Autonomic function classification and sleep quality among young adults in Central Java, Indonesia: A cluster analysis.

AUTONOMIC AND HEMODYNAMIC ACTIVITY IN SEPSIS

The present study evaluated the relationship between acute chest syndrome (ACS) and autonomic nervous system (ANS) activity in patients with hemoglobin SS disease (Hb SS). Nine patients had suffered ACS were matched by age and gender to patients who had not suffered ACS and ANS activity, pulmonary function and history of painful crisis were compared. Correlations between number of episodes of ACS suffered and these variables were determined. The results demonstrated that 1) patients with a history of ACS ever had lower parasympathetic nervous system (PNS) activity and lower global ANS activity than patients with no ACS ever (p < 0.05), 2) the number of ACS episodes ever negatively correlated (p < 0.05) with PNS activity and global ANS activity and 3) There were no significant associations between lung function or a history of painful crisis in these patients. In conclusion, a history of ACS was associated with ANS dysfunction in adults with Hb SS disease.

Objective: The extent of the physiological nocturnal dip of blood pressure (BP) and its variation seems to be correlated with autonomic nervous system's (ANS) activity. This relationship is not completely clear, however, especially with regard to the role of the two different components of the ANS and their balance. For example, patients with primary autonomic failure and very low sympathetic and parasympathetic activities also have a high incidence of nondipping, suggesting that it is not the inability to inhibit sympathetic activity during the night, but the inability to modulate autonomic tone that is responsible for the nondipping phenomenon. In order to assess the relationship between ANS's activity and dipping pattern observed by ABPM, we investigated the time domain HRV indexes obtained from 24-hours-Holter ECG monitoring in a group of hypertensive subjects. Design and method: Were enrolled 132 patients with hypertension who have been subjected to an ABPM and to an 24-hours-Holter ECG monitoring to not more than 30 days apart. Time-domain HRV parameters evaluated were the standard deviation of all normal RR intervals (SDNN), the standard deviation of the averaged normal RR intervals for all 5-min segments (SDANN), the root mean square of differences between adjacent R-R intervals (rMSSD) and the percentage of adjacent R-R intervals that varied by more than 50 ms (pNN50). SDNN and SDANN measures estimates sympathetic nervous system (SNS) activity, whereas rmSSD and pNN50 measures estimates parasympathetic nervous system (PNS) activity. Results: We observed a progressive reduction of SDNN and SDANN values from extreme dippers to dippers to nondippers to reverse dippers although the only statistical significance was obtained comparing extreme vs reverse dipper (p: 0.14). We did not observe differences regarding to the PNS activity HRV markers. Conclusions: In our sample non dippers and reverse dippers patients seems to be marked by a change of the sympatho-vagal balance due to increase of SNS activity as assessed by the reduction of SDNN and SDANN parameters.

The majority of women of reproductive age experience a regular recurrence of various symptoms in the premenstrual phase. The etiopathogenesis of premenstrual symptomatology, however, remains inconclusive. The present study was proposed to evaluate whether the activity of the autonomic nervous system (ANS), which largely contributes to the relative stability of a human's internal environment, is altered during the menstrual cycle of women with premenstrual symptomatology. Thirty eumenorrheic young women participated in this study. All subjects were investigated during the follicular and late luteal phases. The ANS activity was assessed by means of heart rate variability power spectral analysis during supine rest. No intramenstrual cycle differences in the ANS activity were found in women experiencing no or small increases in premenstrual symptoms. In contrast, the sympathetic nervous system (SNS) activity significantly increased and the parasympathetic nervous system (PNS) activity apparently decreased in the late luteal phase in subjects whose premenstrual symptomatology was not unbearable, but substantially increased (>20%) compared to the symptom-free follicular phase. The women with greater degrees of premenstrual distress possessed higher SNS activity and lower PNS activity in the late luteal phase than the women with less symptomatology. The ANS activity in the follicular phase did not differ among the subjects regardless of their premenstrual symptoms. Although causes and consequences continue to elude, the present study provides additional intriguing evidence that the altered functioning of ANS in the late luteal phase could be associated with diverse psychosomatic or behavioral symptoms appearing premenstrually.

Aim: This study examined the effectiveness of an 8-week lavender aromatherapy intervention on improving sleep quality and modulating autonomic nervous system (ANS) activity among nurses working rotating shifts. Methods: A quasi-experimental study was conducted in a hospital in southern Taiwan. Ninety-five nurses were randomly assigned to a lavender aromatherapy group (n=48) or a control group (n=47). The intervention group applied lavender essential oil to pillowcases nightly, while controls maintained usual routines. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline, week 4, and week 8, and physiological indicators of ANS activity were monitored weekly. Results: Lavender aromatherapy significantly improved subjective sleep quality compared to controls, as reflected by reduced PSQI scores over time. Physiological outcomes showed consistent improvements, including reductions in blood pressure and heart rate, alongside increased heart rate variability and parasympathetic activity, indicating enhanced autonomic balance. Conclusion: Lavender aromatherapy effectively improved sleep quality and ANS regulation among shift-working nurses. By lowering blood pressure, heart rate, and sympathetic activity while enhancing parasympathetic tone, this simple, non-pharmacological intervention demonstrates potential for mitigating sleep disturbances and stress-related cardiovascular risks in healthcare professionals. Incorporating lavender aromatherapy into workplace wellness initiatives may support the health and resilience of nursing staff. Future studies should explore combined complementary therapies and evaluate long-term benefits.

