Siobhan Scarlett
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
- The Mercer Institute for Successful Ageing (MISA), St. James's hospital, Dublin, Ireland
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Oursler KK, Briggs BC, Lozano AJ, Harris NM, Parashar A, Ryan AS, Marconi VC. Association of chronotropic incompetence with reduced cardiorespiratory fitness in older adults with HIV. AIDS 2024; 38:825-833. [PMID: 38578959 PMCID: PMC11003719 DOI: 10.1097/qad.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Understanding the physiological drivers of reduced cardiorespiratory fitness in people with HIV (PWH) will inform strategies to optimize healthspan. Chronotropic incompetence is common in heart failure and associated with low cardiorespiratory fitness yet is understudied in PWH. The objective was to determine the prevalence of chronotropic incompetence and its relationship with cardiorespiratory fitness. DESIGN Participants were PWH at least 50 years of age with no prior history of heart failure or coronary heart disease who were enrolled in a randomized exercise trial. Baseline cardiopulmonary exercise testing (CPET) was used to measure cardiorespiratory fitness as peak oxygen consumption (VO2peak) and calculate the chronotropic index from heart rate values. Chronotropic incompetence was defined as an index less than 80%. RESULTS The 74 participants were on average 61 years old, 80% Black or African American, and 93% men. Chronotropic incompetence was present in 31.1%. VO2peak was significantly lower among participants with chronotropic incompetence compared with participants without chronotropic incompetence [mean (SD) ml/min/kg: 20.9 (5.1) vs. 25.0 (4.5), P = 0.001]. Linear regression showed that chronotropic incompetence and age were independent predictors of VO2peak, but smoking and comorbidity were not. The chronotropic index correlated with VO2peak (r = 0.48, P < 0.001). CONCLUSION Among older PWH without heart failure or coronary heart disease, chronotropic incompetence was present in approximately one-third of individuals and was associated with clinically relevant impaired cardiorespiratory fitness. Investigation of chronotropic incompetence in large cohorts which includes PWH and heart failure may contribute to strategies that promote healthy aging with HIV infection and offer a preclinical window for intervention.
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Affiliation(s)
- Krisann K Oursler
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke
- Geriatrics Extended Care, Salem Veterans Affairs Healthcare System, Salem, VA
| | - Brandon C Briggs
- Geriatrics Extended Care, Salem Veterans Affairs Healthcare System, Salem, VA
- Department of Health and Human Performance, Concordia University Chicago, Chicago, IL
| | - Alicia J Lozano
- Department of Statistics, Virginia Polytechnic Institute and State University, Roanoke, VA
| | - Nadine M Harris
- Department of Medicine, Emory University School of Medicine, Atlanta
- Infectious Diseases, VA Atlanta Healthcare System, Decatur, GA
| | - Amitabh Parashar
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke
- Geriatrics Extended Care, Salem Veterans Affairs Healthcare System, Salem, VA
| | - Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center at the Veterans Affairs Maryland Healthcare System, Baltimore, MD
| | - Vincent C Marconi
- Department of Medicine, Emory University School of Medicine, Atlanta
- Infectious Diseases, VA Atlanta Healthcare System, Decatur, GA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Mao P, Hu H, Li R, Zhang Y, Zhang Y, Li Y, Fan B. Circadian changes of autonomic function in patients with zoster-associated pain: A heart rate variability analysis. Brain Behav 2024; 14:e3489. [PMID: 38688880 PMCID: PMC11061204 DOI: 10.1002/brb3.3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To investigate the circadian changes of the autonomic function in patients with zoster-associated pain (ZAP). METHODS A total of 37 patients with ZAP from April 2022 to October 2022 were enrolled as the observation group, and 37 normal volunteers at the same time were selected as the control group. All participants were required to wear a 24-h Holter, which was used to compare the heart rate variability (HRV) between the two groups. HRV analysis involved time- and frequency-domain parameters. RESULTS There was no statistically significant difference in general information between two groups. Patients with ZAP had an increased mean heart rate and decreased the standard deviation of normal-to-normal (SDNN) R-R interval, the root mean square of the differences (RMSSD) in successive RR interval, low frequency (LF), and high frequency (HF) compared with control groups in all periods (p < .05). The ratio of LF/HF between two groups had no significant difference (p = .245). SDNN had no significant difference between day and night in the control group (p > .05), whereas SDNN of ZAP patients in night period was reduced than that in day period (p < .001). The level of RMSSD during the day was lower than those at night in the control group (p < .05), whereas no significant difference of RMSSD between two periods was observed in patients with ZAP (p > .05). CONCLUSION The results of this study indicated that ZAP contributes to the decline of autonomic nervous system (ANS) function, especially parasympathetic components. The patients with ZAP lost parasympathetic advantage and had a worse ANS during the night.
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Affiliation(s)
- Peng Mao
- Department of Pain MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Hui‐Min Hu
- Graduate School of Beijing University of Chinese MedicineBeijingChina
| | - Ran Li
- Graduate School of Beijing University of Chinese MedicineBeijingChina
| | - Yuan‐Jing Zhang
- Graduate School of Beijing University of Chinese MedicineBeijingChina
| | - Yi Zhang
- Department of Pain MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Yi‐Fan Li
- Department of Pain MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Bi‐Fa Fan
- Department of Pain MedicineChina‐Japan Friendship HospitalBeijingChina
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Nojkov B, Burnett C, Watts L, Yin J, Ali K, Zhao T, Gong S, Miller C, Habrowski M, Chey WD, Chen JDZ. The impact of transcutaneous electrical acustimulation (TEA) on rectal distension-induced pain in patients with irritable bowel syndrome (IBS)-A study to determine the optimal TEA delivery modalities and effects on rectal sensation and autonomic function. Neurogastroenterol Motil 2024:e14799. [PMID: 38671591 DOI: 10.1111/nmo.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Treatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut-brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS-Constipation and delineate the effect of TEA on rectal sensation and autonomic function. METHODS Nineteen IBS-C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham-acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36-100 Hz; (2) TEA/ST36-25 Hz; (3) TEA/PC6-100 Hz; (4) TEA/PC6-25 Hz; (5) TEA/Sham-25 Hz. In each session, barostat-guided rectal distention (RD) was performed before and after TEA. Patients graded the RD-induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment. KEY RESULTS Studied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36-100 Hz had significantly decreased pain scores at RD pressure-points 20-50 mmHg (p < 0.04). The average pain reduction was 40%. Post-treatment scores did not change significantly with other TEA modalities except with sham-TEA (lesser degree compared to ST36-100 Hz, p = 0.04). TEA/ST36-100, but not other modalities, increased the rectal sensation threshold (first sensation: p = 0.007; urge to defecate: p < 0.026). TEA/ST36-100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (p < 0.04). CONCLUSIONS & INFERENCES TEA at ST36-100 Hz is superior stimulation point/parameter, compared to TEA at PC-6/sham-TEA, to reduce rectal distension-induced pain in IBS-C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.
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Affiliation(s)
- Borko Nojkov
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lydia Watts
- University of Michigan, Ann Arbor, Michigan, USA
| | - Jieyun Yin
- Transtimulation Research Inc., Oklahoma City, Oklahoma, USA
| | - Khawar Ali
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Shiyuan Gong
- University of Michigan, Ann Arbor, Michigan, USA
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Moon SJE, Schlenk EA, Lee H. Heart Rate Variability in Adults With Substance Use Disorder: A Comprehensive Narrative Review. J Am Psychiatr Nurses Assoc 2024; 30:240-251. [PMID: 36856156 DOI: 10.1177/10783903221145142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use. AIM The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse. METHODS A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances. RESULTS A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility. CONCLUSION HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.
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Affiliation(s)
| | - Elizabeth A Schlenk
- Elizabeth A. Schlenk, PhD, RN, CNL, FAAN, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, University of Pittsburgh, Pittsburgh, PA, USA
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Hirobumi I. A Successful Case Report of Epipharyngeal Abrasive Therapy (EAT) in a Patient With Sleep Apnea Syndrome and Traumatic Tympanic Membrane Perforation Caused by Chronic Epipharyngitis. Cureus 2024; 16:e59089. [PMID: 38680824 PMCID: PMC11052600 DOI: 10.7759/cureus.59089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/01/2024] Open
Abstract
Traumatic perforation of the tympanic membrane often occurs in Japanese patients who scratch their ears to relieve itching. Traumatic tympanic membrane perforation may close spontaneously, but the perforation may remain. One of the causes of prolonged tympanic membrane perforation closure is dysfunction of the Eustachian tube. In this study, I experienced a case of chronic epipharyngitis causing ear fullness and itching, and a traumatic perforation of the tympanic membrane caused by scratching with an earpick. The patient also had sleep apnea syndrome (SAS). Treatment of chronic epipharyngitis with epipharyngeal abrasive therapy (EAT) shortened the time to perforation closure and improved SAS, suggesting that EAT affected the improvement of Eustachian tube function and airway resistance in the epipharynx.
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Huang Y, Liu J, Lv C, Sun C, Meng M, Lowe S, Yu Y. Integrative effects of transcutaneous auricular vagus nerve stimulation on esophageal motility and pharyngeal symptoms via vagal mechanisms in patients with laryngopharyngeal reflux disease. Front Neurosci 2024; 18:1287809. [PMID: 38516311 PMCID: PMC10954818 DOI: 10.3389/fnins.2024.1287809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Background and aim Laryngopharyngeal reflux disease (LPRD) is primarily characterized by discomfort in the pharynx and has limited treatment options. This research aimed to assess the efficacy of transcutaneous auricular vagus nerve stimulation (tVNS) in patients with LPRD and delve into the potential underlying mechanisms. Methods A total of 44 participants, diagnosed with LPRD were divided into two groups randomly. Twice-daily stimulation was delivered for 2 weeks for patients in experimental group, with stimulation ranging from 1.0 mA to 1.5 mA (n = 22), while the control group underwent sham tVNS (n = 22) with the same stimulation parameters and different anatomical location. The severity of symptoms and levels of anxiety and depression were monitored using questionnaires. High-resolution esophageal manometry data were collected, and the patients' autonomic function was assessed through heart rate variability analysis. Results There was a positive correlation between reflux symptom index (RSI) scores and low frequency/high frequency (LF/HF) ratio (r = 0.619; p < 0.001), Hamilton anxiety scale (HAMA) scores (r = 0.623; p < 0.001), and Hamilton depression scale (HAMD) scores (r = 0.593; p < 0.001). Compared to the pre-tVNS phase, RSI (p < 0.001), HAMA (p < 0.001), and HAMD (p < 0.001) scores were significantly reduced after 2 weeks of treatment. Additionally, the resting pressure of the upper esophageal sphincter (UESP; p < 0.05) and lower esophageal sphincter (LESP; p < 0.05) showed significant enhancement. Notably, tVNS led to an increase in root mean square of successive differences (RMSSD; p < 0.05) and high frequency (HF; p < 0.05) within heart rate variability compared to the pre-treatment baseline. Compared to the control group, RSI (p < 0.001), HAMA (p < 0.001), and HAMD (p < 0.001) scores in tVNS group were significantly lower at the end of treatment. Similarly, the resting pressure of UESP (p < 0.05) and LESP (p < 0.05) in tVNS group were significantly higher than that of control group. Notably, RMSSD (p < 0.05) and HF (p < 0.05) in tVNS group were significantly higher than that of control group. Conclusion This study demonstrated that tVNS as a therapeutic approach is effective in alleviating LPRD symptoms. Furthermore, it suggests that improvements in esophageal motility could be associated with vagus nerve-dependent mechanisms.
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Affiliation(s)
- Yizhou Huang
- Department of Gastroenterology, The PLA Navy Anqing Hospital, Anqing, Anhui, China
| | - Jie Liu
- Department of Gastroenterology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Chaolan Lv
- Department of Gastroenterology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenyu Sun
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Muzi Meng
- Bronxcare Health System, New York, NY, United States
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| | - Yue Yu
- Department of Gastroenterology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
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Chalif JI, Chavarro VS, Mensah E, Johnston B, Fields DP, Chalif EJ, Chiang M, Sutton O, Yong R, Trumbower R, Lu Y. Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review. J Clin Med 2024; 13:1090. [PMID: 38398403 PMCID: PMC10889415 DOI: 10.3390/jcm13041090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.
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Affiliation(s)
- J. I. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.I.C.); (V.S.C.); (B.J.)
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
| | - V. S. Chavarro
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.I.C.); (V.S.C.); (B.J.)
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
- Department of Physical Medicine and Rehabilitation, Spaulding Hospital Cambridge, Cambridge, MA 02115, USA
| | - E. Mensah
- Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - B. Johnston
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.I.C.); (V.S.C.); (B.J.)
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
| | - D. P. Fields
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - E. J. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.I.C.); (V.S.C.); (B.J.)
