A comprehensive review of heart rate variability as an indicator in the regulation of the autonomic nervous system by acupuncture:a bibliometric analysis

This study sought to conduct a bibliometric analysis of acupuncture studies focusing on heart rate variability(HRV)and to investigate the correlation between various acupoints and their effects on HRV by utilizing association rule mining and network analysis.A total of 536 publications on the topic of acupuncture studies based on HRV.The disease keyword analysis revealed that HRV-related acupuncture studies were mainly related to pain,inflammation,emotional disorders,gastrointestinal function,and hypertension.A separate analysis was conducted on acupuncture prescriptions,and Neiguan(PC6)and Zusanli(ST36)were the most frequently used acupoints.The core acupoints for HRV regulation were identified as PC6,ST36,Shenmen(HT7),Hegu(LI4),Sanyinjiao(SP6),Jianshi(PC5),Taichong(LR3),Quchi(LI11),Guanyuan(CV4),Baihui(GV20),and Taixi(KI3).Additionally,the research encompassed 46 reports on acupuncture animal experiments conducted on HRV,with ST36 being the most frequently utilized acupoint.The research presented in this study offers valuable insights into the global research trend and hotspots in acupuncture-based HRV studies,as well as identifying frequently used combinations of acupoints.The findings may be helpful for further research in this field and provide valuable information about the potential use of acupuncture for improving HRV in both humans and animals.

A Study into Blood Flow, Heart Rate Variability, and Body Surface Temperature While Listening to Music

In this study we examined the relaxing effects of listening to music on a total of 12 women aged from their 20s to their 40s by measuring their blood flow, heart rate variability, and their body surface temperature. As a result, We found that there was a tendency for the volume of blood flow to the fingertips to significantly increase when listening to classical music, but there was a variety of changes in blood flow between each age group for healing music and J-Pop music. When measuring heart rate it was found that the LF/HF value, which is an index for the autonomic nervous system which shows tension and stress, fell significantly when listening to each type of music. Lastly, there was a trend for body surface temperature to rise when listening to classical or healing music, a rise which was particularly significant when listening to healing music. This study shows that a relaxing effect can be expected for all indices when listening to classical music. However, for healing music and J-Pop, personal musical preferences seemed to have an effect and the results were varied.

Changes in Heart Rate Variability and Effects on POMS by Whether or Not Soil Observation Was Performed

Introduction: The effects of performing soil observation on autonomic nerve function (ANS) and the profile of mood states (POMS) particularly for upsurge of sentiment were studied table. Methods: The subjects were divided into two groups: Group A with soil observation, and Group B without it. Soil observation was performed by smelling soil, touching the soil and other ways. Evaluation was made using heart rate change variability, POMS and visual analog scale (VAS). Results: Group A showed an increase in high frequency (HF) and the LF (low frequency)/HF ratio and a decrease in heart rate, leading to activating the functions of the parasympathetic nervous system. VAS values for “not comforted at all” indicated that the scale was lower in Group A than in Group B. In POMS, a factor of “vigor” became lower in Group B than in Group A. Discussion: It was suggested that soil observation was effective in bringing people to a state of physiological and mental relaxation and reducing stress because it raised the degree of being comforted, increased HF, decreased the heart rate and activated the parasympathetic nervous system. Conclusions: By performing soil observation, the heart rate decreased, HF increased and an upsurge sentiment became normalized.

The association of salivary alpha-amylase, heart rate variability, and psychological stress on objectively measured sleep behaviors among college students

