Autonomic Nervous System Research Articles

Effects of consuming S-allyl-L-cysteine enriched garlic extract on sleep quality in Japanese adults: A randomized, double-blind, placebo-controlled, parallel-group comparative study

Introduction: Sleep promotes well-being, which includes physical and mental health, but many people suffer from sleep deprivation. One of the functional components of garlic, S-allyl-L-cysteine (SAC), can reportedly improve mental fatigue and is expected to regulate the autonomic nervous system and improve sleep quality. This study investigated the effects of SAC-enriched garlic extract intake on sleep quality in healthy Japanese adults. Methods: This was a single center, stratified (male and female with balanced randomization [1:1]), double-blind, placebo-controlled, parallel-group study conducted from September 12, 2023, to February 25, 2024. Participants consumed either the SAC-enriched garlic extract tablet (2 mg/day as SAC) or placebo (22 participants per group) for 12 weeks. The assessment items included the Oguri-Shirakawa-Azumi sleep inventory middle-aged version (OSA-MA), the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J), and St. Mary’s Hospital sleep questionnaire (SMH). The primary outcome was the initiation and maintenance of sleep as measured by the OSA-MA after the 12-week intervention. Results: The final analysis included 19 and 22 participants in the SAC and Placebo groups, respectively. An additional subgroup analysis explored the effect of SAC intake on sleep quality, with 14 and 19 participants in the SAC and Placebo groups, respectively. After the 12-week intervention, the overall analysis showed no significant differences between groups for the primary outcome. In the subgroup analysis, however, the “Initiation and maintenance of sleep” and “Sleepiness on rising” scores in the OSA-MA significantly increased in the SAC group versus placebo. Both the overall and subgroup analyses revealed a decreased total score, subjective sleep quality (C1), and sleep latency (C2) of PSQI-J in the SAC group versus placebo. Regarding the question “How much difficulty did you have in falling asleep last night?” in the SMH, more participants in the SAC group reported “none or very little” in the overall analysis, while all participants reported “none or very little” in the subgroup analysis after the intervention. Conclusions: SAC-enriched garlic extract relieves difficulties associated with initiating and maintaining sleep. Keywords: garlic, S-Allyl-L-Cysteine, sleep quality, falling asleep, sleep maintenance Trial registration number: UMIN000052187

A New Mechanism of Supraventricular Tachycardia: Gene Mutation.

Supraventricular tachycardia (SVT) is very common in daily clinical practice, especially in the emergency department, with rapid onset and urgent management. The review highlights the recent genetic predispositions and mechanisms in SVT. Through analysis of epidemiology, familial clustering, and gene mutations of the relevant literature，the review elucidates the genetic properties and potential pathophysiology of SVT. There are many pathophysiological mechanisms related to atrioventricular node reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT). Currently, there is relatively little research on inappropriate sinus tachycardia (IST), atrial tachycardia (AT), and congenital junctional ectopic tachycardia (CJET). It seems that every type of SVT has gene mutations in ion channels, with three types of SVT having gene mutations in signaling pathways, and others including gene mutations in beta-adrenergic-receptor autoantibodies, autonomic nervous system, and AV node structure. SVT has certain genetic characteristics and is often associated with other heart diseases. From the analysis of mutated genes in SVT, it appears to be a type of cardiac ion channel disease. Unlike common ion channel diseases, it is more insidious and more susceptible to external factors. The confirmation of the genetic basis of SVT provides direction for future hazard stratification assessment and gene targeted therapy drug research.

Transauricular vagus nerve stimulation in preventing post-traumatic stress disorder in emergency trauma surgery patients in China: a study protocol for a multicenter, double-blind, randomised, controlled trial

IntroductionThe incidence of post-traumatic stress disorder (PTSD) in emergency trauma surgery patients is 24%, emphasising the urgent need for effective early interventions and treatments. Transauricular vagus nerve stimulation (ta-VNS) modulates...

Adverse childhood experiences and diurnal cortisol pattern and heart rate variability in adults.