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
| | - M. Chiang
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
- Department of Physical Medicine and Rehabilitation, Spaulding Hospital Cambridge, Cambridge, MA 02115, USA
- Department of Anesthesiology Perioperative and Pain Management, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - O. Sutton
- Department of Anesthesiology Perioperative and Pain Management, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - R. Yong
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
- Department of Anesthesiology Perioperative and Pain Management, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - R. Trumbower
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
- Department of Physical Medicine and Rehabilitation, Spaulding Hospital Cambridge, Cambridge, MA 02115, USA
| | - Y. Lu
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.I.C.); (V.S.C.); (B.J.)
- Harvard Medical School, Boston, MA 02115, USA; (M.C.); (R.Y.); (R.T.)
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Park S, Kim HL, Park KT, Joh HS, Lim WH, Seo JB, Kim SH, Kim MA. Association between arterial stiffness and autonomic dysfunction in participants underwent treadmill exercise testing: a cross-sectional analysis. Sci Rep 2024; 14:3588. [PMID: 38351168 PMCID: PMC10864279 DOI: 10.1038/s41598-024-53681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
Data on the impact of arterial stiffness on autonomic function are limited. We sought to investigate whether heart rate recovery (HRR), a predictor of autonomic function, is impaired in patients with increased arterial stiffness. A total of 475 participants (mean age 55.8 ± 11.1 years, 34.3% women) who underwent a treadmill exercise test (TET) for the evaluation of chest pain were retrospectively analyzed. All patients underwent brachial-ankle pulse wave velocity (baPWV) measurement on the same day. HRR was defined as the difference in heart rate from maximal exercise to 1 min of recovery. Participants with the lowest HRR tertile were older and had more cardiovascular risk factors than those with the highest HRR tertile. Simple correlation analysis showed that baPWV was negatively correlated with HRR (r = - 0.327, P < 0.001). In multiple linear regression analysis, there was a significant association between baPWV and HRR, even after adjusting for potential confounders (β = - 0.181, P < 0.001). In participants who underwent TET, baPWV was negatively correlated with HRR. The results of our study indicate a potential relationship between arterial stiffness and the autonomic nervous system.
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Affiliation(s)
- Sungjoon Park
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyung-Taek Park
- Department of Cardiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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11
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Mannozzi J, Massoud L, Stavres J, Al-Hassan MH, O’Leary DS. Altered Autonomic Function in Metabolic Syndrome: Interactive Effects of Multiple Components. J Clin Med 2024; 13:895. [PMID: 38337589 PMCID: PMC10856260 DOI: 10.3390/jcm13030895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic syndrome (MetS) describes a set of disorders that collectively influence cardiovascular health, and includes hypertension, obesity, insulin resistance, diabetes, and dyslipidemia. All these components (hypertension, obesity, dyslipidemia, and prediabetes/diabetes) have been shown to modify autonomic function. The major autonomic dysfunction that has been documented with each of these components is in the control of sympathetic outflow to the heart and periphery at rest and during exercise through modulation of the arterial baroreflex and the muscle metaboreflex. Many studies have described MetS components in singularity or in combination with the other major components of metabolic syndrome. However, many studies lack the capability to study all the factors of metabolic syndrome in one model or have not focused on studying the effects of how each component as it arises influences overall autonomic function. The goal of this review is to describe the current understanding of major aspects of metabolic syndrome that most likely contribute to the consequent/associated autonomic alterations during exercise and discuss their effects, as well as bring light to alternative mechanisms of study.
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Affiliation(s)
- Joseph Mannozzi
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48001, USA
| | - Louis Massoud
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48001, USA
| | - Jon Stavres
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | | | - Donal S. O’Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48001, USA
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12
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Isaac V, Lopez V, Escobar MJ. Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD). Front Psychiatry 2024; 14:1336040. [PMID: 38298926 PMCID: PMC10827919 DOI: 10.3389/fpsyt.2023.1336040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, that continues to have an elusive etiological background. A number of extant models and theories have historically intended to explain the many factors contributing to ADHD behaviors. One of the most accepted hypotheses has been the executive dysfunction theory associating reduction in executive control to abnormalities in structure and operational dysfunction of dopaminergic signaling networks. Nevertheless, executive functions are not always impaired in ADHD, and the literature describes other symptoms commonly reported suggesting individuals with ADHD would appear to suffer from a more general deficit. Another existing line of research, that has gained much attention recently, establishes that ADHD would have dysregulated states of brain arousal that would account for its commonly observed cognitive deficits and behavioral symptoms, described as the state regulation theory, which has now included measures of autonomic function. This article describes some important aspects that compose and challenge these two most influential theoretical constructs, executive dysfunction and state-regulation, based on their empirical evidence, implying the need to reevaluate the norms used to classify individuals and establish ADHD diagnosis. Large number of controversial results continue to exist within the study of ADHD biological and/or performance markers, possibly due to such heterogeneity and variability within the same diagnosis. The need to resolve these issues and establish newly revised diagnostic criteria for ADHD is critical, as therapeutic success depends on having accurately identified underlying neurophysiological factors in order to appropriately address them in treatment.
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Affiliation(s)
- Valeria Isaac
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Vladimir Lopez
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Josefina Escobar
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
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13
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Boyes NG, Mannozzi J, Rapin N, Alvarez A, Al-Hassan MH, Lessanework B, Lahti DS, Olver TD, O'Leary DS, Tomczak CR. Augmented sympathoexcitation slows postexercise heart rate recovery. J Appl Physiol (1985) 2023; 135:1300-1311. [PMID: 37883101 DOI: 10.1152/japplphysiol.00549.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
Slow heart rate recovery following exercise may be influenced by persistent sympathoexcitation. This study examined 1) the effect of muscle metaboreflex activation (MMA) on heart rate recovery following dynamic exercise; and 2) whether the effect of MMA on heart rate recovery is reversible by reducing sympathoexcitation [baroreflex activation via phenylephrine (PE)] in canines. Twenty-two young adults completed control and MMA protocols during cycle ergometry at 110% ventilatory threshold with 5 min recovery. Heart rate recovery kinetics [tau (τ), amplitude, end-exercise, and end-recovery heart rate] and root mean square of successive differences (RMSSD) were measured. Five chronically instrumented canines completed control, MMA (50%-60% imposed reduction in hindlimb blood flow), and MMA with end-exercise PE infusion (MMA + PE) protocols during moderate exercise (6.4 km·h-1) and 3 min recovery. Heart rate recovery kinetics and MAP were measured. MAP increased during MMA versus control in canines (P < 0.001). Heart rate recovery τ was slower during MMA versus control in humans (17% slower; P = 0.011) and canines (150% slower; P = 0.002). Heart rate recovery τ was faster during MMA + PE versus MMA (40% faster; P = 0.034) and was similar to control in canines (P = 0.426). Amplitude, end-exercise, and end-recovery heart rate were similar between conditions in humans (all P ≥ 0.122) and in canines (all P ≥ 0.084). MMA decreased RMSSD in early recovery (P = 0.004). MMA-induced sympathoexcitation slows heart rate recovery and this effect is markedly attenuated with PE. Therefore, elevated sympathoexcitation via MMA impairs heart rate recovery and inhibition of this stimulus normalizes, in part, heart rate recovery.NEW & NOTEWORTHY Augmented sympathoexcitation, via muscle metaboreflex activation, functionally slows heart rate recovery in both young healthy adults and chronically instrumented canines. Furthermore, elevated sympathoexcitation corresponded with lower parasympathetic activity, as assessed by heart rate variability, during the first 3 min of recovery. Finally, sympathoinhibition, via phenylephrine infusion, normalizes heart rate recovery during muscle metaboreflex activation.
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Affiliation(s)
- Natasha G Boyes
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joseph Mannozzi
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Nicole Rapin
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alberto Alvarez
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Mohamed-Hussein Al-Hassan
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Beruk Lessanework
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Dana S Lahti
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - T Dylan Olver
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donal S O'Leary
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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14
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Collard D, Vriend EMC, Galenkamp H, Moll van Charante EP, Vogt L, Westerhof BE, van den Born BJH. Autonomic regulation in different hypertensive phenotypes - the HELIUS study. Blood Press 2023; 32:2270070. [PMID: 37861395 DOI: 10.1080/08037051.2023.2270070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
Background: Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis and may therefore be differently associated with sympathetic activity. We assessed the association between cardiac autonomic function determined from continuous finger BP recordings and hypertensive phenotypes. Methods: We included 10,221 individuals aged between 18-70 years from the multi-ethnic HELIUS study. Finger BP was recorded continuously for 3-5 minutes from which cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) were determined. Hypertension was classified into isolated systolic (ISH; ≥140/<90), diastolic (IDH; <140/≥90) and combined systolic and diastolic hypertension (SDH; ≥140/≥90). Differences were assessed after stratification by age (younger: ≤40, older: >40 years) and sex, using regression with correction for relevant covariates. For xBRS, values were log-transformed. Results: In younger adults with ISH, xBRS was comparable to normotensive individuals in men (ratio 0.92; 95%CI 0.84-1.01) and women (1.00; 95%CI 0.84-1.20), while xBRS was significantly lower in IDH and SDH (ratios between 0.67 and 0.80). In older adults, all hypertensive phenotypes had significantly lower xBRS compared to normotensives. We found a similar pattern for HRV in men, while in women HRV did not differ between phenotypes. Conclusions: In younger men and women ISH is not associated with a shift towards increased sympathetic control, while IDH and SDH in younger and all hypertensive phenotypes in older participants were associated with increased sympathetic control. This suggests that alterations in autonomic regulation could be a contributing factor to known prognostic disparities between hypertensive phenotypes.
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Affiliation(s)
- D Collard
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E M C Vriend
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - H Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - E P Moll van Charante
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - L Vogt
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Nephrology, Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - B E Westerhof
- Amsterdam UMC, University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, The Netherlands
| | - B J H van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
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15
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Tharpe MA, Linder BA, Babcock MC, Watso JC, Pollin KU, Hutchison ZJ, Barnett AM, Culver MN, Kavazis AN, Brian MS, Robinson AT. Adjusting for muscle strength and body size attenuates sex differences in the exercise pressor reflex in young adults. Am J Physiol Heart Circ Physiol 2023; 325:H1418-H1429. [PMID: 37861651 PMCID: PMC10907031 DOI: 10.1152/ajpheart.00151.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Females typically exhibit lower blood pressure (BP) during exercise than males. However, recent findings indicate that adjusting for maximal strength attenuates sex differences in BP during isometric handgrip (HG) exercise and postexercise ischemia (PEI; metaboreflex isolation). In addition, body size is associated with HG strength but its contribution to sex differences in exercising BP is less appreciated. Therefore, the purpose of this study was to determine whether adjusting for strength and body size would attenuate sex differences in BP during HG and PEI. We obtained beat-to-beat BP in 110 participants (36 females, 74 males) who completed 2 min of isometric HG exercise at 40% of their maximal voluntary contraction followed by 3 min of PEI. In a subset (11 females, 17 males), we collected muscle sympathetic nerve activity (MSNA). Statistical analyses included independent t tests and mixed models (sex × time) with covariate adjustment for 40% HG force, height2, and body surface area. Females exhibited a lower absolute 40% HG force than male participants (Ps < 0.001). Females exhibited lower Δsystolic, Δdiastolic, and Δmean BPs during HG and PEI than males (e.g., PEI, Δsystolic BP, 15 ± 11 vs. 23 ± 14 mmHg; P = 0.004). After covariate adjustment, sex differences in BP responses were attenuated. There were no sex differences in MSNA. In a smaller strength-matched cohort, there was no sex × time interactions for BP responses (e.g., PEI systolic BP, P = 0.539; diastolic BP, P = 0.758). Our data indicate that sex differences in exercising BP responses are attenuated after adjusting for muscle strength and body size.NEW & NOTEWORTHY When compared with young males, females typically exhibit lower blood pressure (BP) during exercise. Adjusting for maximal strength attenuates sex differences in BP during isometric handgrip (HG) exercise and postexercise ischemia (PEI), but the contribution of body size is unknown. Novel findings include adjustments for muscle strength and body size attenuate sex differences in BP reactivity during exercise and PEI, and sex differences in body size contribute to HG strength differences.
