Yoga Nidra for hypertension: A systematic review and meta-analysis.

BACKGROUND: Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity. OBJECTIVE: The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension. METHODS: A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively. RESULTS: Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias. DISCUSSION: This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted. CONCLUSION: This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

Yoga as a complementary therapy in neuropathic pain: A systematic review and meta-analysis of randomized controlled trials.

Yoga is an ancient wisdom comprising a multitude of physical and mental practices that are aimed toward a state of optimum physical, mental, social, and spiritual health. Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory nervous system that is often unresponsive to currently available modes of treatment, portending an inferior quality of life for patients. This systematic review and meta-analysis aim to investigate the effect and the potential role of yoga in NP syndromes. PubMed, Scopus, Elton Bryson Stephens Company (EBSCO), and Cochrane Library were screened for randomized controlled trials (RCTs) assessing the effects of yoga in patients on NP. Usual care, no treatment, or any active treatments were acceptable as control interventions. Primary outcome measures were objective or subjective assessment measures of pain intensity. For each outcome, standardized mean differences and 95% confidence intervals (CIs) were calculated. A total of four studies were included for qualitative synthesis. Meta-analysis of three studies revealed an overall effect (Z) in the favor of yoga as an intervention for NP, when compared to controls, although the effect was not statistically significant (three RCTs; Z = 1.10 [P = 0.27]; Heterogeneity: τ2 = 0.37; χ2 = 27.78, df = 2 [P < 0.00001]; I2 = 93%). This review divulged the overall favorable effect of yoga in NP, although it was not statistically significant. It highlights the promising role of yoga on pain intensity and quality of life in NP syndromes while showing that yoga has the advantage of being an inexpensive and easily accessible mode of therapy. Extensive research on the efficiency and safety of yoga must be conducted using robust RCTs with rigorous methodologies.

Electrophysiological Evidence of Local Sleep During Yoga Nidra Practice.

Background and Objectives: Yoga nidra is a technique sages use to self-induce sleep. Classically, sleep is characterized by three cardinal electrophysiological features, namely, electroencephalography (EEG), electromyography (EMG), and electrooculography (EOG). As the literature on electrophysiological characterization of Yoga nidra is lacking, it is not known whether it is a sleep or awake state. The objective of the study was to electrophysiologically characterize yoga nidra practice. Materials and Methods: Thirty subjects underwent five initial supervised yoga nidra sessions and then continued practice on their own. The subjects completed their sleep diaries for 2 weeks before and during the intervention. The electrophysiological characterization was done after 2 weeks of yoga nidra practice using 19 EEG channels polysomnography for pre-yoga nidra, yoga nidra practice and post-yoga nidra. Polysomnographic data were scored for sleep-wake stages as per standard criteria. Power spectral density (PSD) was calculated from various frequency bands in different time bins. EEG data were grouped by areas, namely, central, frontal, prefrontal, parietal, temporal, and occipital in time bins. Sleep diary parameters were also compared for pre-post-yoga nidra training. Results: After 2 weeks of yoga nidra practice, awake was scored throughout the session (n = 26). PSD results (mean difference in dB between different time bins; P value) showed significant changes. When compared to pre-yoga nidra, there was an increase in delta power in the central area (1.953; P = 0.033) and a decrease in the prefrontal area (2.713; P = 0.041) during yoga nidra. Sleep diary showed improvement in sleep duration (P = 0.0001), efficiency (P = 0.0005), quality (P = 0.0005), and total wake duration (P = 0.00005) after 2 weeks of practice. Interpretations and Conclusions: Yoga nidra practice in novices is electrophysiologically an awake state with signs of slow waves locally, often referred to as local sleep. Clinical Trial: Clinical Trial Registry of India, http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php? trialid = 6253, 2013/05/003682.

Frontal activation as a key for deciphering context congruity and valence during visual perception: An electrical neuroimaging study.