Dysregulation of hypothalamic-pituitary-adrenal axis (HPA axis) and of the autonomic nervous system may link stress throughout the life course with poorer health. This study aims to investigate whether multiple adverse childhood experiences have a long-term impact on markers of these systems - cortisol secretion and heart rate variability - in adulthood. Data were from the Whitehall II cohort study. Fourteen adversities, collected retrospectively in midlife, were considered. Outcomes were total amount of cortisol secretion during the day (area under the curve [AUC]), cortisol awakening response (CAR), and diurnal slope, estimated from six saliva samples taken on a weekday; and resting heart rate (rHR) and heart rate variability (HRV) measured for five minutes at three time points over 10 years with the last measures taken at the same time as the salivary measurement. Regression models were used to examine the association of adversities with AUC, CAR, rHR and HRV and multilevel modelling was applied to analyses of cortisol diurnal slope and the 10-year follow-up of rHR and HRV. At least one early life adversity was reported by 68 % of participants. There was little evidence that increasing number of adversities was associated with any measures of cortisol, rHR or HRV or 10-year change in rHR or HRV. Of the individual adversities, only parental death was associated with increased AUC and CAR. In conclusion, although the HPA axis and autonomic nervous system have been hypothesized as mechanisms relating to adverse childhood experiences with health, our study finds no evidence to support this.

Obesity and hypoxia have differential effects on myocardial innervation in the right ventricle of the male mouse heart.

Obesity, along with hypoxia, is known to be a risk factor for pulmonary hypertension (PH), which can lead to right ventricular hypertrophy and eventually heart failure. Both obesity and PH influence the autonomic nervous system (ANS), potentially aggravating changes in the right ventricle (RV). This study investigates the combined effects of obesity and hypoxia on the autonomic innervation of the RV in a mouse model. Male C57BL/6N mice were subjected to a control diet (CD) or a high-fat diet (HFD) for 30 weeks, with subsets of the mice exposed to chronic normobaric hypoxia (13% O2) during the final 3 weeks. Light and electron microscopic stereology was used to quantify various parameters of nerve fibres innervating the RV myocardium. HFD-induced obesity significantly increased the total length of nerve fibres and axons in the RV under normoxic conditions, indicating hyperinnervation. Quantitatively, the length density of nerve fibres per unit volume of RV (unit: x10-3 µm-2) was similar in CD (0.158 ± 0.04), CD-Hyp (0.176 ± 0.06) and HFD-Hyp (0.147 ± 0.05). In contrast, in HFD the length density of nerve fibres showed higher values 0.206 ± 0.054. The total length of nerve fibres increased by 67% from 2.61 m ± 0.77 m in CD to 4.37 m ± 1.51 m in HFD. The total length of axons increased by 80% from 8.87 m ± 2.75 m to 15.95 m ± 4.62 m. However, when obesity was combined with hypoxia, the total axon length was significantly reduced by 27% in HFD-Hyp compared with HFD. In addition, the mean number of axon profiles per nerve fibre profile decreased from 3.44 ± 0.68 in HFD to 2.95 ± 0.43 in HFD-Hyp. Interestingly, chronic hypoxia alone did not significantly alter RV innervation but led to RV hypertrophy, independent of the diet. The attenuation of obesity-induced hyperinnervation by hypoxia suggests a complex and potentially antagonistic interaction between these conditions. In conclusion, obesity induced by a HFD caused hyperinnervation of the RV, whereas chronic hypoxia alone did not significantly alter RV innervation. Surprisingly, chronic hypoxia attenuated the obesity-induced changes in RV innervation. These findings indicate that the effects of obesity and hypoxia-induced PH on RV innervation are distinct and potentially antagonistic.

Electrophisiological monitoring of pain in non-communicative critically ill patients.

Electrophysiological monitoring of pain provides objective measures that allow for pain control and adjustment of analgesia in non-communicative patients. Among the available electrophysiological devices, automated infrared pupillometry, Analgesia Nociception Index (ANI), and Nociception Level Index (NOL®) stand out. These non-invasive measurement systems analyze the sympathetic or parasympathetic nervous system response to painful stimuli by observing pupillary dilatation and reactivity (pupillometry), heart rate during respiration (ANI), or a combination of multiple parameters from the nociceptive-autonomic medullary circuit (NOL®). These methods have mainly been used in the monitoring of nociception related to procedures in critically ill patients. Furthermore, they have allowed for the prediction, adjustment, and customization of analgesia administration prior to painful procedures. To obtain accurate measurements and properly interpret the values provided by these devices, it is important to consider certain limitations in their use, such as the administration of specific medications or the presence of certain pathologies, due to their influence on the autonomic nervous system response. It is also important to note that the reported level of evidence is limited, as randomized clinical trials in the context of intensive care unit regarding these devices are currently lacking.

