RESUMEN
Global smartphone penetration has led to unprecedented addictive behaviors. To develop a smartphone use/non-use pattern by mobile application (App) in order to identify problematic smartphone use, a total of 79 college students were monitored by the App for 1 month. The App-generated parameters included the daily use/non-use frequency, the total duration and the daily median of the duration per epoch. We introduced two other parameters, the root mean square of the successive differences (RMSSD) and the Similarity Index, in order to explore the similarity in use and non-use between participants. The non-use frequency, non-use duration and non-use-median parameters were able to significantly predict problematic smartphone use. A lower value for the RMSSD and Similarity Index, which represent a higher use/non-use similarity, were also associated with the problematic smartphone use. The use/non-use similarity is able to predict problematic smartphone use and reach beyond just determining whether a person shows excessive use.
Asunto(s)
Conducta Adictiva , Conducta Compulsiva , Teléfono Inteligente , Estudiantes , Recolección de Datos , Femenino , Humanos , Masculino , Aplicaciones Móviles , Universidades , Adulto JovenRESUMEN
This study aimed to test the hypothesis that, during extended wakefulness, parasympathetic activity is associated with the depth of the subsequent recovery sleep in mice. Fourteen male C57BL/6 mice were implanted with electrodes for sleep recording. Continuous spectral analysis was performed on the electroencephalogram (EEG) to obtain theta power (6-9Hz) and delta power (0-4Hz), as well as the R-R interval signals in order to quantify the high-frequency power (HF) and normalized low-frequency power (LF%) that are used to assess parasympathetic and sympathetic activity, respectively. All animals underwent a sleep deprivation experiment and a control experiment (6-h intervention and 1-h recovery period) on two separate days. During sleep deprivation, HF and theta power during wakefulness were significantly higher than during the control wakefulness after the second hour and first hour, respectively. During recovery non-rapid eye movement sleep, there was a rebound in sleep time and delta power as well as an elevation in HF relative to control post-intervention sleep. Both the rise in HF and theta power during extended wakefulness were found to be positively correlated with the delta power rebound. Furthermore, the HF change during extended wakefulness was also correlated with the amount of sleep loss and the enhancement of waking theta power. Our finding suggests that waking parasympathetic activity intimately reflects the cumulative sleep pressure, suggesting a potential role to be an autonomic marker for sleep propensity.
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Encéfalo/fisiopatología , Frecuencia Cardíaca/fisiología , Privación de Sueño/fisiopatología , Sueño/fisiología , Vigilia/fisiología , Animales , Ritmo Delta/fisiología , Modelos Animales de Enfermedad , Electroencefalografía , Masculino , Ratones Endogámicos C57BL , Sistema Nervioso Parasimpático/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Ritmo Teta/fisiologíaRESUMEN
Introduction: The autonomic effects of antidepressants and quetiapine on heart rate variability (HRV) are inconsistent based on past studies. The aim of this study was to explore their influence on the HRV of psychiatric patients without psychotic symptoms. Methods: A total of 94 patients with depression, anxiety, or somatic symptoms, were recruited into this study. Based on their medication, 4 groups were identified: the no antidepressant group (n=19), the SSRI group (using sertraline or escitalopram, n=53), the other antidepressants group (using venlafaxine or mirtazapine, n=9), and the augmentation group (AG, using an antidepressant+quetiapine, n=13). The HRV of the 4 groups were compared. The correlations between HRV and the medication(s) used were clarified. Results: Among the 4 groups, the AG had the lowest HRV with its total power (TP), very low frequency power (VLF) and low frequency power (LF) of HRV being significantly different from those of the other groups. Age and using quetiapine were found to be negatively correlated with TP, VLF and LF. With this study group, the autonomic effects of antidepressants were found not to be significant. Discussion: Among psychiatric patients without psychotic symptoms, quetiapine causes an overt decrease in HRV.
