ВАРІАБЕЛЬНІСТЬ СЕРЦЕВОГО РИТМУ, ЯКІСТЬ СНУ ТА ЛІПІДНИЙ ПРОФІЛЬ ЯК БІОМАРКЕРИ КАРДІОМЕТАБОЛІЧНОГО РИЗИКУ В ЖІНОК СЕРЕДНЬОГО ВІКУ

As reports show cardiovascular (CV) risks in first-degree relatives (FDR) of type2 diabetics, and autonomic imbalance predisposing to CV risks, in the present study we have assessed the contribution of sympathovagal imbalance (SVI) to CV risks in these subjects. Body mass index (BMI), waist-to-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP), and spectral indices of heart rate variability (HRV) were reordered and analyzed in FDR of type2 diabetics (study group, n=293) and in subjects with no family history of diabetes (control group, n=405). The ratio of low-frequency (LF) to high-frequency (HF) power of HRV (LF-HF), a sensitive marker of SVI, was significantly increased (P<0.001) in the study group compared with the control group. The SVI in the study group was due to concomitant sympathetic activation (increased LF) and vagal inhibition (decreased HF). In the study group, the LF-HF ratio was significantly correlated with BMI, WHR, BHR, BP and RPP. Multiple regression analysis showed an independent contribution of LF-HF to hypertension status (P=0.000), and bivariate logistic regression showed significant prediction (odds ratio 2.16, confidence interval 1.130-5.115) of LF-HF to increased RPP, the marker of CV risk, in the study group. Sympathovagal imbalance in the form of increased sympathetic and decreased parasympathetic activity is present in FDR of type2 diabetics. Increased resting heart rate, elevated hypertension status, decreased HRV and increased RPP in these subjects make them vulnerable to CV risks. SVI in these subjects contributes to CV risks independent of the degree of adiposity.

BackgroundObstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA.MethodsSeventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined.ResultsMultivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI.ConclusionsThe improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.

Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). Methods: The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Results: Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Conclusions: Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure.

Role of Heart Rate Variability in Non-Invasive Electrophysiology: Prognostic Markers of Cardiovascular Disease

Characteristics of the distressed (Type D) personality include negative affectivity (NA) and social inhibition (SI), which are associated with an increased risk of major adverse cardiac events and mortality among patients with coronary artery disease (CAD). The aims of this study were to examine: (1) the correlation of NA and SI with psychological characteristics, heart rate variability (HRV) indices, and lipids profiles and (2) the differences in psychological characteristics, HRV indices, and lipid profiles between patients with CAD with Type D personality and those with non-Type D personality. A cross-sectional study was conducted on 168 patients with CAD. The Taiwanese 14-item Type D Scale, Chinese Hostility Inventory-Short Form, Beck Depression Inventory-II, Beck Anxiety Inventory, and Anger Rumination Scale were administered to all of the participants. The raw signals of electrocardiograms were recorded over a 5-min baseline resting period and then transformed to HRV indices representing short-term cardiac autonomic activations. Lipid profiles were acquired from patients' medical records. NA was positively correlated with hostility, depression, anxiety, and anger rumination. With respect to pathophysiological mechanisms for CAD with Type D personality, NA was negatively correlated with standard deviation of all normal-to-normal intervals (SDNN) and total power of HRV and positively correlated with total cholesterol. SI was positively correlated with suppressive hostility behavior and anger rumination; however, SI was not significantly correlated with expressive hostility behavior, or HRV indices and lipid profiles. Pathophysiological mechanisms leading to higher rates of adverse outcomes in CAD in individuals with Type D personalities may involve cardiac autonomic imbalance and lipid dysregulation.