Self-Similarity Analysis of Heartbeat Fluctuations in Sleep Among Female Shift Workers

Cardiovascular signals exhibit self-similarity characteristics, which are influenced by changes in autonomic nervous system (ANS) regulation caused by shift work. This study aims to assess the self-similarity properties of inter-beat interval (IBI) in healthy female shift workers and non-shift workers in different sleep stages to detect alterations in heartbeat fluctuations due to shift work. Short- and long-term self-similarity properties of the IBI signal ([Formula: see text] and [Formula: see text] scaling exponents, respectively) were analyzed using Detrended Fluctuation Analysis. Time and frequency indices were also calculated. In addition, Principal Component Analysis (PCA) was employed to reduce dimensionality and evaluate group separability based on the obtained features. Most indices showed similar values in the different sleep stages for both groups, but [Formula: see text] during light sleep and sympathovagal balance during REM sleep showed a significant decrease in shift workers compared to non-shift workers ([Formula: see text]). In addition, PCA was able to separate shift workers from non-shift workers and differentiate between nighttime and daytime sleep of workers. This analysis aids in identifying cardiovascular impairment associated with shift work and suggests a loss of ANS self-similarity in shift workers, indicating reduced adaptive capacity. Such alterations in ANS behavior could lead to serious health consequences related to cardiovascular disease.

Nourishment of nerves and innervation: A novel approach for the treatment of myocardial infarction.

Autonomic innervation of the heart plays a pivotal role not only in regulating the heart rate but also in modulating the cardiac cell microenvironment via cell-cell interactions and influencing the heart's repair capabilities. Currently, the primary clinical approach for treating myocardial infarction (MI) is percutaneous coronary intervention. However, the myocardial salvage rate remains low for patients with advanced disease. MI is recognized as an autonomic nervous system disorder, marked by sympathetic hyperactivity and the loss of parasympathetic nerves. Following MI, ventricular sympathetic nerve sprouting occurs, leading to an increase in ventricular sympathetic innervation and, consequently, an increased risk of ventricular arrhythmia, which is the primary cause of sudden cardiac death in patients with a history of MI. The vagus nerve positively regulates cardiomyocyte proliferation and regeneration, enhancing ventricular remodeling and cardiac function post-MI. This process is highly significant in the treatment and rehabilitation of MI. Cardiac autonomic nerves are influenced by factors such as inflammation, immunity, intercellular communication, metabolism, genetics, epigenetics, and cytokine secretion related to cardiac mesenchymal nerves. In recent years, significant advancements have been made regarding treatment for MI, specifically in the fields of autonomic nervous system therapies, stem cell and extracellular vesicle treatments, traditional Chinese medicine acupuncture and moxibustion, and peripheral electrophysiological stimulation and bioengineering materials. The balance of dominance between the sympathetic and parasympathetic nervous systems in the heart affects tissue regeneration and cardiac remodeling after MI. The secretion of neurons regulates the microenvironment of cardiac repair. The neural therapy of MI involves multiple fields such as traditional Chinese medicine, biomaterials, stem cell therapy, and drug research and development, and has broad development prospects Key Messages: The regulation exerted by the cardiac autonomic nervous system on the heart significantly influences the prognosis of MI. This involves nervous system modulation of inflammation and heart rate and complex interactions between neurons and cardiomyocytes, immune cells, fibroblasts, adipocytes, stem cells, and other cellular components. Genetic and epigenetic modifications, as well as shifts in energy metabolism, also play crucial roles.

Monitoring Sleep and Nightly Recovery with Wrist-Worn Wearables: Links to Training Load and Performance Adaptations.