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Antidepresivos/farmacología , Depresión/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Fumarato de Quetiapina/farmacología , Adulto , Anciano , Antidepresivos/uso terapéutico , Ansiedad/tratamiento farmacológico , Ansiedad/fisiopatología , Depresión/tratamiento farmacológico , Femenino , Humanos , Modelos Lineales , Masculino , Síntomas sin Explicación Médica , Mianserina/análogos & derivados , Persona de Mediana Edad , Mirtazapina , Escalas de Valoración Psiquiátrica , Fumarato de Quetiapina/uso terapéutico , Sertralina , Taiwán , Clorhidrato de VenlafaxinaRESUMEN
We hypothesize that the time when age-related changes in autonomic functioning and in sleep structure occur are different and that autonomic functioning modulates sleep architecture differently before and after 50 years of age. Sixty-eight healthy subjects (aged 20 to 79 years old, 49 of them women) were enrolled. Correlation analysis revealed that wake after sleep onset, the absolute and relative value of stage 1 (S1; S1%), and relative value of stage 2 (S2) were positively correlated with age; however, sleep efficiency, stage 3 (S3), S3%, and rapid-eye-movement latency (REML) were negatively correlated with age. Significant degenerations of sleep during normal aging were occurred after 50 years of age; however, significant declines of autonomic activity were showed before 50 years of age. Before 50 years of age, vagal function during sleep was negatively correlated with arousal index; however, after 50 years of age, it was positively correlated with S1 and S1%. In addition, sympathetic activity during wake stage was positively related to S2% only after 50 years of age. Our results imply that the age-related changes in autonomic functioning decline promptly as individuals leave the younger part of their adult life span and that age-related changes in sleep slowly develop as individuals enter the older part of their adult life span. Furthermore, while various aspects of sleep architecture are modulated by both the sympathetic and vagal nervous systems during adult life span, the sleep quality is mainly correlated with the sympathetic division after 50 years of age.
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Envejecimiento/fisiología , Sistema Nervioso Autónomo/fisiología , Electrocardiografía , Sueño/fisiología , Adulto , Anciano , Electroencefalografía , Electromiografía , Femenino , Estudios de Seguimiento , Voluntarios Sanos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Procesamiento de Señales Asistido por Computador , Adulto JovenRESUMEN
OBJECTIVES: The long-term hemodynamic effects of carotid angioplasty and stenting (CAS) are unclear. We performed a longitudinal study to investigate the variations in cerebral hemodynamics in patients undergoing CAS. MATERIALS AND METHODS: We performed prospective evaluation of 63 symptomatic male patients (19 patients had transient ischemic attack and 44 had minor stroke; mean age: 77.3 ± 6.3 years [range: 51-86]). The mean blood flow velocities (MBFV) and pulsatility index (PI) of the middle cerebral arteries (MCA) on both sides were evaluated using transcranial color-coded Doppler (TCCD) ultrasonography. Cardiac autonomic activities were evaluated by measuring baroreflex sensitivity (BRS). All parameters were measured at baseline prior to CAS and at 1, 3, 6, and 12 months after CAS. RESULTS: The preoperative MBFV and PI of the ipsilateral MCA were significantly lower than those of the contralateral side. However, after CAS, MBFV in the ipsilateral MCA increased significantly until 2 weeks after stenting, after which the MBFV gradually decreased and remained stable for 1 year after CAS. Further, we observed a nonsignificant increase in MBFV in the contralateral MCA after CAS. In contrast to the MBFV, the BRS values decreased significantly 1 month after stenting and returned to baseline levels 6 months after CAS. CONCLUSIONS: Patients with CAS showed improved global cerebral hemodynamic status. However, the BRS did not normalize initially, and baseline value was achieved at 6 months after stenting.
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Barorreflejo/fisiología , Estenosis Carotídea/patología , Estenosis Carotídea/fisiopatología , Corteza Cerebral/irrigación sanguínea , Hemodinámica , Stents , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Angiografía Cerebral , Humanos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Estudios Prospectivos , Accidente Cerebrovascular/cirugía , Taiwán , Factores de Tiempo , Ultrasonografía Doppler TranscranealRESUMEN
Hippocampal theta rhythm (4-12 Hz) can be observed during locomotor behavior, but findings on the relationship between locomotion speed and theta frequency are inconsistent if not contradictory. The inconsistency may be because of the difficulties that previous analyses and protocols have had excluding the effects of behavior training. We recorded the first or second voluntary wheel running each day, and assumed that theta frequency and activity are correlated with speed in different running phases. By simultaneously recording electroencephalography, physical activity, and wheel running speed, this experiment explored the theta oscillations during spontaneous running of the 12-h dark period. The recording was completely wireless and allowed the animal to run freely while being recorded in the wheel. Theta frequency and theta power of middle frequency were elevated before running and theta frequency, theta power of middle frequency, physical activity, and running speed maintained persistently high levels during running. The slopes of the theta frequency and theta activity (4-9.5 Hz) during the initial running were different compared to the same values during subsequent running. During the initial running, the running speed was positively correlated with theta frequency and with theta power of middle frequency. Over the 12-h dark period, the running speed did not positively correlate with theta frequency but was significantly correlated with theta power of middle frequency. Thus, theta frequency was associated with running speed only at the initiation of running. Furthermore, theta power of middle frequency was associated with speed and with physical activity during running when chronological order was not taken into consideration.