Objective:This study aimed to evaluate sleep behaviors among college students,to assess salivary alpha-amylase(sAA)and heart rate variability(HRV)in association with stress,and to investigate sleep-related factors including sAA,HRV,and stress among them.Methods:Saliva samples for sAA assessment and HRV measurements in the supine position were taken between 3 PM and 6 PM.The level of prolonged psychological stress for the previous week was evaluated using the Korean version of the Global Assessment of Recent Stress(GARS-K),and sleep behaviors were assessed using an actigraphy device.Results:A total of 86 healthy college students participated in this study.Sleep behaviors of the college students were not good,with 84%sleep efficiency(SE)and 62.7 min wake after sleep onset(WASO).The average sAA level was 65.8 U/mL in the participants.Although neither the sAA level nor HRV indices were significantly correlated with prolonged psychological stress,decreased normalized high frequency(nHF)on HRV was independently associated with a higher level of stress when adjusted for age and sex.Higher stress(r=-0.276,P=0.011)and lower sAA(r=0.266,P=0.030)had significant correlations with shorter time in bed;however,it was sAA that was independently associated with time in bed(β=0.244,p=0.044).Decreased nHF(β=0.245,P=0.027)and higher body mass index(BMI)(β=-0.224,P=0.043)were independently related to and poorer SE.Conclusions:Poor sleep behaviors were associated with decreased parasympathetic activity,a physiological change to psychological stress,rather than with psychological stress itself among college students.Thus,sAA and HRV should be considered as significant factors for impaired sleep behaviors in relation to psychological stress.

Effects of Yoga Exercises on Heart Rate Variability Parameters and Perceived Stress in Adolescent Students with High Score in Perceived Stress

Introduction: Hatha Yoga is a widely used form of holistic mind-body therapy for promoting health, and disease prevention like cardiovascular risks and part of treatment for neurological disorders. Objective: The aim of this study was to evaluate the effect of Hatha yoga on the autonomic nervous system by tracking acute changes in the time-domain and frequency-domain metrics of heart rate variability (HRV) in healthy International Baccalaureate students arranged in 3 different groups. Methods: The prospective interventional study was conducted among adolescent students in China. Thirty-six adolescent students were divided in three groups: 12 Hatha yoga experimental group participants;a control group of 12 students without participation in any activity and a recreational sport group of 12 other students. Outcomes measured were HRV parameters such as SDNN, RMSSD LF, HF, and LF/HF. Also, a Competitive State Anxiety Inventory-2 was used to measure stress and anxiety score in terms of Cognitive stress, Somatic Stress and Self Confidence. Results: Compared to baseline values, the Hatha yoga experiment group demonstrated a significant increase in HRV indices: SDNN 87.62 ± 13.89 (>0.0001) and RMSDD 86.61 ± 7.78 (>0.0001) respectively. In contrast it was documented after the 3 weeks of exposure to yoga training a statistically significant decrease in the frequency domain of LF 1911.53 ± 882.15 (0.0464) compared to baseline values. After completion of intervention the yoga experiment group HF (ms2) values were increased 3430.40 ± 858.38 (>0.0001). Decrease and increase in the HF (ms2) in the control and Hatha yoga group were statistically significant after following Hatha yoga. Cognitive anxiety 18.08 ± 6.30 (>0.0001) and Somatic anxiety 17.50 ± 6.33 (>0.0001) decreased after intervention with yoga and self-confidence increased significantly 32.50 ± 1.17 (>0.0001). Conclusions: The investigation showed a significant increase of HRV parameters and cardiac autonomic function as a result of exposure to Yoga practice. Also, there was significant evidence of decrease in cognitive stress and somatic stress;increased values of self-confidence at the end of three weeks yoga exposure in comparison to the baseline values.

Stress prevention by modulation of autonomic nervous system (heart rate variability): A preliminary study using transcranial direct current stimulation