Previous studies on the effects of intensified training on sleep quality/quantity have been somewhat contradictory. Moreover, recreational athletes often track various sleep metrics, and those metrics' actual connections to training adaptations are unknown. This study explored the effects of intensified training on sleep and nightly recovery along with their associations with training adaptations. A total of 24 participants (10 females) performed a 3-week baseline training period (BL), a 2-week overload period (OL), and a 1-week recovery period (REC), which were followed by test days (T1-T3). The endurance performance was assessed with a 3000 m running test. Throughout all of the periods, the nightly recovery information was monitored with a wrist-worn wearable, including sleep quantity and quality, heart rate (HR) and HR variability (HRV), and proprietary parameters combining several parameters and scaling the results individually. In addition, the perceived strain and muscle soreness were evaluated daily. The 3000 m running performance improved from T1 to T2 (-1.2 ± 1.7%, p = 0.006) and from T1 to T3 (-1.7 ± 1.2%, p = 0.002). The perceived strain and muscle soreness increased (p < 0.001) from the final week of the BL to the final week of the OL, but the subjective sleep quality and nightly recovery metrics remained unchanged. The OL average of the proprietary parameter, autonomic nervous system charge ("ANS charge", combining the HR, HRV, and breathing rate), as well as the change in the sleep HR and HRV from the BL to the OL, were associated (p < 0.05) with a change in the 3000 m running time. In conclusion, the subjective recovery metrics were impaired by intensified training, while the sleep and nightly recovery metrics showed no consistent changes. However, there were substantial interindividual differences in nightly recovery, which were also associated with the training adaptations. Therefore, monitoring nightly recovery can help in recognizing individual responses to training and assist in optimizing training prescriptions.

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms.

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.

Novel Conservative Therapies in Migraine Management: The Impact of Fascia Exercises in a Randomized Controlled Trial.

Background/Objectives: Migraine is a complex neurological disorder often associated with autonomic nervous system (ANS) dysfunction. This study aimed to evaluate the effects of fascia exercises on migraine symptoms and explore their potential as a novel conservative treatment approach. Methods: A prospective, randomized controlled trial was conducted with 30 migraine patients who were randomly assigned to a treatment group (fascia exercises) or a control group (conventional physiotherapy). Both groups underwent a six-week intervention consisting of two sessions per week. Pain intensity, migraine-related disability, sleep quality, anxiety, depression, heart rate variability (HRV), and patient satisfaction were assessed before and after the intervention using validated scales. Results: Significant improvements in pain intensity, attack frequency and duration, migraine-related disability, sleep quality, and anxiety levels were observed in both groups (p < 0.05). However, the treatment group demonstrated a more pronounced reduction in depression scores compared to the control group (p < 0.05). While no significant changes in HRV parameters were detected in either group, patient satisfaction was significantly higher in the treatment group (p < 0.05). Conclusions: Fascia exercises represent a promising complementary therapy for migraine management, offering significant improvements in both physical and psychological symptoms. While immediate effects on HRV were not evident, the potential to modulate autonomic balance and address migraine pathophysiology warrants further exploration. These findings highlight the value of fascia exercises as a low-cost, non-invasive approach, emphasizing the need for further research to confirm their long-term clinical benefits and integration into migraine treatment protocols.

Under the surface: Low cardiac vagal tone and poor interoception in young adults with subclinical depressive symptoms.

Depressive symptoms are associated with alterations in central and autonomic nervous system activity, including misperception of bodily activity (e.g., low interoception), somatic symptoms and decreased vagally mediated heart rate variability (vmHRV). However, there is a lack of studies that examine both perception of bodily activity and autonomic function in depression. The present study investigated the association between interoception, vmHRV, and subclinical depressive symptoms. Eighty-eight students were enrolled and vmHRV was calculated from a 5-minute resting electrocardiogram. Interoceptive accuracy (heartbeat tracking task; heartbeat discrimination task), interoceptive sensibility (Body Perception Questionnaire), and depressive symptoms (Depression, Anxiety and Stress Scale - 21 Items) were assessed. Interoceptive accuracy and sensibility positively correlated with vmHRV and negatively correlates with depressive symptoms. Cluster analysis performed on vmHRV, interoceptive accuracy, and sensibility provided two clusters: the first characterized by a pattern of low interoceptive accuracy, sensibility, and decreased resting vmHRV, the second characterized by an opposite pattern. Regression analyses showed that the first cluster was characterized by significantly higher depressive symptoms compared to the second (β=1.97; pBonferroni=0.04), even after controlling for sex, BMI, anxiety, and stress levels. Subclinical depressive symptoms are associated with a consistent impairment in the perception and interpretation of bodily activity and altered regulatory function of the autonomic nervous system. The present results suggest that the alteration of brain-body communication could be involved in subclinical depressive symptoms. Early identification of such alterations could help with targeted preventive strategies.