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Hipocampo/fisiología , Actividad Motora/fisiología , Ritmo Teta/fisiología , Animales , Masculino , Condicionamiento Físico Animal , Ratas , Ratas Endogámicas WKY , Procesamiento de Señales Asistido por ComputadorRESUMEN
Hippocampal theta wave can be induced by running and is linked to cognitive functions. The initiation and maintenance of hippocampal theta during a complete course of running, however, is not well understood. Using a treadmill exercise model, this study wirelessly recorded the hippocampal electroencephalogram, nuchal electromyogram, electrocardiogram, and three-dimensional accelerations of 15 male young rats. Although the speed of the treadmill was constant during the entire 30-min running course, the frequency (Frq) and amplitude (Amp) of hippocampal theta changed dynamically. During the first 24 s (phase I), the Frq, Amp, electromyogram amplitude (EMG), heart rate (HR), and physical activity (PA) all increased. The changes in the Frq, EMG, and PA were among the fastest and the change in the HR was the slowest. After 24 s (phase II), the Frq declined to near baseline but the Amp remained persistently high. The slope of the Frq, Amp, and HR over time during phase I was different to that during phase II. During phase II, the Frq and Amp were significantly correlated with the PA and EMG. We conclude that treadmill running can be classified into two phases based on hippocampal functioning, and hippocampal theta varies with exercise effort during the treadmill running.
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Hipocampo/fisiología , Actividad Motora/fisiología , Carrera/fisiología , Ritmo Teta/fisiología , Aceleración , Animales , Cognición/fisiología , Electromiografía/métodos , Prueba de Esfuerzo , Masculino , Condicionamiento Físico Animal/fisiología , Ratas , Ratas Endogámicas WKYRESUMEN
BACKGROUND: Significant changes in autonomic activity occur at sleep-wake transitions and constitute an ideal setting for investigating the modulatory role of the autonomic nervous system on gastric myoelectrical activity (GMA). METHODS: Using continuous power spectral analysis of electroencephalogram, electromyogram, and electrogastromyogram (EGMG) data from freely moving rats that had undergone chemical sympathetomy and/or truncal vagotomy, sleep-wake-related fluctuations in GMA were compared among the intervention groups. KEY RESULTS: The pattern and extent of fluctuations in EGMG power across the sleep-wake states was blunted most significantly in rats undergoing both chemical sympathectomy and truncal vagotomy. The effect of these interventions also varied with respect to the transition between different sleep-wake states. The most prominent influences were observed between active waking and quiet sleep and between paradoxical sleep and quiet sleep. CONCLUSIONS & INFERENCES: The sleep-wake-related fluctuations in EGMG power are a result of joint contributions from both sympathetic and vagal innervation. Vagotomy mainly resulted in a reduction in EGMG power, while the role of sympathetic innervation was unveiled by vagotomy and this was reflected most obviously in the extent of the fluctuations in EGMG power.
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Sistema Nervioso Autónomo/fisiología , Músculo Liso/fisiología , Sueño/fisiología , Estómago/inervación , Estómago/fisiología , Vigilia/fisiología , Adrenérgicos/metabolismo , Animales , Electroencefalografía/métodos , Electromiografía/métodos , Masculino , Oxidopamina/metabolismo , Ratas , Ratas Endogámicas WKY , Nervio Vago/fisiología , Nervio Vago/cirugíaRESUMEN
Previous studies have shown awareness of uremic dysfunction in end-stage renal disease (ESRD) patients. Dysautonomia in ESRD patients may be reversible after renal transplantation. We used a power spectral analysis (PSA) of heart rate variability (HRV) to assess alterations of autonomic activity in 14 controls and 14 nondiabetic hemodialysis ESRD patients who had undergone renal transplantation. Compared with matched control subjects, the power frequency determinations of low frequency (LF; 3.42 ln(ms(2)) vs 6.38 ln(ms(2)); P < .05 high frequency (HF; 2.29 ln(ms(2)) vs 5.27 ln(ms(2)); P < .05)), and total power (TP; 5.39 ln(ms(2)) vs 7.53 ln(ms(2)); P < .05) were significantly suppressed in ESRD patients undergoing hemodialysis. ESRD patients showed significantly improved HRV after renal transplantation. After renal transplantation, there was no significant difference in the TP (6.82 ln(ms(2)) vs 7.53 ln(ms(2)); P = .15) component between measurements in both patient subgroups. We further divided the ESRD patients into 2 groups based on their pretransplantation HRV, observing alterations in HRV after renal transplantation. Patients with significantly improved HRV were those with more suppressed HRV before transplantation (HF <3 In(ms(2)). Autonomic dysfunction in ESRD patients was not irreversible even if severe, and recovery was observed as early as 6 months after transplantation.