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Affiliation(s)
- McKenna A Tharpe
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Braxton A Linder
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Matthew C Babcock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
- Division of Geriatric Medicine, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, United States
| | - Joseph C Watso
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Kamila U Pollin
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
- War-Related Injury and Illness Study Center, Veterans Affairs Medical Center, Washington, District of Columbia, United States
| | - Zach J Hutchison
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Alex M Barnett
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Meral N Culver
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Andreas N Kavazis
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Michael S Brian
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
- Department of Kinesiology, University of New Hampshire, Durham, New Hampshire, United States
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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16
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Alyahya AI, Charman SJ, Okwose NC, Fuller AS, Eggett C, Luke P, Bailey K, MacGowan GA, Jakovljevic DG. Heart rate variability and haemodynamic function in individuals with hypertrophic cardiomyopathy. Clin Physiol Funct Imaging 2023; 43:421-430. [PMID: 37293795 DOI: 10.1111/cpf.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Heart rate variability (HRV) is a measure of cardiac autonomic function. This study: (1) evaluated the differences in HRV and haemodynamic function between individuals with hypertrophic cardiomyopathy (HCM) and healthy controls, and (2) determined the relationship between HRV and haemodynamic variables in individuals with HCM. METHODS Twenty-eight individuals with HCM (n = 7, females; age 54 ± 15 years; body mass index: 29 ± 5 kg/m2 ) and 28 matched healthy individuals (n = 7 females; age 54 ± 16 years; body mass index: 29 ± 5 kg/m2 ) completed 5-min HRV and haemodynamic measurements under resting (supine) conditions using bioimpedance technology. Frequency domain HRV measures (absolute and normalized low-frequency power (LF), high-frequency power (HF) and LF/HF ratio) and RR interval were recorded. RESULTS Individuals with HCM demonstrated higher vagal activity (i.e., absolute unit of HF power (7.40 ± 2.50 vs. 6.03 ± 1.35 ms2 , p = 0.01) but lower RR interval (914 ± 178 vs. 1014 ± 168 ms, p = 0.03) compared to controls. Stroke volume (SV) index and cardiac index were lower in HCM compared with healthy individuals (SV, 33 ± 9 vs. 43 ± 7 ml/beat/m², p < 0.01; cardiac index,2.33 ± 0.42 vs. 3.57 ± 0.82 L/min/m2 , p < 0.01), but total peripheral resistance (TPR) was higher in HCM (3468 ± 1027 vs. 2953 ± 1050 dyn·s·m2 cm-5 , p = 0.03). HF power was significantly related to SV (r = -0.46, p < 0.01) and TPR (r = 0.28, p < 0.05) in HCM. CONCLUSIONS Short-term frequency domain indices of HRV provide a feasible approach to assess autonomic function in individuals with HCM. Vagal activity, represented by HF power, is increased, and associated with peripheral resistance in individuals with HCM.
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Affiliation(s)
- Alaa I Alyahya
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Sarah J Charman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nduka C Okwose
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Research Centre for Health and Life Sciences, Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Amy S Fuller
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christopher Eggett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Luke
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kristian Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A MacGowan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Research Centre for Health and Life Sciences, Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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17
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Rizvi MR, Sharma A, Malki A, Sami W. Enhancing Cardiovascular Health and Functional Recovery in Stroke Survivors: A Randomized Controlled Trial of Stroke-Specific and Cardiac Rehabilitation Protocols for Optimized Rehabilitation. J Clin Med 2023; 12:6589. [PMID: 37892727 PMCID: PMC10607659 DOI: 10.3390/jcm12206589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Stroke is a major contributor to disability and mortality globally. It leads to physical impairments, including weakness and cardiovascular deconditioning, posing significant challenges to stroke survivors' quality of life. Exercise-based cardiac rehabilitation has shown promise as a rehabilitation strategy. This study aims to assess and compare the impacts of stroke-specific rehabilitation and individualized cardiac rehabilitation exercises on various health parameters in stroke patients. METHODS A randomized controlled trial was conducted, involving 38 stroke patients aged 40-75 years. Group A received stroke-specific rehabilitation, which consisted of a combination of range of motion exercises, strength training for the paralyzed side, balance and coordination training, gait training, functional mobility exercises, neuromuscular reeducation, and breathing exercises. This program was conducted five days per week for 12 weeks. Group B received individually designed cardiac rehabilitation exercises, in addition to stroke-specific rehabilitation. They engaged in this exercise for at least 30-45 min per day, four days per week, and incorporated two days of resistive training over a 12-week period. Baseline and post-intervention assessments included measures of cardiac autonomic function, balance (Berg Balance Scale), mobility (Timed Up and Go Test), cardiovascular fitness indicators, respiratory parameters, exercise efficiency, and perceived exertion. RESULTS Group B receiving individualized cardio rehab showed significant improvements in balance and mobility compared to Group A receiving conventional stroke-specific rehab. Moreover, Group B exhibited enhanced cardiovascular fitness, respiratory performance, exercise efficiency, and autonomic function post-intervention. Notably, Group A displayed no significant improvements in these parameters. CONCLUSIONS Individualized cardiac rehabilitation exercises demonstrated favorable outcomes in improving certain health parameters, highlighting the potential benefits of individualized rehabilitation strategies for stroke patients.
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Affiliation(s)
- Moattar Raza Rizvi
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad 121001, India; (M.R.R.); (A.S.)
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad 121001, India; (M.R.R.); (A.S.)
| | - Ahmed Malki
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Waqas Sami
- Department of Pre-Clinical Affairs, College of Nursing, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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18
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Oprisan AL, Popescu BO. Dysautonomia in Amyotrophic Lateral Sclerosis. Int J Mol Sci 2023; 24:14927. [PMID: 37834374 PMCID: PMC10573406 DOI: 10.3390/ijms241914927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized in its typical presentation by a combination of lower and upper motor neuron symptoms, with a progressive course and fatal outcome. Due to increased recognition of the non-motor symptoms, it is currently considered a multisystem disorder with great heterogeneity, regarding genetical, clinical, and neuropathological features. Often underestimated, autonomic signs and symptoms have been described in patients with ALS, and various method analyses have been used to assess autonomic nervous system involvement. The aim of this paper is to offer a narrative literature review on autonomic disturbances in ALS, based on the scarce data available to date.
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Affiliation(s)
- Alexandra L Oprisan
- Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Laboratory of Cell Biology, Neurosciences and Experimental Neurology, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania
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19
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Thurston TS, Weavil JC, Georgescu VP, Wan HY, Birgenheier NM, Morrissey CK, Jessop JE, Amann M. The exercise pressor reflex - a pressure-raising mechanism with a limited role in regulating leg perfusion during locomotion in young healthy men. J Physiol 2023; 601:4557-4572. [PMID: 37698303 PMCID: PMC10592099 DOI: 10.1113/jp284870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023] Open
Abstract
We investigated the role of the exercise pressor reflex (EPR) in regulating the haemodynamic response to locomotor exercise. Eight healthy participants (23 ± 3 years,V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ : 49 ± 6 ml/kg/min) performed constant-load cycling exercise (∼36/43/52/98%V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ; 4 min each) without (CTRL) and with (FENT) lumbar intrathecal fentanyl attenuating group III/IV locomotor muscle afferent feedback and, thus, the EPR. To avoid different respiratory muscle metaboreflex and arterial chemoreflex activation during FENT, subjects mimicked the ventilatory response recorded during CTRL. Arterial and leg perfusion pressure (femoral arterial and venous catheters), femoral blood flow (Doppler-ultrasound), microvascular quadriceps blood flow index (indocyanine green), cardiac output (inert gas breathing), and systemic and leg vascular conductance were quantified during exercise. There were no cardiovascular and ventilatory differences between conditions at rest. Pulmonary ventilation, arterial blood gases and oxyhaemoglobin saturation were not different during exercise. Furthermore, cardiac output (-2% to -12%), arterial pressure (-7% to -15%) and leg perfusion pressure (-8% to -22%) were lower, and systemic (up to 16%) and leg (up to 27%) vascular conductance were higher during FENT compared to CTRL. Leg blood flow, microvascular quadriceps blood flow index, and leg O2 -transport and utilization were not different between conditions (P > 0.5). These findings reflect a critical role of the EPR in the autonomic control of the heart, vasculature and, ultimately, arterial pressure during locomotor exercise. However, the lack of a net effect of the EPR on leg blood flow challenges the idea of this cardiovascular reflex as a key determinant of leg O2 -transport during locomotor exercise in healthy, young individuals. KEY POINTS: The role of the exercise pressor reflex (EPR) in regulating leg O2 -transport during human locomotion remains uncertain. We investigated the influence of the EPR on the cardiovascular response to cycling exercise. Lumbar intrathecal fentanyl was used to block group III/IV leg muscle afferents and debilitate the EPR at intensities ranging from 30% to 100%V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ . To avoid different respiratory muscle metaboreflex and arterial chemoreflex activation during exercise with blocked leg muscle afferents, subjects mimicked the ventilatory response recorded during control exercise. Afferent blockade increased leg and systemic vascular conductance, but reduced cardiac output and arterial-pressure, with no net effect on leg blood flow. The EPR influenced the cardiovascular response to cycling exercise by contributing to the autonomic control of the heart and vasculature, but did not affect leg blood flow. These findings challenge the idea of the EPR as a key determinant of leg O2 -transport during locomotor exercise in healthy, young individuals.
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Affiliation(s)
- Taylor S. Thurston
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Joshua C. Weavil
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, UT
| | - Vincent P. Georgescu
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Hsuan-Yu Wan
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | | | | | - Jacob E. Jessop
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | - Markus Amann
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, UT
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DiCriscio AS, Beiler D, Smith J, Asdell P, Dickey S, DiStefano M, Troiani V. Assessment of autonomic symptom scales in patients with neurodevelopmental diagnoses using electronic health record data. Res Autism Spectr Disord 2023; 108:102234. [PMID: 37982012 PMCID: PMC10653282 DOI: 10.1016/j.rasd.2023.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Background Sleep disturbances, gastrointestinal problems, and atypical heart rate are commonly observed in patients with autism spectrum disorder (ASD) and may relate to underlying function of the autonomic nervous system (ANS). The overall objective of the current study was to quantitatively characterize features of ANS function using symptom scales and available electronic health record (EHR) data in a clinically and genetically characterized pediatric cohort. Methods We assessed features of ANS function via chart review of patient records adapted from items drawn from a clinical research questionnaire of autonomic symptoms. This procedure coded for the presence and/or absence of targeted symptoms and was completed in 3 groups of patients, including patients with a clinical neurodevelopmental diagnosis and identified genetic etiology (NPD, n=244), those with an ASD diagnosis with no known genetic cause (ASD, n=159), and age and sex matched controls (MC, n=213). Symptoms were assessed across four main categories: (1) Mood, Behavior, and Emotion; (2) Secretomotor, Sensory Integration; (3) Urinary, Gastrointestinal, and Digestion; and (4) Circulation, Thermoregulation, Circadian function, and Sleep/Wake cycles. Results Chart review scores indicate an increased rate of autonomic symptoms across all four sections in our NPD group as compared to scores with ASD and/or MC. Additionally, we note several significant relationships between individual differences in autonomic symptoms and quantitative ASD traits. Conclusion These results highlight EHR review as a potentially useful method for quantifying variance in symptoms adapted from a questionnaire or survey. Further, using this method indicates that autonomic features are more prevalent in children with genetic disorders conferring risk for ASD and other neurodevelopmental diagnoses.
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Affiliation(s)
- A S DiCriscio
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
| | - D Beiler
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
| | - J Smith
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
- Geisinger Health System, Behavioral Health, Danville, PA, United States
| | - P Asdell
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
- Summa Health, Ohio, United States
| | - S Dickey
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
| | - M DiStefano
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
- Geisinger Health System, Precision Health Program, Danville, PA, United States
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States
| | - V Troiani
- Geisinger Health System, Autism and Developmental Medicine Institute (ADMI), Lewisburg, PA, United States
- Department of Imaging Science and Innovation, Center for Health Research, Danville, PA, United States
- Geisinger Neuroscience Institute, Danville, PA, United States
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
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Faitatzidou D, Dipla K, Theodorakopoulou MP, Koutlas A, Tsitouridis A, Dimitriadis C, Pateinakis P, Zafeiridis A, Papagianni A, Jadoul M, Sarafidis P. Heart rate variability at rest and in response to stress: Comparative study between hemodialysis and peritoneal dialysis patients. Exp Biol Med (Maywood) 2023; 248:1745-1753. [PMID: 37916412 PMCID: PMC10792413 DOI: 10.1177/15353702231198081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/10/2023] [Indexed: 11/03/2023] Open
Abstract
Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD). Autonomic nervous system (ANS) dysfunction contributes to this arrhythmogenic background. This study compared heart rate variability (HRV) indices between hemodialysis (HD) and peritoneal dialysis (PD) patients, both at rest and in response to mental and physical stimulation maneuvers. Thirty-four HD and 34 PD patients matched for age, sex, and dialysis vintage, and 17 age- and sex-matched controls were studied. ANS function was examined by linear and non-linear HRV indices. Heart rate was recorded continuously (Finometer-PRO) at rest and during ANS maneuvers (orthostatic, mental-arithmetic, sit-to-stand, handgrip exercise tests). At rest, no significant differences between HD and PD were observed in HRV (root mean square of successive differences [RMSSD]: HD = 57.1 ± 81.1 vs PD = 69.6 ± 113.4 ms; P = 0.792), except for detrended fluctuation analysis (DFA-α1) (HD = 0.87 ± 0.40 vs PD = 0.70 ± 0.20; P = 0.047). DFA-α1 was significantly lower in PD than controls (1.00 ± 0.33; P < 0.05). All HRV indices during the mental-arithmetic test (RMSSD: HD = 128.2 ± 346.0 vs PD = 87.5 ± 150.0 ms; P = 0.893) and the physical stress tests were similar between HD and PD. The standard deviation along the line-of-identity (SD2)/the standard deviation perpendicular to the line-of-identity (SD1) ratio during mental-arithmetic was marginally lower in HD and significantly lower in PD than controls (PD = 1.31 ± 0.47 vs controls = 1.79 ± 0.64; P < 0.05). Both dialysis groups presented similar patterns in HRV responses during orthostatic and handgrip exercise tests. After the sit-to-stand, RMSSD, SD1, SD2, and DFA-α2 were higher compared to rest only in HD (RMSSD = 57.1 ± 81.1 vs 126.7 ± 185.7 ms; P = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function in response to physical stress. In conclusion, HRV indices at rest and after mental and physical stimulation did not differ between HD and PD; however, the ANS responses following the sit-to-stand test were more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality, but small differences in normal ANS recovery may exist.