High-intensity interval aerobic exercise delays recovery from heart rate variability: a systematic review with meta-analysis.

The present review investigates the responses of heart rate variability indices following high-intensity interval aerobic exercise, comparing it with moderate-intensity continuous exercise in adults, with the aim of informing clinical practice. Searches were conducted in four databases until March 2023. Eligible studies included randomized controlled trials that assessed heart rate variability indices such as the standard deviation of normal-to-normal heartbeat intervals (SDNN), the root mean square of successive differences (RMSSD), the proportion of the number of pairs of successive normal-to-normal (NN or R-R) intervals that differ by more than 50 ms (NN50) divided by the total number of NN intervals (pNN50), power in high frequency range (HF), power in low frequency range (LF), and LF/HF before and after high-intensity interval and moderate-intensity continuous aerobic exercise. The risk of bias in included studies was evaluated using the RoB 2 tool. A total of 16 studies were included in the systematic review, while 9 were included in the meta-analysis. Overall, the majority of included individuals were healthy and young. Our meta-analysis indicated that individuals who performed high-intensity interval exercise showed a slower recovery to baseline levels for HF (standardized mean difference, SMD-0.98 [95% CI -1.52 to -0.44], p<0.001) and LF (SMD-0.42 [95% CI -0.81 to -0.02], p=0.04) within the first 10 min of recovery, which did not occur after 1 h. Among the 16 included studies, 10 had some concerns related to bias risk, while 6 were classified as high risk. High-intensity interval aerobic exercise results in delayed recovery of HF and LF indices within the first 10 min after the session. However, our review indicates that healthy individuals restore modulation of the autonomic nervous system to baseline levels after this time interval, regardless of exercise intensity.

Physiological fingerprinting of audiovisual warnings in assisted driving conditions: an investigation of fMRI and peripheral physiological indicators

Physiological responses derived from audiovisual perception during assisted driving are associated with the regulation of the autonomic nervous system (ANS), especially in emergencies. However, the interaction of event-related brain activity and the ANS regulating peripheral physiological indicators (i.e., heart rate variability (HRV) and respiratory rate) is unknown, making it difficult to study the neural mechanism during takeover from the assistance system. In this paper, we established a mapping between the ANS regulation and brain activations of driving events in function magnetic resonance imaging (fMRI)-conditioned audiovisual warnings experiment to add physiological fingerprints for assisted driving. Firstly, we used the general linear model (GLM) to obtain brain activation clusters of driving events and brain activation clusters of peripheral physiological indicators in different frequency bands. Secondly, we redefined the input parameters based on the driving events to calculate the GLM to obtain the brain activation clusters of event-related physiological indicators. Finally, the relationship between the main activation clusters of driving events and the activation of event-related physiological indicators was quantified by the statistical test of the mean-time course of voxels within the region. The results showed that related areas of the brain responsible for movement, visceral autonomic regulation, auditory, and vision actively responded to the audiovisual warnings of automatic driving. The mappings created using them revealed that the correlation between driving event-related activation of brain regions and respiration worked at the onset of audiovisual warnings, especially between the intermediate (IM) and low frequency (LF) bands. For pre-emergency and takeover in audiovisual warnings, the correlations of HRV were dominant, with significant differences among LF, IM and high frequency (HF) bands. At different periods of audiovisual warnings, HRV and respiration play different roles in physiological fingerprints. Compared to respiratory indicators, HRV has higher sensitivity to emergency situations. This study investigates the interaction between driving-related network activity and ANS regulation, revealing the profound connection between driving behavior and neural activity, and contributing to the research of driving assistance systems.

Sedative effects of roasted green tea aroma on autonomic nervous activity, central nervous activity, and subjective mood state in healthy adults