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Frecuencia Cardíaca/fisiología , Fallo Renal Crónico/fisiopatología , Trasplante de Riñón/fisiología , Diálisis Renal , Electrocardiografía/métodos , Femenino , Humanos , Fallo Renal Crónico/cirugía , Masculino , Valores de Referencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
The aim of this study was to assess the acute effects of ephedra on autonomic nervous modulation by means of heart rate variability (HRV) analysis, using a randomized, double-blind, placebo-controlled, crossover design. On three separate days, 20 healthy subjects took capsules containing either 1 or 2 g of ephedra dry extract or a placebo, and the sequential percentage changes in HRV measures were compared. After the subjects took ephedra, the normalized low-frequency component (LF) and the ratio of LF to high-frequency component (HF) increased significantly in a dose-dependent manner, whereas the normalized HF (HF%) decreased significantly. We conclude that ingestion of ephedra tilts the sympathovagal balance dose-dependently toward increased sympathetic activity and impairs parasympathetic activity.
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Sistema Nervioso Autónomo/efectos de los fármacos , Ephedra/efectos adversos , Adulto , Algoritmos , Estudios Cruzados , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Electrocardiografía/efectos de los fármacos , Femenino , Análisis de Fourier , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Adulto JovenRESUMEN
AIMS: There are relatively few effective methods to treat autonomic neuropathy in patients with diabetes mellitus. Our aim was to test the hypothesis that hyperbaric oxygen therapy may restore cardiac neural regulation dysfunction in diabetic individuals with foot complications. METHODS: We conducted a prospective randomized controlled study in patients with diabetic foot problems. Daily heart-rate variability analysis from 5-min electrocardiography was used to evaluate the temporal change of cardiac neural regulation. The experimental group consisted of 23 subjects exposed to hyperbaric oxygen therapy of 202.65 kPa for 90 min every Monday to Friday for 4 weeks (20 treatments). The control group consisted of 15 age-, sex- and disease-matched subjects who were not exposed to hyperbaric therapy. Patients with medical complications and failure of wound healing were excluded to eliminate possible confounding effects. RESULTS: There was no significant difference in baseline R-R interval (RR), variance, high-frequency power (HF), low-frequency power (LF), and LF/HF ratio between the two groups. In the hyperbaric oxygen group there were significant increases in changes of RR (82.7 +/- 16.02 ms); variance 0.88 +/- 0.12 ln(ms2); HF 1.06 +/- 0.18 ln(ms2); and LF 0.87 +/- 0.15 ln(ms2) after the treatment. Measurements of tissue oxygen demonstrated significant increases in local tissue oxygenation in the hyperbaric oxygen group (53.0 +/- 2.6 mmHg) compared with the control group (27.5 +/- 3.1 mmHg), P < 0.05. CONCLUSION: Hyperbaric oxygen therapy has a significant vagotonic effect, which is beneficial in improving cardiac neural regulation in patients with diabetic autonomic dysfunction.
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Diabetes Mellitus Tipo 2/terapia , Pie Diabético/terapia , Oxigenoterapia Hiperbárica , Análisis de Varianza , Distribución de Chi-Cuadrado , Diabetes Mellitus Tipo 2/metabolismo , Pie Diabético/metabolismo , Electrocardiografía , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Estudios Prospectivos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
BACKGROUND: Peri-operative hymodynamic instability is one of the major concerns for anesthesiologists when performing general anesthesia for individuals with autonomic dysfunction. The purpose of this study was to examine the potential usage of pre-operative measurement of heart rate variability (HRV) in identifying which individuals, with or without diabetes, may be at risk of blood pressure (BP) instability during general anesthesia. METHODS: We studied 46 patients with diabetes and 87 patients without diabetes ASA class II or III undergoing elective surgery. Participants' cardiovascular autonomic function and HRV were assessed pre-operatively, and hymodynamic parameters were monitored continuously intra-operatively by an independent observer. RESULTS: Only 6% of the participants were classified as having cardiovascular autonomic neuropathy (CAN) based on traditional autonomic function tests whereas 15% experienced hypotension. Total power (TP, P = 0.006), low frequency (LF, P = 0.012) and high frequency (HF, P = 0.028) were significantly lower in individuals who experienced hypotension compared with those who did not. Multivariate logistic regression analysis revealed that TP [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.05-0.47, P = 0.001] independently predicted the incidence of hypotension, indicating that each log ms2 increase in total HRV lowers the incidence of hypotension during general anesthesia by 0.15 times. After stepwise multiple linear regression analysis (R2= 11.5%), HF (beta = -11.1, SE = 2.79, P < 0.001) was the only independent determinant of the magnitude of systolic blood pressure (SBP) reduction at the 15th min after tracheal intubation. CONCLUSIONS: Spectral analysis of HRV is a sensitive method for detecting individuals who may be at risk of BP instability during general anesthesia but may not have apparent CAN according to traditional tests of autonomic function.