Introduction: Transcranial Direct Current Stimulation (tDCS) is a non-invasive, technique for brain stimulation. Anodal stimulation causes neuronal depolarisation and long-term potentiation, while cathodal stimulation causes hyperpolarisation and long-term depression. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both. Associated with these reactions is a frequently reported increase in Low Frequency (LF) Heart Rate Variability (HRV), a decrease in High Frequency (HF) power, and/or an increase in the LF/HF ratio. Objectives and aims: The present work aims to explore the tDCS potential in the modulation of the Autonomic Nervous System (ANS), through indirect stimulation of Anterior Cingulate Cortex (ACC). Methods: Two subjects, a 39 year old female and a 49 year old male, gave informed consent. Saline soaked synthetic sponges involving two, thick, metalic (stainless steel) rectangles, with an area of 25 cm2 each have been used as electrodes, connected to Iomed Phoresor II Auto device. It has been delivered a 2 mA current, for 20 minutes, over the left Dorsolateral Prefrontal Cortex (DLPFC) (Anode). Spectrum analysis (cStress software) of HRV has been performed before and after tDCS administration. Results: The female/male subject results of LF power, HF power and LF/HF ratio, before tDCS administration, were, respectively: 50.1 nu/60 nu, 46.1 nu/21.7 nu and 1.087/2.771;and, after tDCS administration, respectively: 33.5 nu/52.7 nu, 47.6 nu/ 22.8 nu and 0.704/2.312. Conclusions: tDCS over the left DLPFC (left ACC) increased parasympathetic activity and decreased sympathetic activity, suggesting the importance of tDCS in the management of stress-related disorders.

Characteristics of Sleep and Autonomic Activity in Active Older Adults Based on Metabolic Age: A Comparative Case Study

Background: The balance of autonomic nervous system activity and its relationship with body composition, sleep quality, and activities of daily living among older people is still unclear. Purpose: This comparative case study examined the characteristics of body composition, sleep quality, and autonomic nerve activity in active older adults with a younger body age-calculated from age trends in body composition and basal metabolic rate. Methods: We selected two cases with a metabolic age younger than their actual age. They had good sleep quality, no sarcopenia, strong muscle and grip strength, and balanced autonomic nervous system activity. They were compared with two other age- and gender-matched cases, who had poor sleep quality, unbalanced autonomic nervous system activity, and had a physical age closer to their actual age. Results: Older adults with more muscle mass and higher basal metabolism were younger than their actual age, had a better sleep status, and had a good balance of autonomic nervous activity during exercise stimulation. They also had lower percentages of body and visceral fat and higher percentages of body water. Conclusion: Two cases had a metabolic age younger than their actual age were found to be much younger than their actual age. However, the older adults with normal muscle mass and basal metabolic rate had poor sleep status and no sympathetic hyperactivity during exercise simulation.

Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization?

AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12.1 years old; 80% males),two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction(STEMI) patients(in which reperfusion wassuccessfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction(NSTEMI) patients(percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event(95%CI of the mean 23.3-28.0). Primary endpoint was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events(MCE,defined as mortality or readmission for new MI,new revascularization,episodes of heart failure or stroke). Possible correlations between HRV parameters(mainly the standard deviation of all normal RR intervals,SDNN),clinical features(age,sex,type of MI,history of diabetes,left ventricle ejection fraction),angiographic characteristics(number of coronary arteries with critical stenoses,success and completeness of revascularization) and long-term outcomes were analysed.RESULTS Markedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN(χ~2 =1.536,P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis(respectively: P = 0.008 and P = 0.008),while no correlation was found between depressed SDNN and history of previous MI(P = 0.999) or number of diseased coronary arteries(P = 0.428) or unsuccessful percutaneous coronary intervention(PCI)(P = 0.691). Patients with left ventricle ejection fraction(LVEF) < 40% presented more often SDNN values in the lowest quartile(P < 0.001). After > 2 years from infarction,a total of 10 patients(3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI(P = 0.141),although all-cause and cardiac mortality were higher among NSTEMI cases(respectively: 14% vs 2%,P = 0.001; and 10% vs 1.5%,P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN(respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles(P = 0.540),with no difference for STEMI(P = 0.180) or NSTEMI patients(P = 0.541). By the contrary,eventsfree survival was worse if patients presented with LVEF < 40%(P = 0.001).CONCLUSION In our group of patients with a recent complicated MI,abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases,and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression ofHRV parameters recorded in the subacute phase of the disease,both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.