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Affiliation(s)
- Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki GR57001, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
| | - Aggelos Koutlas
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki GR57001, Greece
| | - Alexandros Tsitouridis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
| | - Chrysostomos Dimitriadis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
| | - Panagiotis Pateinakis
- Department of Nephrology, Papageorgiou General Hospital, Thessaloniki GR56429, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki GR57001, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels B-1200, Belgium
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki GR54642, Greece
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Siddiqui MS, Dev V, Khandelwal E. Cardiac Autonomic Neuropathy in Newly Diagnosed Patients With Type 2 Diabetes Mellitus. Cureus 2023; 15:e47366. [PMID: 38022011 PMCID: PMC10657480 DOI: 10.7759/cureus.47366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Cardiac autonomic neuropathy (CAN) is a debilitating complication in diabetes mellitus, leading to life-threatening arrhythmias and various impairments. Its prevalence varies widely, and early detection and management are crucial. This study investigates the prevalence of CAN in newly diagnosed type 2 diabetes mellitus patients in Central India, comparing them to a control group. METHODOLOGY This case-control study included 35 newly diagnosed type 2 diabetes mellitus patients and 35 age-matched healthy controls from the general population. Cardiac autonomic function testing (AFT) was done by heart rate variability (HRV), the deep breathing test (DBT), the cold pressor test (CPT), and the lying-to-standing test (LST). Parameters were recorded and analyzed using statistical tests. RESULTS Patients with type 2 diabetes mellitus had significantly higher weight, BMI, fasting blood sugar, post-prandial blood sugar, urine albumin-creatinine ratios, and systolic and diastolic blood pressure than controls. Abnormalities in HRV and E: I ratio during the DBT and CPT were more prevalent in these patients. Parasympathetic dysfunction (delta HR) and a lower E: I ratio were also significantly high in this group. Also, LST results suggested a greater likelihood of orthostatic symptoms in the patients' group. CONCLUSION This study highlights the importance of AFT in diagnosing early CAN in newly diagnosed patients. Early diagnosis and management of diabetic CAN are essential to prevent complications.
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Affiliation(s)
- Md Sabah Siddiqui
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Vishnu Dev
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ekta Khandelwal
- Physiology/Autonomic & Vascular Functions, All India Institute of Medical Sciences, Raipur, Raipur, IND
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23
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Ferreira M, Laranjo S, Cunha P, Geraldes V, Oliveira M, Rocha I. Orthostatic Stress and Baroreflex Sensitivity: A Window into Autonomic Dysfunction in Lone Paroxysmal Atrial Fibrillation. J Clin Med 2023; 12:5857. [PMID: 37762798 PMCID: PMC10532155 DOI: 10.3390/jcm12185857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The abnormal neural control of atria has been considered one of the mechanisms of paroxysmal atrial fibrillation (PAF) pathogenesis. The baroreceptor reflex has an important role in cardiovascular regulation and may serve as an index of autonomic function. This study aimed to analyze the baroreceptor reflex's role in heart rate regulation during upright tilt (HUT) in patients with lone PAF. The study included 68 patients with lone PAF and 34 healthy individuals who underwent baroreflex assessment. Parameters such as baroreflex sensitivity (BRS), number of systolic blood pressure (BP) ramps, and the baroreflex effectiveness index (BEI) were evaluated. The study found that PAF patients had comparable resting BPs and heart rates (HRs) to healthy individuals. However, unlike healthy individuals, PAF patients showed a sustained increase in BP with an upright posture followed by the delayed activation of the baroreceptor function with a blunted HR response and lower BEI values. This indicates a pronounced baroreflex impairment in PAF patients, even at rest. Our data suggest that together with BRS, BEI could be used as a marker of autonomic dysfunction in PAF patients, making it important to further investigate its relationship with AF recurrence after ablation and its involvement in cardiovascular autonomic remodeling.
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Affiliation(s)
- Mónica Ferreira
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Pedro Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
| | - Vera Geraldes
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
| | - Mário Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
| | - Isabel Rocha
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
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Tattersall MC, Hughey CM, Piasecki TM, Korcarz CE, Hansen KM, Ott NR, Sandbo N, Fiore MC, Baker TB, Stein JH. Cardiovascular and Pulmonary Responses to Acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-Term Users. Chest 2023; 164:757-769. [PMID: 37044158 PMCID: PMC10504598 DOI: 10.1016/j.chest.2023.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/14/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The acute cardiovascular and pulmonary effects of contemporary electronic nicotine delivery systems (ENDS) in long-term users are not known. RESEARCH QUESTION What are the cardiovascular and pulmonary responses to an acute 15-min product use challenge with ENDS and combustible cigarettes in regular nicotine-containing product users compared with control participants who do not use tobacco or vape? STUDY DESIGN AND METHODS Observational challenge study before and after nicotine-containing product use of 395 individuals who used ENDS exclusively (n = 164; exhaled carbon monoxide level, < 5 parts per million [ppm]; positive urine NicCheck I [Mossman Associates] results, 82%; fourth-generation ENDS), participants who smoked cigarettes exclusively (n = 117; carbon monoxide level, > 5 ppm; positive urine NicCheck I results), and control participants (n = 114; carbon monoxide level, < 5 ppm; negative urine NicCheck I results). RESULTS During the 15-min product challenge, cigarette users took a median of 14.0 puffs (interquartile range [IQR], 9.3 puffs); ENDS users took 9.0 puffs (IQR, 7.5 puffs; P < .001). After product challenge, compared with control participants, ENDS users showed greater increases in adjusted mean differences in systolic BP (5.6 mm Hg [95% CI, 4.4-6.8 mm Hg] vs 2.3 mm Hg [95% CI, 0.8-3.8 mm Hg]; P = .001), diastolic BP (4.2 mm Hg [95% CI, 3.3-5.0 mm Hg] vs 2.0 mm Hg [95% CI, 1.1-3.0 mm Hg; P = .003), and heart rate (4.8 beats/min [95% CI, 4.0-5.6 beats/min] vs -1.3 beats/min [95% CI, -2.2 to -0.3 beats/min]; P < .001) and greater reductions in brachial artery diameter (-0.011 cm [95% CI, -0.013 to 0.009 cm] vs -0.006 cm [95% CI, -0.004 to -0.009 cm]; P = .003), time-domain heart rate variability (-7.2 ms [95% CI, -10.5 to -3.7 ms] vs 3.6 ms [95% CI, 1.6-9.3 ms]; P = .001), and FEV1 (ENDS: -4.1 [95% CI, -5.4 to -2.8] vs control participants: -1.1 [95% CI, -2.7 to 0.6]; P = .005) with values similar to those of cigarette users. ENDS users performed worse than control participants on all exercise parameters, notably metabolic equivalents (METs; adjusted mean difference, 1.28 METs [95% CI, 0.73-1.83 METs]; P < .001) and 60-s heart rate recovery (adjusted mean difference, 2.9 beats/min [95% CI, 0.7-5.0 beats/min]; P = .008). INTERPRETATION ENDS users had acute worsening of blood pressure, heart rate, and heart rate variability, as well as vasoconstriction, impaired exercise tolerance, and increased airflow obstruction after vaping, compared to control participants. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03863509; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christina M Hughey
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Thomas M Piasecki
- University of Wisconsin Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Claudia E Korcarz
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristin M Hansen
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy R Ott
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nathan Sandbo
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael C Fiore
- University of Wisconsin Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Timothy B Baker
- University of Wisconsin Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James H Stein
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Van de Winckel A, Carpentier ST, Deng W, Zhang L, Philippus A, Battaglino R, Morse LR. Feasibility of using remotely delivered Spring Forest Qigong to reduce neuropathic pain in adults with spinal cord injury: a pilot study. Front Physiol 2023; 14:1222616. [PMID: 37719467 PMCID: PMC10500194 DOI: 10.3389/fphys.2023.1222616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction: Approximately 69% of 299,000 Americans with spinal cord injury (SCI) suffer debilitating chronic neuropathic pain, which is intractable to treatment. The aim of this study is to determine feasibility, as the primary objective, and estimates of efficacy of a remotely delivered Qigong intervention in adults with SCI-related neuropathic pain, as the secondary objective. Methods: We recruited adults with SCI-related neuropathic pain, with SCI ≥3 months, with complete or incomplete SCI, and highest neuropathic pain level of >3 on the Numeric Pain Rating Scale (NPRS), using nationwide volunteer sampling. Using a non-randomized controlled trial design, participants practiced Spring Forest Qigong's "Five Element Qigong Healing Movements" (online video) by combining movement to the best of their ability with kinesthetic imagery, at least 3x/week for 12 weeks. Adherence was automatically tracked through the Spring Forest Qigong website. Outcomes of neuropathic pain intensity (NPRS) were assessed weekly, and SCI-related symptoms were assessed at baseline, 6, and 12 weeks of Qigong practice and at 6-week and 1-year follow-ups. Results: We recruited 23 adults with chronic SCI (7/2021-2/2023). In total, 18 participants started the study and completed all study components, including the 6-week follow-up. Twelve participants completed the 1-year follow-up assessment. Feasibility was demonstrated through participants' willingness to participate, adherence, and acceptability of the study. Mean age of the 18 participants was 60 ± 12 years, and they were 15 ± 11 years post-SCI with the highest baseline neuropathic pain of 7.94 ± 2.33, which was reduced to 4.17 ± 3.07 after 12 weeks of Qigong practice (Cohen's d = 1.75). This pain relief remained at 6-week and 1-year follow-ups. Participants reported reduced spasm frequency (change score 1.17 ± 1.20, d = 0.98) and severity (0.72 ± 1.02, d = 0.71), reduced interference of neuropathic pain on mood (3.44 ± 2.53, d = 1.36), sleep (3.39 ± 2.40, d = 1.41), daily activities (3.17 ± 2.77, d = 1.14), greater ability to perform functional activities (6.68 ± 3.07, d = 2.18), and improved mood (2.33 ± 3.31, d = 0.70) after Qigong. Discussion: Remote Spring Forest Qigong's "Five Element Qigong Healing Movements" practice is feasible in adults with SCI-related neuropathic pain, with promising prolonged results of neuropathic pain relief and improvement in SCI-related symptoms after Qigong practice. Clinical trial registration: https://www.clinicaltrials.gov/ct2/show/NCT04917107, identifier NCT04917107.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Sydney T. Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Angela Philippus
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Leslie R. Morse
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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Vágvölgyi A, Ábrahám JE, Máthéné Köteles É, Korom A, Barnai M, Szűcs M, Orosz A, Kempler P, Menyhárt A, Nemes A, Várkonyi T, Baczkó I, Kósa I, Lengyel C. A three-month physical training program improves cardiovascular autonomic function in patients with metabolic syndrome with and without diabetes - a pilot study. Front Endocrinol (Lausanne) 2023; 14:1224353. [PMID: 37664832 PMCID: PMC10469893 DOI: 10.3389/fendo.2023.1224353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Vascular complications and neuropathy may develop in the presence of metabolic syndrome. The aim of our study was to measure the cardiovascular autonomic function following physical training in patients with metabolic syndrome with and without diabetes. Subjects and methods 56 patients with metabolic syndrome (32 men/24 women, 40 non-diabetic patients (NDMetS)/16 diabetic patients (DMetS) [mean ± SD]: age: 50.35 ± 8.03 vs. 56.8 ± 9.30 years, p=0.023; baseline BMI: 32.2 ± 7.03 vs. 32.8 ± 5.94 kg/m2, p=0.739) were involved in our study. All tests and measurements were carried out before and following a 3-month physical training period. Autonomic function was assessed by means of five standard cardiovascular reflex tests. ECG repolarization parameters, including short-term QT variability and stress-ECG were also measured. Results In the whole population, Valsalva-ratio (VR) and the autonomic score (AS) improved following training (VR: 1.49 ± 0.24 vs. 1.64 ± 0.34, p=0.001; AS: 2.05 ± 1.73 vs. 1.41 ± 1.36, p=0.015) accompanied by the significant decrease of the systolic (150.3 ± 16.12 vs. 134.1 ± 16.67 mmHg, p<0.001) and diastolic (90.64 ± 12.8 vs. 82.79 ± 11.1 mmHg, p<0.001) blood pressure. An improvement in VR was detected in NDMetS patients following training (1.51 ± 0.24 vs. 1.67 ± 0.31, p= 0.002). No significant changes could be detected in autonomic tests' results in the DMetS patient group following training. The applied exercise training program did not lead to significant changes in ECG repolarization. The stress-ECG test in the whole study population yielded a significant increase in the test duration (12.9 ± 3.76 vs. 15.1 ± 2.96 min, p<0.001) and in the test load (10.5 ± 2.78 vs. 11.6 ± 2.39 MET, p<0.001). The load capability improved significantly in both subgroups: 11.1 ± 2.04 vs. 12.1 ± 1.82, (p<0.001) and 9.0 ± 3.64 vs. 10.4 ± 3.05, (p=0.033) in subpopulations of NDMetS and DMetS, respectively. The DMetS patients achieved a significantly lower MET score at baseline (p=0.039) and following training (p=0.044) in comparison to the NDMetS patients. Conclusion The three-month exercise program improved the Valsalva-ratio and the AN score in the MetS patients, that is potentially protective against cardiovascular events. The training had some beneficial effect on blood pressure and the results of the stress-ECG tests in both groups. The absence of significant change in the reflex tests in DMetS group reflects an impaired adaptation compared to the NDMestS group.