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Anestesia General/efectos adversos , Frecuencia Cardíaca/fisiología , Hipotensión/inducido químicamente , Adulto , Anciano , Envejecimiento/fisiología , Arritmias Cardíacas/inducido químicamente , Arritmias Cardíacas/fisiopatología , Sistema Nervioso Autónomo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Electrocardiografía , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Caracteres Sexuales , Maniobra de ValsalvaRESUMEN
Long-term exposure to intermittent hypoxia (IH), such as that occurring in association with sleep apnea, may result in systemic hypertension; however, the time course changes in arterial pressure, autonomic functions, and baroreflex sensitivity are still unclear. We investigated the changes in cardiovascular neural regulations during the development of chronic IH-induced hypertension in rats. Sprague-Dawley rats were exposed to repetitive 1.25-min cycles (30 s of N2+45 s of 21% O2) of IH or room air (RA) for 6 h/day during light phase (10 AM-4 PM) for 30 days. Arterial pressure was measured daily using the telemetry system during RA breathing. The mean arterial pressure (MAP) and interpulse interval (PPI) signals were then used to assess the autonomic functions and spontaneous baroreflex sensitivity by auto- and cross-spectral analysis, respectively. Stable MAP, low-frequency power of MAP (BLF), and low-frequency power (LF)-to-high frequency power (HF) ratio of PPI (LF/HF) were significantly higher in IH-exposed rats, compared with those of RA-exposed rats. Elevation of the MAP, BLF, LF/HF, and minute ventilation started 5 days after IH exposure and lasted until the end of the 30-day observation period. Additionally, IH-exposed rats had significant lower slope of MAP-PPI linear regression (under a successively descending and ascending) and magnitude of MAP-PPI transfer function (at frequency ranges of 0.06-0.6 Hz or 0.6-2.4 Hz) after IH exposure for 17 days. However, RA-exposed rats did not exhibit these changes. The results of this study indicate that chronic IH-induced hypertension is associated with a facilitation of cardiovascular sympathetic outflow and inhibition of baroreflex sensitivity in conscious rats.
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Barorreflejo/fisiología , Estado de Conciencia/fisiología , Hipertensión/fisiopatología , Hipoxia/fisiopatología , Sistema Nervioso Simpático/fisiología , Animales , Metabolismo Basal/fisiología , Presión Sanguínea/fisiología , Temperatura Corporal/fisiología , Dióxido de Carbono/metabolismo , Sistema Cardiovascular/inervación , Sistema Cardiovascular/fisiopatología , Hipertensión/etiología , Hipoxia/complicaciones , Masculino , Consumo de Oxígeno/fisiología , Pulso Arterial , Ratas , Ratas Sprague-Dawley , Volumen de Ventilación Pulmonar/fisiología , Factores de TiempoRESUMEN
BACKGROUND: Previous limited observations have suggested that atherosclerosis may affect the distensibility of the carotid sinus and then impair the baroreflex sensitivity (BRS). No studies have been done to compare the BRS and heart rate variability (HRV) in patients with carotid stenosis and normal controls. METHODS: A convenience-consecutive sample of 118 patients with transient ischemic attack or minor stroke 3 months to 1 year before (mean 6 months) who met the study criteria were referred to the neurovascular laboratory of the study hospital. Forty-three age-matched healthy adults were recruited as the normal controls. The inclusion criteria for participation were (1) no diabetes mellitus, (2) no history, symptoms or ECG signs of coronary artery disease or myocardial infarction, and (3) presence of carotid stenosis greater than or equal to 50%. The diagnosis of carotid stenosis was made using color-coded duplex ultrasound with published criteria. We categorized the patients into two groups: group 1 had moderate stenosis (50-75%) and group 2 had high-grade stenosis (75-99%). Instantaneous systolic blood pressure (SBP) and heart rate of all participants were assessed noninvasively using servo-controlled infrared finger plethysmography. The fluctuation in SBP as well as the interpulse interval (IPI) was divided into three components at specific