Static Stretching Combined with Conscious Slower Breathing May Increase Parasympathetic Activity and Reduce Stress in Adult Women

Background: Women are thought to be more susceptible to stress than men in a stressful society, and reducing stress is crucial for women to maintain their health. Static stretching (SST) is applied in various fields to not only increase muscle flexibility but also reduce stress. Additionally, conscious slower breathing (CSB) predominates parasympathetic activity, causing a relaxing effect. These results indicate that combining SST and CSB may be more useful in reducing stress. However, to the best of our knowledge, the effect of this combination remains unclear. Objective: This study aimed to elucidate the effects of the combination of SST and CSB on autonomic activity and stress in adult women. Methods: Eleven healthy Japanese adult female participants performed SST with nonconscious natural breathing for 20 min. The same participants performed SST in combination with CSB (2 s inspiratory and 4 s expiratory) for 20 min on another day. Salivary cortisol and chromogranin A levels were measured before and after stretching as stress markers of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. The coefficient of variation of the R-R interval (CVR-R) and high-frequency component (HF), which reflect parasympathetic nerve activity, and heart rate and low-frequency component (LF)/HF ratio, which reflect sympathetic nerve activity, were measured before, during, and after stretching. Results: SST decreased cortisol levels but with no significant changes in chromogranin A, heart rate, CVR-R, HF, or LF/HF ratio. The combination of SST and CSB increased CVR-R and HF levels in addition to decreasing cortisol levels but with no significant changes in chromogranin A, heart rate, or LF/HF levels. Conclusion: These results indicate that the combination of SST and CSB may increase parasympathetic activity and reduce stress. However, future randomized controlled trials with larger sample sizes should support this conclusion.

Modeling of Heart Rate Variability Using Time-Frequency Representations

The heart rate variability signal is highly correlated with the respiration even at high workload exercise.It is also known that this phenomenon still exists during increasing exercise.In the current study,we managed to model this correlation during increasing exercise using the time varying integral pulse frequency modulation(TVIPFM)model that relates the mechanical modulation(MM)to the respiration and the cardiac rhythm.This modulation of the autonomic nervous system(ANS)is able to simultaneously decrease sympathetic and increase parasympathetic activity.The TVIPFM model takes into consideration the effect of the increasing exercise test,where the effect of a time-varying threshold on the heart period is studied.Our motivation is to analyze the heart rate variability(HRV)acquired by time varying integral pulse frequency modulation using time frequency representations.The estimated autonomic nervous system(ANS)modulating signal is filtered throughout the respiration using a time varying filtering,during exercise stress testing.And after summing power of the filtered signal,we compare the power of the filtered modulation of the ANS obtained with different time frequency representations:smoothed pseudo Wigner–Ville representation,spectrogram and their reassignments.After that,we used a student t-test p<0.01 to compare the power of heart rate variability in the frequency band of respiration and elsewhere.

Evaluation with Heart Rate Variability for the Treatment Effect of Aminophylline in Patients with Bradycardia after Cervical Spinal Cord Injury: A Preliminary Study

After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.

High frequency heart rate variability evoked by repetitive transcranial magnetic stimulation over the medial prefrontal cortex: A preliminary investigation on brain processing of acute stressor-evoked cardiovascular reactivity