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Affiliation(s)
- Anna Vágvölgyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Judit Erzsébet Ábrahám
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Éva Máthéné Köteles
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Andrea Korom
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mária Barnai
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- Department of Oncology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Adrienn Menyhárt
- Department of Oncology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Várkonyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Kósa
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Mathieu NM, Fekete EM, Muskus PC, Brozoski DT, Lu KT, Wackman KK, Gomez J, Fang S, Reho JJ, Grobe CC, Vazirabad I, Mouradian GC, Hodges MR, Segar JL, Grobe JL, Sigmund CD, Nakagawa P. Genetic Ablation of Prorenin Receptor in the Rostral Ventrolateral Medulla Influences Blood Pressure and Hydromineral Balance in Deoxycorticosterone-Salt Hypertension. Function (Oxf) 2023; 4:zqad043. [PMID: 37609445 PMCID: PMC10440998 DOI: 10.1093/function/zqad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
Non-enzymatic activation of renin via its interaction with prorenin receptor (PRR) has been proposed as a key mechanism of local renin-angiotensin system (RAS) activation. The presence of renin and angiotensinogen has been reported in the rostral ventrolateral medulla (RVLM). Overactivation of bulbospinal neurons in the RVLM is linked to hypertension (HTN). Previous studies have shown that the brain RAS plays a role in the pathogenesis of the deoxycorticosterone (DOCA)-salt HTN model. Thus, we hypothesized that PRR in the RVLM is involved in the local activation of the RAS, facilitating the development of DOCA-salt HTN. Selective PRR ablation targeting the RVLM (PRRRVLM-Null mice) resulted in an unexpected sex-dependent and biphasic phenotype in DOCA-salt HTN. That is, PRRRVLM-Null females (but not males) exhibited a significant delay in achieving maximal pressor responses during the initial stage of DOCA-salt HTN. Female PRRRVLM-Null subsequently showed exacerbated DOCA-salt-induced pressor responses during the "maintenance" phase with a maximal peak at 13 d on DOCA-salt. This exacerbated response was associated with an increased sympathetic drive to the resistance arterioles and the kidney, exacerbated fluid and sodium intake and output in response to DOCA-salt, and induced mobilization of fluids from the intracellular to extracellular space concomitant with elevated vasopressin. Ablation of PRR suppressed genes involved in RAS activation and catecholamine synthesis in the RVLM but also induced expression of genes involved in inflammatory responses. This study illustrates complex and sex-dependent roles of PRR in the neural control of BP and hydromineral balance through autonomic and neuroendocrine systems. Graphical abstract.
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Affiliation(s)
- Natalia M Mathieu
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Eva M Fekete
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Patricia C Muskus
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Daniel T Brozoski
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ko-Ting Lu
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kelsey K Wackman
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Javier Gomez
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shi Fang
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - John J Reho
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Connie C Grobe
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ibrahim Vazirabad
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Gary C Mouradian
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Matthew R Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jeffrey L Segar
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Justin L Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Curt D Sigmund
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Pablo Nakagawa
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Luck JC, Blaha C, Cauffman A, Gao Z, Arnold AC, Cui J, Sinoway LI. Autonomic and vascular function testing in collegiate athletes following SARS-CoV-2 infection: an exploratory study. Front Physiol 2023; 14:1225814. [PMID: 37528892 PMCID: PMC10389084 DOI: 10.3389/fphys.2023.1225814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction: Recent studies suggest that SARS-CoV-2 infection alters autonomic and vascular function in young, otherwise healthy, adults. However, whether these alterations exist in young competitive athletes remains unknown. This study aimed to assess the effects of COVID-19 on cardiac autonomic control and vascular function in collegiate athletes who tested positive for COVID-19, acknowledging the limitations imposed by the early stages of the pandemic. Methods: Sixteen collegiate athletes from various sports underwent a battery of commonly used autonomic and vascular function tests (23 ± 9, range: 12-44 days post-infection). Additionally, data from 26 healthy control participants were included. Results: In response to the Valsalva maneuver, nine athletes had a reduced early phase II blood pressure response and/or reduced Valsalva ratio. A depressed respiratory sinus arrhythmia amplitude was observed in three athletes. Three athletes became presyncopal during standing and did not complete the 10-min orthostatic challenge. Brachial artery flow-mediated dilation, when allometrically scaled to account for differences in baseline diameter, was not different between athletes and controls (10.0% ± 3.5% vs. 7.1% ± 2.4%, p = 0.058). Additionally, no differences were observed between groups when FMD responses were normalized by shear rate (athletes: 0.055% ± 0.026%/s-1, controls: 0.068% ± 0.049%/s-1, p = 0.40). Discussion: Few atypical and borderline responses to autonomic function tests were observed in athletes following an acute SARS-CoV-2 infection. The most meaningful autonomic abnormality being the failure of three athletes to complete a 10-min orthostatic challenge. These findings suggest that some athletes may develop mild alterations in autonomic function in the weeks after developing COVID-19, while vascular function is not significantly impaired.
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Affiliation(s)
- J. Carter Luck
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Cheryl Blaha
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Aimee Cauffman
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Zhaohui Gao
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Amy C. Arnold
- Department of Neural and Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Jian Cui
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Lawrence I. Sinoway
- Milton S. Hershey Medical Center, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States
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Wan Y, Lv M, Zhou K, Li Z, Du X, Wu W, Xue R. Mood Disorders are Correlated with Autonomic Nervous Function in Chronic Insomnia Patients with OSA. Nat Sci Sleep 2023; 15:511-522. [PMID: 37426309 PMCID: PMC10327906 DOI: 10.2147/nss.s396773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/21/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To evaluate the correlation between sleep microstructure, autonomic nervous system activity, and neuropsychological characteristics in chronic insomnia (CI) patients with obstructive sleep apnea (OSA). Patients and Methods Forty-five CI-OSA patients, forty-six CI patients and twenty-two matched healthy control subjects (HCs) were enrolled. CI-OSA patients were then divided into two groups: mild OSA and moderate-to-severe OSA. All participants completed neuropsychological tests, which included the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Mini-mental State Examination (MMSE). The autonomic nervous system activity and sleep microstructure were examined by the PSM-100A. Results The CI-OSA patients exhibited higher scores on the PSQI, ESS, ISI, HAMA, and HAMD than HCs and CI patients (all p < 0.01). The CI-OSA patients had a lower proportion of stable sleep, REM sleep and a higher proportion of unstable sleep ratio (all p < 0.01) than HCs and CI patients (all p < 0.01). The CI-OSA patients had higher ratios of LF and LF/HF, and lower ratios of HF and Pnn50% (all p < 0.01) than HCs and CI patients (all p < 0.01). Compared to CI-mild OSA patients, the CI-moderate-to-severe OSA patients presented with a higher ESS scores, higher ratios of LF and LF/HF, and lower ratios of HF (all p < 0.05). In CI-OSA patients, higher HAMD scores were correlated with decreased MMSE scores (r=-0.678, p < 0.01). A higher LF ratio was correlated with higher HAMD and HAMA scores (r=0.321, p=0.031, r =0.449, p =0.002), and a higher HF ratio was correlated with lower HAMD and HAMA scores (r=-0.321, P =0.031, r =-0.449, p =0.002). Conclusion OSA exacerbates the abnormalities of sleep microstructure and the autonomic nervous dysfunction in CI patients. Dysfunction of the autonomic nervous system could contribute to mood deterioration in CI with OSA patients.
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Affiliation(s)
- Yahui Wan
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Mengdi Lv
- Departments of Neurology, Tianjin First Central Hospital, Tianjin, 300190, People’s Republic of China
| | - Kaili Zhou
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Zheng Li
- Departments of Neurology, Binhai Hospital, Peking University, Tianjin, 300450, People’s Republic of China
| | - Xueyun Du
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Wei Wu
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Rong Xue
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
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Seeley MC, Gallagher C, Ong E, Langdon A, Chieng J, Bailey D, Page A, Lim HS, Lau DH. High incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with long-COVID: Implications for management and healthcare planning. Am J Med 2023:S0002-9343(23)00402-3. [PMID: 37391116 PMCID: PMC10307671 DOI: 10.1016/j.amjmed.2023.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Autonomic dysfunction including postural orthostatic tachycardia syndrome (POTS) has been reported in individuals with post-acute sequelae of Covid-19 (PASC). However, the degree of dysautonomia in PASC has not been compared to those with POTS and healthy controls. METHODS All participants were prospectively enrolled between 5th August 2021 and 31st October 2022. Autonomic testing included beat-to-beat hemodynamic monitoring to assess respiratory sinus arrhythmia, Valsalva ratio and orthostatic changes during a 10-minute active standing test as well as Sudomotor assessment. The Composite Autonomic Symptom Score (COMPASS-31) was used to assess symptoms and the Euroquol 5-Dimension survey (EQ-5D-5L) was used to assess health-related quality of life (HrQoL) measures. RESULTS A total of 99 participants (n=33 PASC, n=33 POTS and n=33 healthy controls; median age 32 [18], 85.9% females) were included. Compared to healthy controls, the PASC and POTS cohorts demonstrated significantly reduced respiratory sinus arrhythmia (p<0.001), greater heart rate increase during 10-minute active standing test (p<0.001), greater burden of autonomic dysfunction evidenced by higher COMPASS-31 scores across all subdomains (all p<0.001) and poor HrQoL across all EQ-5D-5L domains (all p<0.001), lower median EQ-VAS (p<0.001) and lower utility scores (p<0.001). The majority (79%) of those with PASC met the internationally established criteria for POTS. CONCLUSION The prevalence of autonomic symptomology or POTS was high in those with PASC, leading to poor HrQoL and high health disutility. Autonomic testing should be routinely undertaken in those with PASC to aid diagnosis and direct appropriate management to improve health outcomes. TRIAL REGISTRATION ANZCTR 12621000476831.
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Affiliation(s)
- Marie-Claire Seeley
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; South Australian Health and Medical Research Institute
| | - Celine Gallagher
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; South Australian Health and Medical Research Institute
| | - Eric Ong
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Amy Langdon
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Jonathan Chieng
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide
| | - Danielle Bailey
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide
| | - Amanda Page
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; South Australian Health and Medical Research Institute; College of Medicine and Public Health, Flinders University, South Australia, Australia; The University of Melbourne, Austin and Northern Health, Victoria, Australia
| | - Han S Lim
- The University of Melbourne, Austin and Northern Health, Victoria, Australia
| | - Dennis H Lau
- Australian Dysautonomia and Arrhythmia Research Collaborative, Faculty of Health and Medical Sciences, The University of Adelaide; South Australian Health and Medical Research Institute.