Introduction: To clarify the physiological and psychological effects of roasted green tea aroma, this study examined the effects of roasted green tea extract and its major aromatic components on autonomic nervous activity, central nervous activity, and subjective mood state. Methods: Twenty healthy adults who were not averse to the aroma of green tea, did not smoke, did not display any flu symptoms, and were not receiving drug treatment participated in this study. The study samples comprised a roasted green tea extract from Shizuoka first-growth green tea (Test I) and three pyrazines, which are the main aromatic components of roasted green tea (Test III). The pupil miosis rate, peripheral skin temperature, and cerebral blood flow were measured after 2 min of inhalation of the study samples as physiological evaluations. Subjective mood state was investigated using a questionnaire for psychological evaluation. Results: The results showed that inhalation of roasted green tea aroma significantly increased the pupillary miosis rate and peripheral skin temperature, similar to the effects observed with hot water. Furthermore, inhalation of roasted green tea aroma reduced the amount of oxygenated hemoglobin in the prefrontal cortex, suggesting that it also has a sedative effect on the central nervous system. In the psychological evaluation using the Visual Analog Scale, roasted green tea aroma inhalation reduced the scores for “tension”, and “anxiety” while increasing those for “mood” and “comfort” relative to those observed with hot water. In addition, the evaluation of the main aromatic components of roasted green tea, specifically three different pyrazines, demonstrated physiological effects similar to those of roasted green tea even at room temperature when tested at concentrations derived from the results of the analysis. Conclusion: The aroma of roasted green tea has both physiological and psychological sedative effects that differ from those of hot water and suggest that these pyrazines play a role in producing these effects, with 2,3,5-trimethylpyrazine being the most important aromatic component. Furthermore, the findings suggest that roasted green tea aroma exerts a sedative effect on the autonomic nervous system by suppressing sympathetic nerve activity while increasing parasympathetic nerve activity.

The Effect of Audible Joint Manipulation Sounds in the Upper Cervical Spine on Brain Wave and Autonomic Nervous System Activity.

High-velocity, low-amplitude (HVLA) manipulation is a common manual therapy technique used for treating pain and musculoskeletal dysfunction. An audible manipulation sound is commonly experienced by patients who undergo HVLA manipulation; however, there is little known about the effects and clinical relevance of the audible manipulation sound on cortical output and the autonomic nervous system. This study aimed to identify the immediate impact of the audible manipulation sound on brainwave activity and pupil diameter in asymptomatic subjects following an HVLA cervical manipulation. 40 subjects completed this quasi-experimental repeated measure study design. Subjects were connected to electroencephalography and pupillometry simultaneously, and an HVLA cervical distraction manipulation was performed. The testing environment was controlled to optimize brainwave and pupillometry data acquisition. Pre-manipulation, immediately after manipulation, and post-manipulation data were collected. The presence of an audible manipulation sound was noted. Twenty subjects experienced an audible manipulation sound. Brainwave activity changes were significant (p < 0.05) in both the audible manipulation sound and non-manipulation sound groups. Pupil diameter changes (p < 0.05) occurred in both eyes of the non-manipulation sound group and in the left eye of the audible-manipulation sound group. Brainwave activity patterns were similar in both groups. The presence of an audible manipulation sound is not required to produce central nervous system changes following an HVLA cervical manipulation; however, the audible manipulation sound does prolong the effects of brainwave activity, indicating a prolonged relaxation effect.

Oral medications for the treatment of postural orthostatic tachycardia syndrome; a systematic review of studies before and during the COVID-19 pandemic.

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex form of dysautonomia that presents with abnormal autonomic reflexes upon standing, leading to symptoms such as lightheadedness, tachycardia, fatigue, and cognitive impairment. The COVID-19 pandemic has brought renewed attention to POTS due to its overlap with post-acute sequelae of COVID-19 (PASC). Studies have found that a substantial percentage of COVID-19 survivors exhibit symptoms resembling POTS, elevating POTS diagnoses to previously unseen levels. We systematically reviewed the literature for existing high-quality evidence on potential interventions. A systematic review of the literature was performed to identify studies of oral medications for the management of POTS. We searched for published manuscripts on the medical management of POTS through 6 April 2024 which met pre-specified inclusion criteria. We conducted quality appraisal and assessed risk of bias before extracting the data and performing synthesis to determine the current state of the evidence; particularly in the context of PASC. The study search and selection process identified 32 studies that met inclusion criteria, comprising randomized controlled trials, observational studies, and systematic reviews. Most included studies were judged to be of moderate to high quality, with largely low risk of bias. The most frequently studied medications were beta-blockers, ivabradine, and midodrine. Ivabradine and midodrine demonstrated the highest rate of symptomatic improvement, while beta-blockers showed the largest reduction in heart rate variability. Limited evidence was available for PASC-associated POTS, but findings suggest that treatments may have similar efficacy in both PASC and non-PASC cases. Ivabradine, midodrine, and beta-blockers currently appear to be reasonable front-line choices in pharmacologic management of POTS (PASC associated and otherwise). Further RCTs that evaluate long term outcomes of medications are needed to further establish evidence based pharmacologic treatment approaches for POTS. Particular areas of inquiry include differential efficacy of recommended therapies based on POTS subtypes, and a need for treatments directly targeting the underlying autonomic nervous system dysfunction. PROSPERO, identifier CRD42024505967, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=505967.