Introduction: Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for brain stimulation. Repetitive TMS (rTMS) over the medial Prefrontal Cortex (mPFC), Broadman Area 10 (BA10) may stimulate transynaptically perigenual Anterior Cingulate Cortex (pACC, BA 33), insula, amigdala, hypothalamus and connected branches of the Autonomic Nervous System (ANS) involved in stressorevoked cardiovascular reactivity. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both, and, consequently, an increase in systolic/stroke volume, total vascular impedance/resistance and heart rate, a decrease of baroreflex sensitivity, i.e., an increase in blood pressure/arterial tension. Objectives and Aims: The present work aims, using TMS and accordingly to Gianaros modeling, based on functional neuroimaging studies and previous neuroanatomical data from animal models, to probe the connectivity of brain systems involved in stressor-evoked cardiovascular reactivity and to explore TMS potential as a tool for detection and stratification of individual differences concerning this reactivity and hemorreological risk factors correlated with the development of Coronary Heart Disease (CHD). Methods: Both subjects, a 52 years old male and a 40 years old female with previous increased Low Frequency (LF)/High Frequency (HF) Heart Rate Variability (HRV) ratios (respectively, 4.209/3.028) without decompensated cardiorespiratory symptoms, gave informed consent, and ethico-legal issues have been observed. Electroencephalographic (EEG) monitoring has been performed for safety purposes. Immediately after administration, over the mPFC, of 15 pulses of rTMS, during 60 second, with an inductive electrical current, at the stimulating coil, of 85.9 Ampère per μsecond and 66 Ampère per μsecond, respectively, for male and female subjects (a “figure-of-eight” coil and magnetic stimulator MagLite, Dantec/Medtronic, have been used), HRV spectrum analysis (cStress software) has been performed (during 5 minutes, in supine position). Results: In both subjects, LF power, HF power and LF/HF ratio results, before and after rTMS administration, pointed towards sympathetic attenuation and parasympathetic augmentation (respectively, in male/female subject: decreased LF power—65.1 nu/69.3 nu, before rTMS;56.1 nu/41.6 nu, after rTMS;increased HF power—15.5 nu/22.9 nu, before rTMS;30.9 nu/45.5 nu, after rTMS). Conclusions: In this preliminary investigation, the existence of a link between “mind” and heart’s function has been put in evidence, through a reversible “virtual” lesion, of brain systems involved in cardiovascular control, caused by TMS. Repetitive TMS over mPFC decreased brain function involved in stressorevoked cardiovascular reactivity, suggesting the importance of TMS in the management of stress-related cardiovascular disorders.

Quran memorisation and heart rate variability:How do they correlate?

BACKGROUND Heart rate variability(HRV)was shown to be affected by performing religious activities.AIM To examine the relationship between the level of Quran(the holy book of Muslims)memorisation and HRV among teenagers.METHODS This experimental study included 16 Tahfiz students and 16 non-Tahfiz students(n=32).The HRV was measured in three tasks:Recalling familiar verses,memorising new verses,and recalling the newly memorised verses of the Quran.HRV analysis was done using these parameters:Standard deviation of N-N(heartbeat peak)interval;low frequency(LF);high frequency(HF)and LF/HF ratio.RESULTS There were significant differences between tasks for all parameters(P<0.05).However,between the groups,only the LF/HF ratio had significant differences,with F=5.04,P<0.05.Pearson correlation showed a moderate positive correlation between the number of pages memorised and the LF/HF ratio(r=0.61,P<0.05).CONCLUSION Quran memorisation increased the HRV and our results suggested that this activity could be developed as an effective sympathovagal modulation training activity.

Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment

Cardiac autonomic neuropathy(CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction anddilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability(the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescription of prostacyclin analogues,thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na^+,K^+-ATPase(phosphodiesterase inhibitor),ALA,dihomo-γ-linolenic acid(DGLA),ω-3 polyunsaturated fatty acids(ω-3 PUFAs),and the simultaneous prescription of ALA,ω-3 PUFAs and DGLA,but the future investigations are needed.Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological,in the foreground midodrine and fludrocortisone acetate,treatment methods are necessary.

Cardiovascular autonomic neuropathy in diabetes:Pathophysiology,clinical assessment and implications

Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

Successful use of closed-loop allostatic neurotechnology for post-traumatic stress symptoms in military personnel： self-reported and autonomic improvements