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Boyes NG, Nelson MD, Palmero-Canton A, Luchkanych AMS, Khan R, Bare I, Haddad T, Abdalla S, Marshall RA, Morse CJ, Zhai A, Haddad H, Marciniuk D, Karjala G, Olver TD, Tomczak CR. Muscle metaboreflex control of left ventricular systolic function in heart failure with reduced ejection fraction. J Appl Physiol (1985) 2023. [PMID: 37348013 DOI: 10.1152/japplphysiol.00074.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Heart failure with reduced ejection fraction (HFrEF) exhibits exaggerated sympathoexcitation and altered cardiac and vascular responses to muscle metaboreflex activation (MMA). However, left ventricular (LV) responses to MMA are not well studied in patients with HFrEF. The purpose of this study was to examine LV function during MMA using cardiac magnetic resonance imaging (MRI) in patients with HFrEF. METHODS Thirteen patients with HFrEF and 18 healthy age-matched controls underwent cardiac MRI during rest and MMA. MMA protocol included 6-min of isometric handgrip exercise followed by 6-min of brachial post-exercise circulatory occlusion. LV stroke volume index (SVi), end-systolic volume index (ESVi), end-diastolic volume index (EDVi) and global longitudinal strain (GLS) were measured by 2- and 4-chamber cine images. Volumes were indexed to body surface area. Heart rate (via ECG) and brachial mean arterial pressure (MAP) were recorded. Cardiac output and total peripheral resistance (TPR) were calculated. RESULTS SVi decreased during MMA in HFrEF (P=0.037) but not controls (P=0.392). ESVi (P=0.007) and heart rate (P<0.001) increased during MMA in HFrEF but not controls (P≥0.170). TPR (P=0.021) and MAP (P<0.001) increased during MMA in both groups. Cardiac output (P=0.946), EDVi (P=0.177), and GLS (P=0.619) were maintained from rest to MMA in both groups. CONCLUSIONS Despite similarly maintained cardiac output, LV strain, and increased TPR in HFrEF and control groups, SVi decreased, and heart rate increased during MMA in patients with HFrEF. These findings suggest an impaired contractility reserve in response to increased TPR during MMA in HFrEF.
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Affiliation(s)
- Natasha G Boyes
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
| | - Alberto Palmero-Canton
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
| | - Adam M S Luchkanych
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rafique Khan
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Idris Bare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tony Haddad
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sherif Abdalla
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rory A Marshall
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cameron J Morse
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alexander Zhai
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Haissam Haddad
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Darcy Marciniuk
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Geoffrey Karjala
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - T Dylan Olver
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Pan S, Karey E, Nieves-Cintron M, Chen YJ, Hwang SH, Hammock BD, Pinkerton KE, Chen CY. Effects of chronic secondhand smoke exposure on cardiovascular regulation and the role of soluble epoxide hydrolase in mice. Front Physiol 2023; 14:1185744. [PMID: 37362438 PMCID: PMC10285070 DOI: 10.3389/fphys.2023.1185744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Secondhand smoke (SHS) is a significant risk factor for cardiovascular morbidity and mortality with an estimated 80% of SHS-related deaths attributed to cardiovascular causes. Public health measures and smoking bans have been successful both in reducing SHS exposure and improving cardiovascular outcomes in non-smokers. Soluble epoxide hydrolase (sEH) inhibitors have been shown to attenuate tobacco exposure-induced lung inflammatory responses, making them a promising target for mitigating SHS exposure-induced cardiovascular outcomes. Objectives: The objectives of this study were to determine 1) effects of environmentally relevant SHS exposure on cardiac autonomic function and blood pressure (BP) regulation and 2) whether prophylactic administration of an sEH inhibitor (TPPU) can reduce the adverse cardiovascular effects of SHS exposure. Methods: Male C57BL/6J mice (11 weeks old) implanted with BP/electrocardiogram (ECG) telemetry devices were exposed to filtered air or 3 mg/m3 of SHS (6 hr/d, 5 d/wk) for 12 weeks, followed by 4 weeks of recovery in filtered air. Some mice received TPPU in drinking water (15 mg/L) throughout SHS exposure. BP, heart rate (HR), HR variability (HRV), baroreflex sensitivity (BRS), and BP variability were determined monthly. Results: SHS exposure significantly decreased 1) short-term HRV by ∼20% (p < 0.05) within 4 weeks; 2) overall HRV with maximum effect at 12 weeks (-15%, p < 0.05); 3) pulse pressure (-8%, p < 0.05) as early as week 4; and 4) BRS with maximum effect at 12 weeks (-11%, p < 0.05). Four weeks of recovery following 12 weeks of SHS ameliorated all SHS-induced cardiovascular detriments. Importantly, mice exposed to TPPU in drinking water during SHS-related exposure were protected from SHS cardiovascular consequences. Discussion: The data suggest that 1) environmental relevant SHS exposure significantly alters cardiac autonomic function and BP regulation; 2) cardiovascular consequences from SHS can be reversed by discontinuing SHS exposure; and 3) inhibiting sEH can prevent SHS-induced cardiovascular consequences.
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Affiliation(s)
- Shiyue Pan
- Department of Pharmacology, University of California Davis, Davis, CA, United States
| | - Emma Karey
- Department of Pharmacology, University of California Davis, Davis, CA, United States
| | | | - Yi-Je Chen
- Department of Pharmacology, University of California Davis, Davis, CA, United States
| | - Sung Hee Hwang
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Center, University of California Davis, Davis, CA, United States
| | - Bruce D. Hammock
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Center, University of California Davis, Davis, CA, United States
| | - Kent E. Pinkerton
- Center for Health and the Environment, University of California Davis, Davis, CA, United States
| | - Chao-Yin Chen
- Department of Pharmacology, University of California Davis, Davis, CA, United States
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Shafiq MA, Ellingson CA, Krätzig GP, Dorsch KD, Neary JP, Singh J. Differences in Heart Rate Variability and Baroreflex Sensitivity between Male and Female Athletes. J Clin Med 2023; 12:3916. [PMID: 37373610 DOI: 10.3390/jcm12123916] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Heart rate variability (HRV), systolic blood pressure variability (BPV), and spontaneous baroreflex sensitivity (BRS) are indirect and approximate measures of autonomic regulation of the cardiovascular system. Studies have shown differences in HRV and BRS between males and females; however, no study has observed differences in BPV, HRV, or BRS between male and female athletes. One hundred males (age 21.2 ± 2.1 y; BMI 27.4 ± 4.5 kg/m2) and sixty-five females (age: 19.7 ± 1.6 y; BMI 22.7 ± 2.2 kg/m2) were assessed during the pre-season baseline. We collected resting beat-to-beat blood pressure and R-R intervals using finger photoplethysmography and a 3-lead electrocardiogram, respectively. Participants underwent a controlled slow breathing protocol (six breaths/minute: 5 s inhale, 5 s exhale) for 5 min. Spectral and linear analysis was conducted on blood pressure and ECG data. Regression curves were fitted to the blood pressure and R-R signals, with the slopes providing the BRS parameters. Male athletes had significantly (p < 0.05) lower mean heart rate, RR interval SD2/SD1, HRV % low-frequency, and higher BP high-frequency power during controlled respiration. No differences were found in any BRS parameters. HRV and BPV responses to a slow breathing protocol differed between male and female athletes; however, BRS responses did not.
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Affiliation(s)
- M Abdullah Shafiq
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Cody A Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Gregory P Krätzig
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Kim D Dorsch
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
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Mondal H, Kumar M. Heart Rate Variability in Normotensive and Hypertensive Adults After a Year of Receiving Oxford/AstraZeneca COVID-19 Vaccine: A Cross-Sectional Observational Study. Cureus 2023; 15:e40010. [PMID: 37425583 PMCID: PMC10328452 DOI: 10.7759/cureus.40010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aim Heart rate variability (HRV) helps in assessing the autonomic nervous system's function, which has been implicated in cardiovascular disease risk. HRV has been found to be deranged in hypertension. In addition, studies have shown that COVID-19 infection and vaccination can affect HRV. However, the long-term effect of HRV on hypertension has not been explored after COVID-19 vaccination. The objective of this study was to observe the HRV in hypertensive adults after one year of receiving the Oxford/AstraZeneca COVID-19 vaccine and to compare it with normotensive adults. Methods The study included 105 normotensives (blood pressure below 120/80 mmHg) and 75 hypertensive participants who had received the Oxford/AstraZeneca COVID-19 vaccine one year prior. HRV was measured using the PowerLab system (ADInstruments) with the participants in a sitting posture. The HRV parameters assessed included the time domain, frequency domain, and nonlinear measures. Data were presented in descriptive and inferential statistical terms, and the parameters of two groups of individuals were compared by either an unpaired t-test or the Mann-Whitney U test. Results A total of 105 normotensive participants with a mean age of 42.51 ± 9.28 years and 75 hypertensive participants with a mean age of 44.24 ± 10.19 years comprised the sample (p=0.24). Normotensive individuals had a higher standard deviation of RR intervals, a higher coefficient of variation of RR intervals, a higher standard deviation of heart rate, and a higher percentage of successive differences in RR intervals in the time domain. They also had higher values of very low-frequency power, low-frequency (LF) power, and high-frequency (HF) power in the frequency domain. The LF/HF ratio was not significantly different between the two groups. In nonlinear analysis, SD2, a measure of long-term heart rate variability, was higher in normotensive individuals. Conclusion The Oxford/AstraZeneca COVID-19 vaccine did not have a significant effect on HRV parameters in normotensive and hypertensive adults one year after vaccination. However, changes in HRV parameters were observed between supine and standing positions, suggesting the importance of postural changes in HRV assessment.
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Affiliation(s)
- Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, IND
| | - Manish Kumar
- Physiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Costa T, Rushton SP, Watson S, Ng WF. Depression in Sjögren's syndrome mediates the relationship between pain, fatigue, sleepiness, and overall quality of life. Rheumatol Immunol Res 2023; 4:78-89. [PMID: 37818348 PMCID: PMC10561071 DOI: 10.2478/rir-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/28/2023] [Indexed: 10/12/2023]
Abstract
Objectives Sjögren's syndrome (SS) includes many extra-glandular symptoms such as fatigue, pain, sleepiness and depression, which impact on quality of life (QoL). These symptoms also influence each other and could be linked by autonomic nervous system (ANS) dysregulation. Our aim was to model the role of putative predictive variables, including depression in the relationships between ANS function, fatigue, and QoL in SS. Methods Cross-sectional analysis of self-reported data from the multicentre UK primary SS registry. The Composite Autonomic Symptom Scale (COMPASS) was used to assess autonomic function, the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and the EuroQol-5 Dimension (EQ-5D) to assess QoL. Validated scales were used for other clinical variables. Using multiple regression analysis and structural equation modelling (SEM), we investigated how the QoL of people with SS is impacted by the direct and indirect effects of fatigue, sleepiness, depression, symptom burden and ANS function, and their interactions. Results Data was obtained for 1046 people with SS, 56% COMPASS completers. Symptoms of ANS dysregulation were common. Participants with ANS dysregulation had more severe depression, anxiety, dryness, fatigue, pain, sleepiness and QoL (P < 0.01 for all). Depression, anxiety, dryness, and pain were independent predictors of ANS function in the multiple regression model (P < 0.05 for all). ANS function could not be included in the SEM. The SEM model had good fit to the data (comparative fit index = 0.998) and showed that, in people with SS, depression mediates the effects of pain, fatigue and sleepiness on QoL. Conclusion Our results show that diagnosing and treating depression in people with SS could have direct positive impact on QoL, and significantly ameliorate the impact of fatigue and pain.
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Affiliation(s)
- Tiago Costa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Northern Centre for Mood Disorders, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT, UK
| | - Stephen P Rushton
- School of Natural and Environmental Science, Agriculture Building, Newcastle University, King’s Road, Newcastle upon Tyne, NE1 7RU, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Northern Centre for Mood Disorders, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT, UK
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
- NIHR Newcastle Clinical Research Facility, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - On behalf of the UK primary Sjögren's Syndrome Registry
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Northern Centre for Mood Disorders, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT, UK
- School of Natural and Environmental Science, Agriculture Building, Newcastle University, King’s Road, Newcastle upon Tyne, NE1 7RU, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
- NIHR Newcastle Clinical Research Facility, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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Qu Y, Sun YY, Abuduxukuer R, Si XK, Zhang P, Ren JX, Fu YL, Zhang KJ, Liu J, Zhang PD, Jin H, Yang Y, Guo ZN. Heart Rate Variability Parameter Changes in Patients With Acute Ischemic Stroke Undergoing Intravenous Thrombolysis. J Am Heart Assoc 2023:e028778. [PMID: 37232237 PMCID: PMC10381989 DOI: 10.1161/jaha.122.028778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Autonomic dysfunction has been revealed in patients with acute ischemic stroke and is associated with poor prognosis. However, autonomic nervous system function assessed by heart rate variability (HRV) and its relationship with clinical outcomes in patients undergoing intravenous thrombolysis (IVT) remain unknown. Methods and Results Patients who did and did not undergo IVT between September 2016 and August 2021 were prospectively and consecutively recruited. HRV values were measured at 1 to 3 and 7 to 10 days after stroke to assess autonomic nervous system function. A modified Rankin scale score ≥2 at 90 days was defined as an unfavorable outcome. Finally, the analysis included 466 patients; 224 underwent IVT (48.1%), and 242 did not (51.9%). Linear regression showed a positive correlation of IVT with parasympathetic activation-related HRV parameters at 1 to 3 days (high frequency: β=0.213, P=0.002) and with both sympathetic (low frequency: β=0.152, P=0.015) and parasympathetic activation-related HRV parameters (high frequency: β=0.153, P=0.036) at 7 to 10 days after stroke. Logistic regression showed HRV values and autonomic function within 1 to 3 and 7 to 10 days after stroke were independently associated with 3-month unfavorable outcomes after adjusting for confounders in patients who underwent IVT (all P<0.05). Furthermore, addition of HRV parameters to conventional risk factors significantly improved risk-predictive ability of 3-month outcome (the area under the receiver operating characteristic curve significantly improved from 0.784 [0.723-0.846] to 0.855 [0.805-0.906], P=0.002). Conclusions IVT positively affected HRV and autonomic nervous system activity, and autonomic function assessed by HRV in acute stroke phase was independently associated with unfavorable outcomes in patients undergoing IVT.