To the Editor: We have read the article by Barthel et al1 describing the first prospective trial to determine the predictive value of heart rate turbulence (HRT) in patients after acute myocardial infarction. In previous studies, the ability of HRT to predict risk was only determined retrospectively.2 We would like to critically discuss here the uniqueness of the emerging risk factor, HRT, in comparison with other parameters. Interestingly, Barthel et al1 found that HRT was the strongest ECG-based risk predictor. This conclusion is surprising for 2 reasons, as follows. First, in an editorial comment3 on the original article by Schmidt et al,2 it was noted that the positive predictive value of HRT is only moderately higher than other ECG risk parameters, and it was suggested that …

To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post-COVID-19 period. The COVID-19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well-being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath. A quantitative cross-sectional study. This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed. Among the nurses surveyed during the COVID-19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well-being. HRV is a valuable and cost-effective measure for monitoring and managing nurses' well-being in the post-COVID-19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well-being by identifying those at high risk of job stress and poor sleep quality.

Patients with psychiatric disorders exhibit general autonomic dysregulation and elevated cardiovascular risks, which could be indexed by heart rate variability (HRV). However, HRV is susceptible to age and other patient-specific factors. This study aimed to investigate the HRV profile and age-related variations, as well as the potential influence of sex, BMI, and HR on HRV in psychiatric populations. There were 571 consecutive patients diagnosed with schizophrenia (SZ) (N = 282) or major depressive disorder (MDD) (N = 289) recruited and classified as adolescent (11-21 years) and adult (> 21 years) groups. HRV indices were measured with 3-minute resting ECG recordings. Compared to adolescent subjects, all time-domain and nonlinear HRV indices were notably reduced in adults, while frequency-domain HRV was comparable. Between SZ and MDD groups, only HTI differed significantly. Age and psychiatric disorders exhibited complex interaction effects on HRV. Stratified by age stage, MDD patients exhibited slightly higher HRV in adolescence but slightly lower HRV in adulthood. In logistic regression analysis, HTI and SD2 were significantly distinctive between adolescents and adults in MDD group, while pNN50 was distinctive in SZ group. Moreover, female subjects demonstrated lower time-domain HRV, LF/HF and SD2 than males. HR exhibited inverse relationship with three domain HRV. No significant effect of BMI was observed. In psychiatric populations, compared to adolescents, adults decreased in time-domain and nonlinear HRV, but not in frequency-domain HRV. Age and psychotic disorders exhibited complex interaction effects on HRV. Sex and HR also emerged as important influencing factors of HRV.

Background and Objectives:Heart rate variability (HRV) reflects the autonomic integration of the heart. There have been many reports asserting that HRV in patients with myocardial infarction or heart failure is an independent prognostic factor to predict fatal arrhythmia and sudden cardiac death. However, the role of HRV is still controversial in stable angina patients without a history of myocardial infarction. In this study, we tried to compare HRV indices between stable angina patients and normal subjects. Materials and Methods:Twentyone stable anginal patients without a history of myocardial infarction (mean age:57±2 years) and twenty-one relatively healthy persons without a history of coronary heart disease (mean age:53±2 years) were included in the study and underwent 24-hour ambulatory ECG monitoring. In the patients group, all underwent coronary angiography following 24-hour ambulatory ECG monitoring. HRV was analyzed over the whole 24 hours, using time and frequency domain parameters, according to time phases and coronary angiographic severity. Results: There were no significant differences in age, sex or cardiovascular risk factors, with the exception of hypertension (p=0.001) between the two groups. HRV indices such as rMSSD, pNN50, LF, HF, LFnorm and HFnorm were significantly decreased (p<0.05) in the patients group. However, the angiographic severity of coronary arteries did not show any significant effect on the HRV indices in the patients group. Conclusion:We observed significantly reduced HRV indices in patients with stable angina without a history of myocardial infarction. (Korean Circulation J 2001;30(5):484-491)