Background:Military-related post-traumatic stress(PTS)is associated with numerous symptom clusters and diminished autonomic cardiovascular regulation.Highresolution,relational,resonance-based,electroencephalic mirroringis a noninvasive,closed-loop,allostatic,acoustic stimulation neurotechnology that produces realtime translation of dominant brain frequencies into audible tones of variable pitch and timing to support the autocalibration of neural oscillations.We report clinical,autonomic,and functional effects after the use offor symptoms of military-related PTS.Methods:Eighteen service members or recent veterans(15 active-duty,3 veterans,most from special operations,1 female),with a mean age of 40.9(SD=6.9)years and symptoms of PTS lasting from 1 to 25 years,undertook19.5(SD=1.1)sessions over 12 days.Inventories for symptoms of PTS(Posttraumatic Stress Disorder Checklist–Military version,PCL-M),insomnia(Insomnia Severity Index,ISI),depression(Center for Epidemiologic Studies Depression Scale,CES-D),and anxiety(Generalized Anxiety Disorder 7-item scale,GAD-7)were collected before(Visit1,V1),immediately after(Visit2,V2),and at 1 month(Visit3,V3),3(Visit4,V4),and 6(Visit5,V5)months after intervention completion.Other measures only taken at V1 and V2 included blood pressure and heart rate recordings to analyze heart rate variability(HRV)and baroreflex sensitivity(BRS),functional performance(reaction and grip strength)testing,blood and saliva for biomarkers of stress and inflammation,and blood for epigenetic testing.Paired t-tests,Wilcoxon signed-rank tests,and a repeated-measures ANOVA were performed.Results:Clinically relevant,significant reductions in all symptom scores were observed at V2,with durability through V5.There were significant improvements in multiple measures of HRV and BRS[Standard deviation of the normal beat to normal beat interval(SDNN),root mean square of the successive differences(rMSSD),high frequency(HF),low frequency(LF),and total power,HF alpha,sequence all,and systolic,diastolic and mean arterial pressure]as well as reaction testing.Trends were seen for improved grip strength and a reduction in C-Reactive Protein(CRP),Angiotensin II to Angiotensin 1–7 ratio and Interleukin-10,with no change in DNA n-methylation.There were no dropouts or adverse events reported. Conclusion:Service members or veterans showed reductions in symptomatology of PTS,insomnia,depressive mood,and anxiety that were durable through 6 months after the use of a closed-loop allostatic neurotechnology for the autocalibration of neural oscillations.This study is the first to report increased HRV or BRS after the use of an intervention for service members or veterans with PTS.Ongoing investigations are strongly warranted.Trial registration:NCT03230890,retrospectively registered July 25,2017.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Vitamin C ameliorated cardiac autonomic neuropathy in type 2 diabetic rats

BACKGROUND Vitamin C(VC)is a common antioxidant with cell protection potentials.However,its possible protective effect on cardiac autonomic nerves from diabetic induced insults is yet to be explored.AIM To investigate the effects of VC on diabetic cardiac autonomic neuropathy.METHODS Thirty male Wistar rats were equally grouped into control,diabetic and diabetic+VC.Type 2 diabetes was induced with fructose diet and alloxan.VC(1 g/kg)was administered for 4 wk via oral canula.Blood pressure and heart rate were measured non-invasively using tail flick blood pressure monitor.Spectral analysis of heart rate variability(HRV)was used to assess cardiac autonomic neuropathy.Blood was collected from the ocular sinus for biochemical analysis.Urethane(1 g/kg-ip)was used for anaesthesia prior to HRV and cervical dislocation to harvest hearts.Intracardiac autonomic nerve was assessed using tyrosine hydroxylase immunohistochemistry on fixed heart sections.RESULTS Results were analysed using ANOVA atα0.05.Unlike VC and control groups,diabetic rats showed significantly(P<0.0001)reduced HRV,increased heart-rate and blood pressure,initial increase in cardiac tyrosine hydroxylase activities at week-2 and sparse activity at week-4 of diabetes.Furthermore,apolipoprotein B,Oxidative stress and inflammatory markers were significantly(P<0.01)reduced in VC treated rats.CONCLUSION VC possesses cardio-autonomic nerve protective potential and ameliorates the symptoms of cardiac autonomic neuropathy in type 2 diabetes.The possible mechanisms via which VC exert these effects may be via downregulation of oxidative stress,inflammation and apolipoprotein B.