frequency ranges by fast Fourier transform as high frequency (HF; 0.15-0.4 Hz), low frequency (LF; 0.04-0.15 Hz) and very low frequency (VLF; 0.004-0.04 Hz). The BRS was expressed as (1) transfer function with its magnitude in the HF and LF ranges, (2) BRS index alpha, and (3) regression coefficient by sequence analysis. The HRV was expressed as total power and power in the three frequency ranges (HF, LF and VLF). RESULTS: The final analysis included 99 patients (mean age 72 +/- 6 years, 79 male) and 43 healthy controls (mean age 68 +/- 7 years, 30 male). Forty-three patients were classified as group 1 (stenosis 50-75%) and 56 as group 2 (stenosis 75-99%). There was no significant difference in the IPI between patients and controls (p value = 0.8637). We observed a significant decrease in all three HRV components (VLF, LF and HF) in the patients; however, there were no differences between the two patient groups with various degrees of stenosis. All the indices of BRS, including the magnitude of SBP-IPI transfer function at LF and HF, the computed BRS index alpha and the regression coefficient of sequence analysis, revealed similar results. Patients exhibited a significant reduction in the BRS (p < 0.001) compared with controls, and no difference was found between the two groups of patients. CONCLUSIONS: Our study linked significant carotid stenosis to two important autonomic markers (BRS and HRV) that may have prognostic value for patients with cardiovascular events. Further prospective studies are needed to explore whether or not the decreased BRS and HRV can be predictors for poor cardiovascular prognosis, or even for shortened life span in general, in patients with significant carotid stenosis.
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Barorreflejo/fisiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/fisiopatología , Frecuencia Cardíaca/fisiología , Pletismografía , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Seno Carotídeo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Pulso Arterial , Índice de Severidad de la EnfermedadRESUMEN
OBJECT: Children with epilepsy have been found to be at increased risk of death during childhood. Sudden unexpected death (SUDEP) has accounted for at least 12% of deaths of children with epilepsy. The exact mechanisms of SUDEP are unknown; however, theories suggested have, to date, focused on autonomic instability. The purpose of this study was to investigate autonomic function in children with chronic epilepsy by means of power spectrum analysis of heart rate variability. METHODS: Thirty patients with epilepsy and 30 control subjects, all between the ages of 4 and 10 years, were enrolled in this study. Power spectrum analysis of heart rate variability (HRV) was performed under standardized conditions after the patients had rested for 15 min. Each patient was tested in a supine position first and then again in a head-up tilted position, with 15 min between the two tests. RESULTS: There was no significant difference between the low-frequency component (LF) and the high-frequency component (HF) of heart rate variability, or the LF/HF ratio, between the study and control groups, whether the test subjects were in the supine or the head-up tilt position. In the control group, however, the subjects showed a significantly greater LF component and a smaller HF component of heart rate variability, and a greater LF/HF ratio in the head-up position than in the supine position. This implies a normal sympathovagal balance. This phenomenon was not observed in the study group. This implies that the modulating effects on autonomic function deriving from the hemisphere were probably disturbed, owing to the brain lesions that each of the study group patients had already sustained. CONCLUSIONS: A disturbed balance of activity between the sympathetic and parasympathetic nervous system might result from the loss of hemispheric influence in patients with epilepsy. Nevertheless, further investigation is clearly necessary to ascertain the possible association of this disturbed balance with SUDEP. Further investigation is also needed to establish the exact location of the region in the brain that gives rise to this modulating influence.