Silent myocardial ischemic episodes as well as decreased heart rate variability (HRV) indices are associated with an unfavorable outcome in patients with coronary artery disease. Nipradilol, which is a nonselective beta-adrenergic and nitrate-like vasodilator anti-anginal agent developed in Japan, may ameliorate silent myocardial ischemia, while it also improves exercise tolerance and HRV indices in patients with chronic stable angina. To investigate the effect of nipradilol (6 mg daily) on silent myocardial ischemic episodes and HRV indices, and to study its effect on the relationship between them, 24 patients with chronic stable angina underwent exercise treadmill testing and a 24-hour ambulatory electrocardiogram (ECG). The study protocol utilized a single blind, 4-week placebo-controlled design. The HRV indices from ambulatory ECG included mean RR (ms), SDNN (ms), SDANN (ms), SD (ms), rMSSD (ms), pNN50 (%); frequency analysis of HRV consisted of total (ms, 0.01-1.00 Hz), low (ms, 0.04-0.15 Hz) and high (ms, 0.15-0.40 Hz) components. Nipradilol significantly decreased the mean heart rate at submaximal and maximal exercise and the mean pressure rate product at submaximal and maximal exercise. It significantly improved exercise-induced maximal ST segment depression from -1.7 +/- 0.6 mm to -1.1 +/- 0.7 mm (p < 0.05). Silent myocardial ischemic episodes recorded during the 24-hour ambulatory ECG significantly decreased after nipradilol administration. Nipradilol also significantly influenced several HRV indices as well as the relationship between silent myocardial ischemic episodes and the HRV indices. Nipradilol significantly increased SD, rMSSD, pNN50, total spectra, low frequency spectra and high frequency spectra. In addition, nipradilol significantly decreased the LF/HF ratio from 1.7 (1.5-2.0) to 1.5 (1.3-1.8). These effects of nipradilol on HRV indices concomitantly occurred with the reduction in silent myocardial ischemic episodes. Nipradilol was found to effectively improve the episodes of silent myocardial ischemia as well as exercise-induced ischemia probably due to its beta-blocking properties and not nitrate-like actions. In addition, nipradilol also had a favorable effect on the HRV indices.

Cardiovascular disease (CVD) is the primary cause of mortality in women in developed countries. CVD risk rises with age, yet for women there is a rapid increase in CVD risk that occurs after the onset of menopause. This observation suggests the presence of factors in the middle-aged women that accelerate the progression of CVD independent of chronological aging. Leisure time physical activity (LTPA) is a well-established protective factor against CVD. However, its role in attenuating atherogenic lipid profile changes and CVD risk in post-menopausal women has not been well-established. The present study is part of the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, a population-based cohort study in which middle-aged Caucasian women (47–55) were classified into pre-menopausal, peri-menopausal, and post-menopausal groups based on follicle stimulating hormone levels and bleeding patterns. Comprehensive questionnaires, laboratory visits, anthropometric measurements, and physical activity monitoring by accelerometers were used to characterize the menopausal groups and serum lipid profiles were analyzed to quantify CV (cardiovascular) risk factors. Based on our findings, LTPA may attenuate menopause-associated atherogenic changes in the serum CV risk factors of healthy middle-aged women. However, LTPA does not seem to entirely offset the lipid profile changes associated with the menopausal transition.

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on insomnia and other sleep disturbances in health care professionals. A survey was distributed using social media and organizational emails to Brazilian active health care professionals during the COVID-19 outbreak. We explored potential associated factors including age, sex, occupation, workplace, work hours, income, previous infection with COVID-19, recent/current contact with COVID-19 patients, regional number of incident deaths, anxiety, and burnout. We evaluated new-onset/previous insomnia worsening episodes (primary outcome), new pharmacological treatments, sleep quality, duration, nightmares, and snoring (secondary outcomes). A total of 4,384 health professionals from all regions of the country were included in the analysis (44 ± 12 years, 76% females, 53.8% physicians). Overall, 55.7% were assisting patients with COVID-19, and 9.2% had a previous COVID-19 infection. The primary outcome occurred in 32.9% of respondents in parallel to 13% new pharmacological treatments for insomnia. The sleep quality worsened for 61.4%, while 43.5% and 22.8% reported ≥ 1-hour sleep duration reduction and worsening or new-onset nightmares, respectively. Multivariate analyses showed that age (odds ratio [OR]: 1.008; 95% confidence interval [CI] 1.001-1.015), females (OR: 1.590; 95% CI 1.335-1.900), weight change (decrease: OR: 1.772; 95% CI 1.453-2.161; increase: OR: 1.468; 95% CI 1.249-1.728), prevalent anxiety (OR: 3.414; 95% CI 2.954-3.948), new-onset burnout (OR: 1.761; 95% CI 1.489-2.083), family income reduction > 30% (OR: 1.288; 95% CI 1.069-1.553), and assisting patients with COVID-19 (OR: 1.275; 95% CI 1.081-1.506) were independently associated with new-onset or worsening of previous insomnia episodes. We observed a huge burden of insomnia episodes and other sleep disturbances in health care professionals during the COVID-19 pandemic. Drager LF, Pachito DV, Moreno CRC, etal. Insomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals. J Clin Sleep Med. 2022;18(2):373-382.