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Affiliation(s)
- Yang Qu
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Ying-Ying Sun
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Reziya Abuduxukuer
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Xiang-Kun Si
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Peng Zhang
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Jia-Xin Ren
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Yu-Li Fu
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Ke-Jia Zhang
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Jia Liu
- Laboratory for Engineering and Scientific Computing Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences Shenzhen China
| | - Pan-Deng Zhang
- Laboratory for Engineering and Scientific Computing Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences Shenzhen China
| | - Hang Jin
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Yi Yang
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
- Neuroscience Research Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
- Neuroscience Research Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
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Kong SDX, Gordon CJ, Hoyos CM, Wassing R, D’Rozario A, Mowszowski L, Ireland C, Palmer JR, Grunstein RR, Shine JM, McKinnon AC, Naismith SL. Heart rate variability during slow wave sleep is linked to functional connectivity in the central autonomic network. Brain Commun 2023; 5:fcad129. [PMID: 37234683 PMCID: PMC10208252 DOI: 10.1093/braincomms/fcad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/20/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Reduced heart rate variability can be an early sign of autonomic dysfunction in neurodegenerative diseases and may be related to brain dysfunction in the central autonomic network. As yet, such autonomic dysfunction has not been examined during sleep-which is an ideal physiological state to study brain-heart interaction as both the central and peripheral nervous systems behave differently compared to during wakefulness. Therefore, the primary aim of the current study was to examine whether heart rate variability during nocturnal sleep, specifically slow wave (deep) sleep, is associated with central autonomic network functional connectivity in older adults 'at-risk' of dementia. Older adults (n = 78; age range = 50-88 years; 64% female) attending a memory clinic for cognitive concerns underwent resting-state functional magnetic resonance imaging and an overnight polysomnography. From these, central autonomic network functional connectivity strength and heart rate variability data during sleep were derived, respectively. High-frequency heart rate variability was extracted to index parasympathetic activity during distinct periods of sleep, including slow wave sleep as well as secondary outcomes of non-rapid eye movement sleep, wake after sleep onset, and rapid eye movement sleep. General linear models were used to examine associations between central autonomic network functional connectivity and high-frequency heart rate variability. Analyses revealed that increased high-frequency heart rate variability during slow wave sleep was associated with stronger functional connectivity (F = 3.98, P = 0.022) in two core brain regions within the central autonomic network, the right anterior insular and posterior midcingulate cortex, as well as stronger functional connectivity (F = 6.21, P = 0.005) between broader central autonomic network brain regions-the right amygdala with three sub-nuclei of the thalamus. There were no significant associations between high-frequency heart rate variability and central autonomic network connectivity during wake after sleep onset or rapid eye movement sleep. These findings show that in older adults 'at-risk' of dementia, parasympathetic regulation during slow wave sleep is uniquely linked to differential functional connectivity within both core and broader central autonomic network brain regions. It is possible that dysfunctional brain-heart interactions manifest primarily during this specific period of sleep known for its role in memory and metabolic clearance. Further studies elucidating the pathophysiology and directionality of this relationship should be conducted to determine if heart rate variability drives neurodegeneration, or if brain degeneration within the central autonomic network promotes aberrant heart rate variability.
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Affiliation(s)
- Shawn D X Kong
- Correspondence to: Shawn Dexiao KongHealthy Brain Ageing ProgramBrain and Mind Centre, University of Sydney100 Mallett St, Camperdown, NSW 2050, Australia E-mail:
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Rick Wassing
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Angela D’Rozario
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
| | - Catriona Ireland
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
| | - James M Shine
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
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Rajendran R, Sharma VK, Vinod KV, Ananthakrishnan R, Nandeesha H, Subramanian SK. Comparison of cardiac autonomic function across complete glycaemic spectrum. J Basic Clin Physiol Pharmacol 2023; 34:329-336. [PMID: 35596255 DOI: 10.1515/jbcpp-2022-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/06/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Autonomic imbalance is attributed as key mechanism altering metabolic regulation in diabetes mellitus. In view of controversial reports on autonomic function in FDRD and prediabetes, we aimed to assess and compare the autonomic function across the complete glycaemic spectrum in Indian population. METHODS Short term heart rate variability and cardiac autonomic reactivity tests - blood pressure and heart rate response to orthostatic tolerance and deep breathing exercise, and diastolic response to isometric handgrip exercise were recorded in normoglycemic apparently healthy individual, normoglycemic first degree relatives of diabetes, prediabetes and diabetes individuals. RESULTS Resting heart rate is significantly higher in FDRD, prediabetes and diabetes as compared to controls (control < FDRD = prediabetes = diabetes). Total power, LF power (control < FDRD < prediabetes = diabetes) and HF power (control < FDRD < prediabetes < diabetes) decreased along the glycaemic spectrum. Time-domain variables of HRV (SDNN, RMSSD, NN50, pNN50) were reduced as we move along the glycaemic spectrum (control < FDRD < prediabetes = diabetes). Cardiac autonomic function reactivity parameters such as 30:15 ratio and E:I ratio are decreased in prediabetes and diabetes group as compared to control and FDRD group (control = FDRD < prediabetes = diabetes). Diastolic response to isometric hand grip increases along the glycaemic spectrum starting from FDRD (control < FDRD < prediabetes = diabetes). CONCLUSIONS Autonomic dysfunction is observed even in first degree relatives of diabetes. Autonomic dysfunction increases as we move along the glycaemic spectrum (control < FDRD < prediabetes < diabetes).
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Schiwe D, Vendrusculo FM, Becker NA, Donadio MVF. Impact of asthma on heart rate variability in children and adolescents: Systematic review and meta-analysis. Pediatr Pulmonol 2023; 58:1310-1321. [PMID: 36719098 DOI: 10.1002/ppul.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Asthma is associated with abnormal autonomic function, and heart rate variability is considered a simple, accurate, and noninvasive tool for monitoring the autonomic system. Thus, the aim of this study was to investigate the impact of asthma on heart rate variability in children and adolescents. METHODS This systematic review of observational studies and clinical trials evaluated heart rate variability in children and adolescents with asthma compared to healthy controls. The data were extracted independently by two reviewers. The quality of the selected articles was assessed using Agency for Health Care Research and Quality indicators. Random effects meta-analysis was performed for each outcome, with the effect size reported as standardized mean difference. RESULTS Fifteen studies were included, of which five were classified as having high methodological quality. In the meta-analysis, long-term recording of the standard deviation of all normal-to-normal sinus R-R intervals differed significantly between groups (standardized mean difference [SMD] = -0.46 [95% confidence interval {CI}: -0.79 to -0.14], p < 0.005, I2 = 0%). Moreover, R-R intervals (long-term) were significantly shorter in asthmatic children than controls (SMD = -0.47 [95% CI: -0.68 to -0.25], p < 0.0001, I2 = 0). There were no significant differences between adjacent normal R-R intervals that exceed 50 ms (long-term) and the root mean square of successive differences between normal sinus R-R intervals (short-term). Regarding frequency-domain variables, long-term low frequency measurements differed significantly between groups (SMD = -0.34 [95% CI: -0.58 to -0.10], p < 0.005, I2 = 15%). There were no differences in high frequency measurements or in the ratio between low/high frequency powers (short- or long-term) between groups. CONCLUSION The results confirm the impact of asthma on heart rate variability in children and adolescents, indicating lower heart rate variability and sympathetic modulation.
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Affiliation(s)
- Daniele Schiwe
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Fernanda Maria Vendrusculo
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Nicolas Acosta Becker
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Department of Physiotherapy, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Sharma V, Pattnaik S, Ahluwalia H, Kaur M. Pre-pandemic autonomic function as a predictor of the COVID clinical course in young adults. Clin Exp Pharmacol Physiol 2023. [PMID: 37122115 DOI: 10.1111/1440-1681.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
Long coronavirus disease (COVID) is emerging as a common clinical entity in the current era. Autonomic dysfunction is one of the frequently reported post-COVID complications. We hypothesize a bi-directional relationship between the autonomic function and the COVID course. This postulation has been inadequately addressed in the literature. A retrospective cohort (pre and post-comparison) study was conducted on 30 young adults whose pre-COVID autonomic function test results were available. They were divided into case and control groups based on whether they tested reverse transcription polymerase chain reaction positive for COVID-19. Autonomic function tests were performed in both the case and control groups. COVID infection in healthy young adults shifts the sympatho-vagal balance from the pre-disease state. Postural orthostatic tachycardia syndrome was present in 35% of the COVID-affected group. COVID course parameters were found to be associated with parasympathetic reactivity and the baroreflex function. Baseline autonomic function (parasympathetic reactivity represented by Δ heart rate changes during deep breathing and 30:15 ratio during lying-to-standing test) was also associated with the COVID course, the post-COVID symptoms and the post-COVID autonomic function profile. Additionally, multiple regression analysis found that the baseline parasympathetic reactivity was a very important determinant of the clinical course of COVID, the post-COVID symptoms and the post-COVID autonomic profile. Sympatho-vagal balance shifts to parasympathetic withdrawal with sympathetic predominance due to COVID infection in healthy young adults. There is a bi-directional relationship between the autonomic function and the COVID course.
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Affiliation(s)
- Vagisha Sharma
- Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sanghamitra Pattnaik
- Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himani Ahluwalia
- Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manpreet Kaur
- Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Buzkova P, Cauley JA, Fink HA, Robbins JA, Mukamal KJ, Barzilay JI. Age-Related Factors Associated with Hip Fracture Risk. Endocr Pract 2023:S1530-891X(23)00061-7. [PMID: 36889582 DOI: 10.1016/j.eprac.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Advancing age is a powerful risk factor for hip fracture. The biological mechanisms through which aging impacts hip fracture risk have not been well studied. METHODS Biological factors associated with "advancing age" that help to explain how aging is associated with hip fracture risk are reviewed. The findings are based on analyses of the Cardiovascular Health Study, an ongoing observational study of adults ages >65 years with 25 years of follow up. RESULTS Five age-related factors were found to be significantly associated with hip fracture risk: (1) microvascular disease of the kidney (albuminuria and / or elevated urine albumin to creatinine ratio) and of the brain (abnormal white matter disease on brain MRI); (2) increased serum levels of carboxymethyl-lysine (CML), an advanced glycation end-product that reflects glycation and oxidative stress; (3) reduced parasympathetic tone, as derived from 24-hour Holter monitoring; (4) carotid artery atherosclerosis in the absence of clinical cardiovascular disease; and (5) increased trans-fatty acid levels in the blood. Each of these factors was associated with a 10-25%. increased risk of fracture. These associations were independent of traditional risk factors for hip fracture. CONCLUSION Several factors associated with older age help to explain how "aging" may be associated with hip fracture risk. These same factors may also explain the high risk for mortality following hip fracture.
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Affiliation(s)
- Petra Buzkova
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN
| | - John A Robbins
- Department of Medicine, University of California, Irvine, CA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, and Department of Endocrinology, Emory University School of Medicine, Atlanta, GA
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Hu G, Collet JP, Zhao M, Lu Y, Wang Y. Associations between Autonomic Function and Cognitive Performance among Patients with Cerebral Small Vessel Disease. Brain Sci 2023; 13. [PMID: 36831887 DOI: 10.3390/brainsci13020344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Data linking heart rate variability (HRV) and cognitive status remains controversial and scarce, particularly in cerebral small vessel disease (CSVD) patients. Whether the association between HRV and cognitive performance exists in CSVD patients is unclear. Hence, we aimed to investigate the association between HRV and cognitive performance in patients with CSVD. This cross-sectional study was conducted among 117 CSVD patients. All patients underwent HRV assessment and global cognitive evaluation by the Mini-Mental-State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Multivariable analyses were performed to evaluate the association between HRV and cognitive status. The mean age of study population was 59.5 ± 11.8 years and 39.3% were female. After adjusting for confounding factors, a higher high frequency (HF) norm was independently associated with better MMSE scores (β = 0.051; 95% confidence interval (CI): 0.012~0.090; p = 0.011) and MoCA scores (β = 0.061; 95% CI: 0.017~0.105; p = 0.007), while a higher low frequency (LF)/HF ratio was independently associated with worse MMSE scores (β = -0.492; 95% CI: -0.893~-0.092; p = 0.017) and MoCA scores (β = -0.691; 95% CI: -1.134~-0.248; p = 0.003). The HF norm was positively associated with global cognitive performance, whereas the LF/HF ratio was negatively associated with global cognitive performance among CSVD patients. Further study of the relationship between autonomic function and cognitive performance is warranted.