Unlocking the mind-body connection: An HRV-based assessment of cardiac autonomic responses to yogic postures

The cardiac autonomic nervous system (CANS) plays a crucial role in regulating cardiovascular health. While yoga is considered an effective lifestyle intervention for enhancing autonomic regulation, most existing studies focus on the effects of meditation or breathing practices. Limited research exists on the influence of specific yogic postures on heart rate variability (HRV), a sensitive indicator of cardiac autonomic function.: This study aimed to investigate the immediate impact of specific yoga asanas, namely Padahastasana (PD), Ardha Chakrasana (AD), Ardhkatichakrasan Right (AKRD), Ardhkatichakrasan Left (AKLD), Trikonasana Right (TRD), Trikonasana Left (TLD), and Sarvangasana (SD) on HRV in healthy individuals. This observational pilot study was conducted with 30 healthy male volunteers aged 18–30 years. HRV was recorded for 15 minutes for each participant during the pre, during-, and post-asana phases. The frequency and time-domain components of HRV were analysed using SPSS 21.0. Significant changes were observed in the frequency domain parameters such as the LF/HF ratio, LF power, and HF power post-intervention. Notably, backward and inversion asana significantly increased vagal modulation, suggesting a shift towards parasympathetic dominance. The findings of this study indicate that specific yoga asana significantly modulate cardiac autonomic regulation, underscoring their potential utility in cardiovascular health and rehabilitation. Further research is warranted to explore the long-term impact of these postures on cardiac autonomic function.

Orienting Gaze Toward a Visual Target: Neurophysiological Synthesis with Epistemological Considerations.

The appearance of an object triggers an orienting gaze movement toward its location. The movement consists of a rapid rotation of the eyes, the saccade, which is accompanied by a head rotation if the target eccentricity exceeds the oculomotor range and by a slow eye movement if the target moves. Completing a previous report, we explain the numerous points that lead to questioning the validity of a one-to-one correspondence relation between measured physical values of gaze or head orientation and neuronal activity. Comparing the sole kinematic (or dynamic) numerical values with neurophysiological recordings carries the risk of believing that the activity of central neurons directly encodes gaze or head physical orientation rather than mediating changes in extraocular and neck muscle contraction, not to mention possible changes happening elsewhere (in posture, in the autonomous nervous system and more centrally). Rather than reducing mismatches between extrinsic physical parameters (such as position or velocity errors), eye and head movements are behavioral expressions of intrinsic processes that restore a poly-equilibrium, i.e., balances of activities opposing antagonistic visuomotor channels. Past results obtained in cats and monkeys left a treasure of data allowing a synthesis, which illustrates the formidable complexity underlying the small changes in the orientations of the eyes and head. The aim of this synthesis is to serve as a new guide for further investigations or for comparison with other species.

Catheter Ablation for Vasovagal Syncope: The Therapeutic Potential of Gateway Plexi

Vasovagal syncope (VVS) is the most common cause of syncope, and significantly impacts quality of life despite its benign nature. For some patients, conventional management strategies such as lifestyle changes, pharmacotherapy and pacemaker implantation, fail to prevent recurrence. Cardioneuroablation (CNA), a novel intervention targeting the cardiac autonomic nervous system’s ganglionated plexi, has shown promise in addressing refractory VVS. This review examines the therapeutic potential of CNA, exploring the anatomy and physiology of the cardiac autonomic nervous system, the role of ganglionated plexi in cardiac regulation and the rationale behind their selection as ablation targets. The review also discusses diverse strategies for ganglionated plexi identification and ablation. The gateway ganglionated plexi hypothesis is used to explain the success of CNA across varied procedural methods, despite the absence of a standardized technique. These gateway ganglionated plexi, located near the sinoatrial and atrioventricular nodes, potentially serve as central nodes influencing heart rhythm and rate, thus explaining the high success rates in VVS treatment using different approaches.