The engagement of athletes in competitive Padel is becoming progressively prevalent, and this heightened participation elicits apprehensions regarding the prevalence of overtraining and sports-related injuries. In this framework, the objective of the present investigation was to examine the potential role of Heart Rate Variability (HRV) monitoring in identifying overtraining injuries among female professional Padel athletes. A cohort of 66 elite female Padel players, with ages ranging from 17 to 32 years, was recruited for the study. The duration of the investigation extended over a 13-week period, during which the participants were observed concerning HRV indices and musculoskeletal injuries while adhering to their customary Padel training protocols. The assessment of HRV indices was executed to ascertain the autonomic nervous system’s response to a state of overload injury, while the Oslo Sports Trauma Research Center (OSTRC) Overuse Injury Questionnaire was administered to assess the prevalence of musculoskeletal overuse injuries, both at baseline and upon completion of the observational period. Utilizing a Paired Samples t-test analysis, the results indicated a statistically significant difference between pre- and post-test assessments, which illustrated that the observational cohort experienced a notable decline in HRV concomitant with an escalation in the incidence of musculoskeletal overuse injuries. Consequently, the findings imply that the monitoring of HRV responses may facilitate the early detection of overuse injuries, inform rehabilitation strategies, and advance return-to-sport protocols, thereby safeguarding and promoting the recovery of injured tissues.

Introduction Poor sleep quality is a well-established risk for posttraumatic symptoms (PTSS; Casement et al., 2012; Germain et al., 2004; 2005). Conversely, self-reported resilience is a well-established protective factor against PTSS (Mealer et al., 2012; Wrenn et al., 2011) and has also been shown to moderate the negative impacts of stressful life events on sleep quality (Li et al., 2019). Fewer studies have investigated whether autonomic indices of regulatory control moderate the impacts of resilience and sleep quality on PTSS. Resting heart rate variability (HRV) is a widely supported measure of top-down regulation of cognitive, behavioral and autonomic outcomes (Thayer &amp; Ruiz-Padial, 2006). Higher HRV has been linked with increased capacity for stress coping as well as regulation of affect and attention (Bornstein &amp; Suess, 2000). This study investigates whether resting HRV moderates the relationship between resilience, sleep quality, and PTSS. Methods Participants completed the PTSD Checklist for DSM-5 criteria (PCL-5), the Pittsburg Sleep Quality Index (PSQI), and the Connor-Davidson Resilience Scale (CD-RISC-10). A resting baseline assessment of electrocardiogram was used to derive resting-state HRV. Participants (N = 42; 86% women; 76% Caucasian) were recruited from college courses and the surrounding community. Results Individuals were grouped into higher and lower HRV. In the lower HRV group, resilience was not related to PTSS, but poorer sleep quality predicted higher PTSS severity (B=.79). Specific components of sleep quality that predicted PTSS in the lower HRV group were sleep disturbance (B=.38) and daytime dysfunction (B=.76). In the higher HRV group, greater resilience predicted lower PTSS severity (B=-.63), but sleep quality was not related to PTSS. Sleeping medication was the only component that predicted PTSS in the higher HRV group, such that less sleep medication was related to higher PTSS (B=-.751). Conclusion These findings suggest that higher HRV in combination with a self-perception of greater resilience are protective factors against PTSS as well as the effects of poorer sleep quality on PTSS. Resting HRV provides an index of regulatory control that may also be a physiological component of resilience. Support (if any) This project was funded by the Dean’s Discovery Fund at Virginia Tech.

Heart Rate Variability Reflects Severity of COPD in PiZ α1-Antitrypsin Deficiency