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Matthews R, Early KS, Vincellette CM, Losso J, Spielmann G, Irving BA, Allerton TD. The Effect of Watermelon Juice Supplementation on Heart Rate Variability and Metabolic Response during an Oral Glucose Challenge: A Randomized, Double-Blind, Placebo-Controlled Crossover Trial. Nutrients 2023; 15:nu15040810. [PMID: 36839167 PMCID: PMC9967111 DOI: 10.3390/nu15040810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Heart rate variability (HRV) provides a simple method to evaluate autonomic function in health and disease. A reduction in HRV may indicate autonomic dysfunction and is strongly associated with aspects of cardiometabolic disease, including hyperglycemia. Reduced nitric oxide (NO) bioavailability is also implicated in the development of cardiometabolic disease and autonomic dysfunction. Watermelons are natural sources of L-arginine and L-citrulline, substrates used for NO synthesis. Watermelon consumption can improve NO bioavailability. We conducted a randomized, double-blind, placebo-controlled crossover trial to test the effects of 2 weeks of daily watermelon juice (WMJ) supplementation on HRV in response to an oral glucose challenge (OGC) in healthy young adults. We also performed indirect calorimetry to assess if our intervention altered the metabolic response to the OGC. WMJ supplementation preserved high-frequency power (HF) (treatment effect, p = 0.03) and the percentage of successive differences that differ by more than 50 ms (pNN50) (treatment effect, p = 0.009) when compared to the placebo treatment. There was no difference in resting energy expenditure or substate oxidation according to treatment. We report that WMJ supplementation attenuates OGC-induced reductions in HRV. Future work should emphasize the importance of NO bioavailability in autonomic dysfunction in cardiometabolic disease.
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Affiliation(s)
- Rachel Matthews
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Kate S. Early
- Department of Kinesiology and Health Sciences, Columbus State University, Columbus, GA 39207, USA
| | | | - Jack Losso
- School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Guillaume Spielmann
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Brian A. Irving
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Timothy D. Allerton
- Pennington Biomedical Research Center, Vascular Metabolism Laboratory, Baton Rouge, LA 70808, USA
- Correspondence: ; Tel.: +1-225-763-2940
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Looser VN, Ludyga S, Gerber M. Does heart rate variability mediate the association between chronic stress, cardiorespiratory fitness, and working memory in young adults? Scand J Med Sci Sports 2023; 33:609-618. [PMID: 36631930 DOI: 10.1111/sms.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
Young adulthood is a demanding development phase rendering individuals at risk for high levels of stress. While chronic stress may impair working memory maintenance, cardiorespiratory fitness is suggested to have a protective effect. Heart rate variability (HRV) contributes to this cognitive domain, but also retaliates to stress and aerobic exercise. Therefore, the present study investigated the mediating role of resting HRV on the association between chronic stress, cardiorespiratory fitness, and working memory maintenance in young healthy adults. Healthy participants (N = 115, 48% female) aged 18-35 years (M = 24.1, SD = 3.8) completed the Åstrand test on a bicycle ergometer to estimate maximal oxygen consumption [ V ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ (ml/min/kg)]. In addition, working memory maintenance was assessed using the modified Sternberg task with low (three items) and high cognitive load (six items). Using electrocardiography, HRV was recorded and the LF/HF ratio was extracted for mediation analyses. Path analysis revealed that cardiorespiratory fitness was significantly associated with accuracy on high cognitive load trials (β = 0.19, p = 0.035), but not on trials with low cognitive load. Perceived levels of chronic stress failed to show a significant association with working memory maintenance, independently of cognitive load. The pattern of results remained unchanged after introduction of HRV as a mediator (β = 0.18, p = 0.045). In conclusion, higher cardiorespiratory fitness is associated with better maintenance of verbal information in working memory. However, this association cannot be explained by vagal influences on memory processing driven by the autonomic nervous system.
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Affiliation(s)
- Vera Nina Looser
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Kaniusas E, Fudim M, Czura CJ, Panetsos F. Editorial: Neuromodulation in COVID-19: From basic research to clinical applications. Front Physiol 2023; 14:1148819. [PMID: 36875048 PMCID: PMC9978783 DOI: 10.3389/fphys.2023.1148819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Eugenijus Kaniusas
- Instutute of Biomedical Electronics, Faculty of Electrical Engineering and Information Technology, Vienna University of Technology (TU Wien), Vienna, Austria
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, United States.,Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | | | - Fivos Panetsos
- Neurocomputing and Neurorobotics Research Group, Universidad Complutense de Madrid, Madrid, Spain.,Institute for Health Research (IdISSC), San Carlos Clinical Hospital, Madrid, Spain.,Silk Biomed SL, Madrid, Spain
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Inbaraj G, Udupa K, Vasuki PP, Nalini A, Sathyaprabha TN. Resting heart rate variability as a diagnostic marker of cardiovascular dysautonomia in postural tachycardia syndrome. J Basic Clin Physiol Pharmacol 2023; 34:103-109. [PMID: 36367272 DOI: 10.1515/jbcpp-2022-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system characterised by orthostatic intolerance and orthostatic tachycardia without hypotension. Heart rate variability (HRV) is the most reliable and objective tool for assessing autonomic dysfunction severity. In the present study, we aimed to investigate HRV changes in resting supine position, predicting severity and cardiovascular risk in patients with POTS. METHODS We compared 100 POTS patients with 160 healthy controls matched for age and gender in a case-control design. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time-domain measures. RESULTS The resting heart rate of patients with POTS was significantly higher than that of healthy controls. In HRV measures, root mean square successive difference of RR intervals (RMSSD), total and high frequency (HF) powers were statistically lower with an increased low frequency (LF) to high-frequency ratio in patients with POTS compared to healthy controls. Further, stepwise logistic regression analysis showed increased basal HR and LF/HF as significant predictors of POTS and its severity. CONCLUSIONS This is the first study on a large cohort of patients with POTS from India wherein HRV was assessed. The study showed reduced parasympathetic activity and increased sympathetic activity in patients with POTS compared to healthy controls. These findings of increased resting heart rate and LF/HF were found to be potential predictors of POTS and future cardiovascular risks, which need to be replicated in a larger and more homogenized cohort.
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Affiliation(s)
- Ganagarajan Inbaraj
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Talakad N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Asmuje NF, Mat S, Goh CH, Myint PK, Tan MP. Increased Beat-to-Beat Blood Pressure Variability Is Associated With Impaired Cognitive Function. Am J Hypertens 2022; 35:998-1005. [PMID: 36153737 DOI: 10.1093/ajh/hpac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Emerging evidence has linked visit-to-visit, day-to-day and 24-h ABPM blood pressure variability (BPV) with cognitive impairment. Few studies have, however, considered beat-to-beat BPV. This study, therefore, evaluated the relationship between beat-to-beat BPV and cognitive function among community-dwellers aged 55 years and over. METHODS Data was obtained from the Malaysian Elders Longitudinal Research (MELoR) study, which employed random stratified sampling from three parliamentary constituencies within the Klang Valley. Beat-to-beat blood pressure (BP) was recorded using non-invasive BP monitoring (TaskforceTM, CNSystems). Low frequency (LF), high frequency (HF) and low-to-high frequency (LF:HF) ratio for BPV were derived using fast Fourier transformation. Cognition was evaluated using the Montreal Cognitive Assessment (MoCA) test, and categorized into normal aging, mild impairment and moderate-to-severe impairment. RESULTS Data from 1,140 individuals, mean age (SD) 68.48 (7.23) years, were included. Individuals with moderate-to-severe impairment had higher HF-BPV for systolic (SBP) and diastolic (DBP) blood pressure compared to individuals within the normal aging group [OR (95% CI) = 2.29 (1.62-3.24)] and [OR (95% CI) = 1.80 (1.32-2.45)], while HF-SBPV [OR (95% CI) = 1.41 (1.03-1.93)] but not HF-DBPV was significantly higher with mild impairment compared to normal aging after adjustments for potential confounders. Moderate-to-severe impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.29 (0.18-0.47)] and LF:HF-DBPV [OR (95% CI) = 0.49 (0.34-0.72)], while mild impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.52 (0.34-0.80)] but not LF:HF-DBPV [OR (95% CI) = 0.81 (0.57-1.17)], compared to normal aging with similar adjustments. CONCLUSION Higher HF-BPV, which indicates parasympathetic activation, and lower LF:HF-BPV, which addresses sympathovagal balance, were observed among individuals with moderate-to-severe cognitive impairment. Future studies should determine whether BPV could be a physiological marker or modifiable risk factor for cognitive decline.
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Affiliation(s)
- Nur Fazidah Asmuje
- Kolej Genius Insan, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia.,Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Physiotherapy Programme and Center of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Choon Hian Goh
- Department of Mechatronics and Biomedical Engineering, Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Department of Medicine for The Elderly, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Innovations in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
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Curzio O, Billeci L, Belmonti V, Colantonio S, Cotrozzi L, De Pasquale CF, Morales MA, Nali C, Pascali MA, Venturi F, Tonacci A, Zannoni N, Maestro S. Horticultural Therapy May Reduce Psychological and Physiological Stress in Adolescents with Anorexia Nervosa: A Pilot Study. Nutrients 2022; 14. [PMID: 36558357 DOI: 10.3390/nu14245198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Studies in psychiatric populations have found a positive effect of Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type (AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart rate and its variability; skin conductance registration and thermal mapping of the individual’s face. An olfactory identification test was administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs. control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R.
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de Freitas VH, Mariano IM, Amaral AL, Rodrigues ML, Carrijo VHV, Nakamura FY, Puga GM. Blood Pressure and Heart Rate Variability Responses to High-Intensity Interval Training in Untrained Postmenopausal Women. Res Q Exerc Sport 2022; 93:749-757. [PMID: 34709130 DOI: 10.1080/02701367.2021.1917756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/09/2021] [Indexed: 06/13/2023]
Abstract
Purpose: The aim of this study was to analyze the blood pressure (BP) and heart rate variability (HRV) responses in untrained postmenopausal women submitted to acute single sessions of high-intensity interval training (HIT). Method: Sixteen postmenopausal women (59.9 ± 5.6 years, 26.7 ± 3.0 kg/m2) participated in a random order of two acute sessions in a balanced crossover format: control without exercise in sitting position or HIT session. BP and heart rate (HR) were recorded before and during 60 min following the sessions. Results: Diastolic (DBP), mean BP (MBP), and double product (DPO) showed interaction (p < .01). DBP, MBP, and DPO increased (p < .01) after HIT but not after the control session. The area under the curve (AUC) of DBP (p = .02) and DPO (p < .01) were different between conditions. Time and frequency indices of HRV presented interaction (p < .05) which impaired these indices post-HIT, but not post-control. The AUC of time and frequency HRV indices were different between conditions. Conclusions: A single session of HIT may increase BP and cardiac stress and cause perturbation of the autonomic function in untrained postmenopausal women.
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Samajdar SS, Das S, Sarkar S, Mukherjee S, Pathak A, Stålsby Lundborg C, Saha I, Tripathi SK, Pal J, Chatterjee N, Joshi SR. Association between Polypharmacy and Cardiovascular Autonomic Function among Elderly Patients in an Urban Municipality Area of Kolkata, India: A Record-Based Cross-Sectional Study. Geriatrics (Basel) 2022; 7. [PMID: 36547272 DOI: 10.3390/geriatrics7060136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
We assessed the association between polypharmacy and cardiovascular autonomic function among community-dwelling elderly patients having chronic diseases. Three hundred and twenty-one patients from an urban municipality area of Kolkata, India were studied in August 2022. The anticholinergic burden and cardiac autonomic function (Valsalva ratio, orthostatic hypotension, change in diastolic blood pressure after an isometric exercise, and heart rate variability during expiration and inspiration) were evaluated. Binary logistic regression analysis was performed to find out the association of polypharmacy and total anticholinergic burden with cardiac autonomic neuropathy. A total of 305 patients (age, 68.9 ± 3.4; 65.9% male) were included. Of these patients, 81 (26.6%) were on polypharmacy. Out of these 81 patients, 42 patients were on ninety-eight potential inappropriate medications. The anticholinergic burden and the proportion of patients with cardiac autonomic neuropathy were significantly higher among patients who were on polypharmacy than those who were not (8.1 ± 2.3 vs. 2.3 ± 0.9; p = 0.03 and 56.8% vs. 44.6%; p = 0.01). The presence of polypharmacy and a total anticholinergic burden of > 3 was significantly associated with cardiac autonomic neuropathy (aOR, 2.66; 95% CI, 0.91−3.98 and aOR, 2.51; 95% CI, 0.99−3.52, respectively). Thus, polypharmacy was significantly associated with cardiac autonomic neuropathy among community-dwelling elderly patients.
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