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Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Muerte Súbita/etiología , Epilepsia/fisiopatología , Frecuencia Cardíaca , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Estudios de Casos y Controles , Niño , Preescolar , Electrocardiografía , Epilepsia/complicaciones , Femenino , Humanos , Masculino , Posición Supina , Pruebas de Mesa InclinadaRESUMEN
INTRODUCTION: Hyperventilation has been demonstrated to alter autonomic function. Sympathomimetic drugs (isoproterenol) and parasympatholytic drugs (atropine) may be needed to facilitate induction of supraventricular tachycardia (SVT). The aim of this study was to test the clinical utility and mechanisms of hyperventilation to facilitate SVT initiation. METHODS AND RESULTS: Fourteen patients with clinically documented SVT (9 AV nodal reentrant tachycardia and 5 AV reciprocating tachycardia) but noninducible during baseline electrophysiologic study were included. Immediately after hyperventilation test (at least 30 respirations/min) for 2 minutes, systolic blood pressure, sinus cycle length, anterograde and retrograde 1:1 conduction, and induced SVT were measured. Arterial blood gas, pH, and heart rate variability before and after hyperventilation were measured. Seven of nine patients with AV nodal reentrant tachycardia and 3 of 5 patients with AV reciprocating tachycardia could be induced immediately after the hyperventilation test. After hyperventilation, anterograde AV and retrograde VA 1:1 conduction were improved, sinus cycle length was decreased, and heart rate variability were decreased in both groups. CONCLUSION: Hyperventilation can facilitate induction of SVT. Improvement of conduction properties and changes of autonomic function are the possible mechanisms.
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Hiperventilación/complicaciones , Taquicardia Supraventricular/etiología , Taquicardia Supraventricular/terapia , Nervio Accesorio/fisiopatología , Adulto , Nodo Atrioventricular/fisiopatología , Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Estimulación Cardíaca Artificial , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Hiperventilación/fisiopatología , Masculino , Persona de Mediana Edad , Inducción de Remisión , Taquicardia Supraventricular/fisiopatología , Factores de TiempoRESUMEN
Previous work from our laboratory using heart rate variability (HRV) has demonstrated that women before menopause have a more dominant parasympathetic and less effective sympathetic regulations of heart rate compared with men. Because it is still not clear whether normal or preeclamptic pregnancy coincides with alternations in the autonomic functions, we evaluated the changes of HRV in 17 nonpregnant, 17 normotensive pregnant, and 11 preeclamptic women who were clinically diagnosed without history of diabetic neuropathy, cardiac arrhythmia, and other cardiovascular diseases. Frequency-domain analysis of short-term, stationary R-R intervals was performed to evaluate the total variance, low-frequency power (LF; 0.04-0.15 Hz), high-frequency power (HF; 0.15-0.40 Hz), ratio of LF to HF (LF/HF), and LF in normalized units (LF%). Natural logarithm transformation was applied to variance, LF, HF, and LF/HF for the adjustment of the skewness of distribution. We found that the normal pregnant group had a lower R-R value and HF but had a higher LF/HF and LF% compared with the nonpregnant group. The preeclamptic group had lower HF but higher LF/HF compared with either the normal pregnant or nonpregnant group. Our results suggest that normal pregnancy is associated with a facilitation of sympathetic regulation and an attenuation of parasympathetic influence of heart rate, and such alterations are enhanced in preeclamptic pregnancy.
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Frecuencia Cardíaca/fisiología , Sistema Nervioso Parasimpático/fisiopatología , Preeclampsia/diagnóstico , Preeclampsia/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Adulto , Algoritmos , Presión Sanguínea/fisiología , Técnicas de Diagnóstico Cardiovascular , Técnicas de Diagnóstico Obstétrico y Ginecológico , Femenino , Humanos , Embarazo , Nervio Vago/fisiopatologíaRESUMEN
The autonomic control of respiratory-related arterial pressure variability (RAPV) remains uncharacterised. We set out to test the hypothesis that the autonomic nervous system may participate in RAPV via its effect on pulse pressure (PP). Experiments were performed on adult male Sprague-Dawley rats anaesthetised with ketamine and paralysed with pancuronium under positive-pressure ventilation. Respiratory variability in each parameter was quantified by auto-spectral analysis and the relationship between variabilities in two signals assessed by cross-spectral analysis. PP and systolic pressure (SP) exhibited similar powers of respiratory variability that were far more pronounced than for diastolic pressure (DP) or mean pressure (MP). The variability in PP preceded that in SP, MP or DP. The largest phase lag occurred between PP and DP and was equivalent to the time delay of one pulse interval. Coherence between respiratory variabilities in PP and MP was nearly perfect. Propranolol dose dependently suppressed respiratory variability in each pressure parameter and eventually disrupted the PP-MP relationship in respiratory variability. However, the influence of lung volume on MP persisted with a near-zero phase lag. Combined administration of phentolamine and atropine facilitated respiratory variability in PP and SP and failed to block the effect of propranolol. However, the combined administration moved the dose/response curve of propranolol and respiratory variability in each pressure parameter to the right. We conclude that, in addition to non-autonomic mechanisms, RAPV may be facilitated by cardiac sympathetic function via the effect on PP variability. The autonomic mechanism can still be evoked during combined alpha-adrenoceptor and muscarinic blockade, possibly via baroreflex mechanisms.