The object-context associations and the valence are two important stimulus attributes that influence visual perception. The current study investigates the neural sources associated with schema congruent and incongruent object-context associations within positive, negative, and neutral valence during an intermittent binocular rivalry task with simultaneous high-density EEG recording. Cortical sourceswere calculated using the sLORETA algorithm in 150 ms after stimulus onset (Stim + 150) and 400 ms before response (Resp-400) time windows. No significant difference in source activity was found between congruent and incongruent associations in any of the valence categories in the Stim + 150 ms window indicating that immediately after stimulus presentation the basic visual processing remains the same for both. In the Resp-400 ms window, different frontal regions showed higher activity for incongruent associations with different valence such as the superior frontal gyrus showed significantly higher activations for negative while the middle and medial frontal gyrus showed higher activations for neutral and finally, the inferior frontal gyrus showed higher activations for positive valence. Besides replicating the previous knowledge of frontal activations in response to context congruity, the current study provides further evidence for the sensitivity of the frontal lobe to the valence associated with the incongruent stimuli.

State-dependent perception and perceptual reversals during intermittent binocular rivalry: An electrical neuroimaging study.

The object-context relationship and valence are two important stimulus attributes that affect visual perception. Although previous studies reveal how these two factors affect visual perception individually, the interplay between valence with congruent or incongruent object-context associations during visual perception is explored scarcely. Further, what is perceived, is affected by the intrinsic state of the brain at the moment of appearance of the stimulus which could be assessed by EEG microstates. Hence, the current study was designed to explore how the pre-stimulus EEG microstate influences the perception of emotional congruent and incongruent stimuli as well as perceptual reversals and stability during an intermittent binocular rivalry. Results revealed the association of specific pre-stimulus microstates with the perception of neutral and negative congruent stimuli as well as perceptual reversals and stability. Electrical neuroimaging of these microstates showed higher activation in the precuneus and middle occipital gyrus preceding the perception of neutral congruent stimuli and lingual gyrus preceding the perception of negative congruent stimuli. Increased source activity in superior temporal gyrus and superior frontal gyrus was found preceding stability and lower activation in parahippocampal gyrus was observed preceding reversals. Together these results suggest that the pre-stimulus activation of areas involved in visual priming, retrieval, and semantics leads to congruent perception. Pre-stimulus DMN suppression was required for perceptual reversals whereas stability was accompanied by pre-stimulus activation of areas related to the specific nature of the stimulus. Therefore, we propose that in addition to stimulus attributes, the pre-stimulus intrinsic brain activity could be an important determinant of the performance.

Does valence influence perceptual bias towards incongruence during binocular rivalry?

The efficient processing of complex visual environments is essential for effective functioning. In the natural environment, processing the context is as important as the processing of the target object since no object can be found in isolation. Congruent object-context associations in a visual scene facilitate object recognition, whereas incongruent associations decrease performance accuracy. Although there is a performance reduction, incongruent scenes are reported to have a perceptual bias due to the reallocation of the attentional resources towards the associated semantic conflict. Another key attribute that prepares the visual system to identify the important aspects of the environment is valence, and any visual scene can be classified into one of the three valence categories. Hence, the current study was designed to investigate how valence influences the perceptual bias towards incongruent object-context associations. An intermittent binocular rivalry task was used to measure the perceptual bias across valence categories. The results revealed a significant predominance of incongruent pictures when the associated valence was negative and neutral and remained unbiased for positive valence. We propose a valence-congruency interaction in which perceptual bias towards incongruence is greatly influenced by valence.

Functional brain microstate predicts the outcome in a visuospatial working memory task.

Humans have limited capacity of processing just up to 4 integrated items of information in the working memory. Thus, it is inevitable to commit more errors when challenged with high memory loads. However, the neural mechanisms that determine the accuracy of response at high memory loads still remain unclear. High temporal resolution of Electroencephalography (EEG) technique makes it the best tool to resolve the temporal dynamics of brain networks. EEG-defined microstate is the quasi-stable scalp electrical potential topography that represents the momentary functional state of brain. Thus, it has been possible to assess the information processing currently performed by the brain using EEG microstate analysis. We hypothesize that the EEG microstate preceding the trial could determine its outcome in a visuospatial working memory (VSWM) task. Twenty-four healthy participants performed a high memory load VSWM task, while their brain activity was recorded using EEG. Four microstate maps were found to represent the functional brain state prior to the trials in the VSWM task. One pre-trial microstate map was found to determine the accuracy of subsequent behavioural response. The intracranial generators of the pre-trial microstate map that determined the response accuracy were localized to the visuospatial processing areas at bilateral occipital, right temporal and limbic cortices. Our results imply that the behavioural outcome in a VSWM task could be determined by the intensity of activation of memory representations in the visuospatial processing brain regions prior to the trial.