Asunto(s)
Sistema Nervioso Autónomo/fisiología , Presión Sanguínea/fisiología , Pulso Arterial , Fenómenos Fisiológicos Respiratorios , Agonistas alfa-Adrenérgicos/farmacología , Agonistas Adrenérgicos beta/farmacología , Animales , Atropina/farmacología , Combinación de Medicamentos , Pulmón/fisiología , Mediciones del Volumen Pulmonar , Masculino , Fentolamina/farmacología , Propranolol/farmacología , Ratas , Ratas Sprague-Dawley , Respiración/efectos de los fármacos , Fenómenos Fisiológicos Respiratorios/efectos de los fármacosRESUMEN
Previous work from our laboratory has demonstrated that the very low-frequency (VLF: 0-0.25 Hz) and low-frequency (LF: 0.25-0.8 Hz) power of arterial pressure variability (APV) are related to vasomotor reactivity in response to control signals from the rostral ventrolateral medulla (RVLM) via the sympathetic system in the rat. The present study evaluated the differences in the dynamic property of central vasomotor control between spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY). Experiments were carried out in 10- to 12-wk-old rats that were anesthetized with continuous infusion of pentobarbital sodium, paralyzed with pancuronium, and maintained on mechanical ventilation. We found that SHR exhibited significantly higher arterial pressure (AP), heart rate (HR), and VLF, LF, and high-frequency (0.8-2.4 Hz) power of APV than WKY under resting state. Broad-band electrical stimulation of the RVLM elicited parallel APV in the VLF and LF ranges in both rat strains. The evoked APV and transfer magnitude of the APV to stimulus spike rate variability (RVLM-AP magnitude) were significantly higher in SHR, especially in the LF range. The response frequency of central vasomotor control, represented by the high-cut frequency of RVLM-AP magnitude, was also extended in SHR. The disparity in RVLM-AP transfer magnitude between SHR and WKY became virtually absent after combined alpha- and beta-adrenoceptor blockade by phentolamine and propranolol. These results suggest that the dynamic control of RVLM on AP reactivity is enhanced in SHR, in which the adrenergic system may play a major role.
Asunto(s)
Hipertensión/fisiopatología , Bulbo Raquídeo/fisiopatología , Ratas Endogámicas SHR/fisiología , Sistema Vasomotor/fisiopatología , Potenciales de Acción , Antagonistas Adrenérgicos alfa/farmacología , Antagonistas Adrenérgicos beta/farmacología , Animales , Presión Sanguínea , Estimulación Eléctrica , Electrocardiografía , Masculino , Fentolamina/farmacología , Propranolol/farmacología , Ratas , Ratas Endogámicas WKY/fisiologíaRESUMEN
To clarify the influence of gender on sympathetic and parasympathetic control of heart rate in middle-aged subjects and on the subsequent aging process, heart rate variability (HRV) was studied in normal populations of women (n = 598) and men (n = 472) ranging in age from 40 to 79 yr. These groups were divided into eight age strata at 5-yr intervals and were clinically diagnosed as having no hypertension, hypotension, diabetic neuropathy, or cardiac arrhythmia. Frequency-domain analysis of short-term, stationary R-R intervals was performed, which reveals very-low-frequency power (VLF; 0.003-0.04 Hz), low-frequency power (LF; 0.04-0.15 Hz), high-frequency power (HF; 0.15-0.40 Hz), the ratio of LF to HF (LF/HF), and LF and HF power in normalized units (LF% and HF%, respectively). The distribution of variance, VLF, LF, HF, and LF/HF exhibited acute skewness, which was adjusted by natural logarithmic transformation. Women had higher HF in the age strata from 40 to 49 yr, whereas men had higher LF% and LF/HF between 40 and 59 yr. No disparity in HRV measurements was found between the sexes in age strata >/=60 yr. Although absolute measurements of HRV (variance, VLF, LF, and HF) decreased linearly with age, no significant change in relative measurements (LF/HF, LF%, and HF%), especially in men, was detected until age 60 yr. We conclude that middle-aged women and men have a more dominant parasympathetic and sympathetic regulation of heart rate, respectively. The gender-related difference in parasympathetic regulation diminishes after age 50 yr, whereas a significant time delay for the disappearance of sympathetic dominance occurs in men.