Objective An imbalance in autonomic nervous system (ANS) activity may play a role in asthma, but it is unclear whether this is associated with specific pathophysiology. This study assessed ANS activity by measuring heart rate variability (HRV) in eosinophilic (EA) and non-eosinophilic asthma (NEA) and people without asthma. Methods HRV, combined hypertonic saline challenge/sputum induction, exhaled nitric oxide (FeNO), skin prick tests to measure atopy, and spirometry tests were conducted in teenagers and young adults (14–21 years) with (n = 96) and without (n = 72) generally well-controlled asthma. HRV parameters associated with sympathetic and parasympathetic ANS branches were analyzed. EA and NEA were defined using a 2.5% sputum eosinophil cut-point. Airway hyperreactivity (AHR) was defined as ≥15% reduction in FEV1 following saline challenge. Results HRV parameters did not differ between asthmatics and non-asthmatics or EA and NEA. They were also not associated with markers of inflammation, lung function or atopy. However, increased absolute low frequency (LFµs2; representing increased sympathetic nervous system (SNS) activity) was found in asthmatics who used β-agonist medication compared to those who did not (median: 1611, IQR 892–3036 vs 754, 565–1592; p < 0.05) and increased normalized low frequency (LF nu) was found in those with AHR compared to without AHR (64, 48–71 vs 53, 43–66; p < 0.05). Conclusion ANS activity (as measured using HRV analysis) is not associated with pathophysiology or inflammatory phenotype in young asthmatics with generally well-controlled asthma. However, enhanced SNS activity can be detected in asthmatics with AHR or who use β-agonist medication.

Analysis of heart rate variability (HRV) is a recognized tool in the assessment of autonomic nervous system (ANS) activity. Indeed, both time and spectral analysis techniques enable us to obtain indexes that are related to the way the ANS regulates the heart rate. However, these techniques are limited in terms of the lack of thresholds of the numerical indexes, which is primarily due to high inter-subject variability. We proposed a new fetal HRV analysis method related to the parasympathetic activity of the ANS. The aim of this study was to evaluate the performance of our method compared to commonly used HRV analysis, with regard to i) the ability to detect changes in ANS activity and ii) inter-subject variability. This study was performed in seven sheep fetuses. In order to evaluate the sensitivity and specificity of our index in evaluating parasympathetic activity, we directly administered 2.5 mg intravenous atropine, to inhibit parasympathetic tone, and 5 mg propranolol to block sympathetic activity. Our index, as well as time analysis (root mean square of the successive differences; RMSSD) and spectral analysis (high frequency (HF) and low frequency (LF) spectral components obtained via fast Fourier transform), were measured before and after injection. Inter-subject variability was estimated by the coefficient of variance (%CV). In order to evaluate the ability of HRV parameters to detect fetal parasympathetic decrease, we also estimated the effect size for each HRV parameter before and after injections. As expected, our index, the HF spectral component, and the RMSSD were reduced after the atropine injection. Moreover, our index presented a higher effect size. The %CV was far lower for our index than for RMSSD, HF, and LF. Although LF decreased after propranolol administration, fetal stress index, RMSSD, and HF were not significantly different, confirming the fact that those indexes are specific to the parasympathetic nervous system. In conclusion, our method appeared to be effective in detecting parasympathetic inhibition. Moreover, inter-subject variability was much lower, and effect size higher, with our method compared to other HRV analysis methods.

Several cardiovascular disease (CVD) risk factors (e.g., hypertension, poor glycemic control) can affect and be affected by autonomic nervous system (ANS) activity. Since excess adiposity can influence CVD development through its effect on hypertension and diabetes mellitus, it is important to determine how adiposity and altered ANS activity are related. The present study employed structural equation modeling to investigate the relation between adiposity and ANS activity both directly and indirectly through biological variables typically associated with glycemic impairment and cardiac stress in older adults. Utilizing the Atherosclerosis Risk in Communities (ARIC) dataset, 1,145 non-smoking adults (74±4.8 yrs, 62.8% female) free from known CVD, hypertension, and diabetes and not currently taking beta-blockers were evaluated for fasting blood glucose (FBG), insulin, and HbA1c concentrations, waist circumference (WC), blood pressure (BP), and markers of ANS activity. WC was recorded just above the iliac crest and was used to reflect central adiposity. Resting 2-minute electrocardiograph recordings, pulse wave velocity, and ankle-brachial index data were used to assess the root mean square of successive differences in RR intervals (RMSSD) and the pre-ejection period (PEP), markers of parasympathetic and sympathetic activity, respectively. FBG, insulin, and HbA1c inferred a latent variable termed glycemic impairment (GI), whereas heart rate and diastolic BP inferred a latent variable termed cardiac stress (CS). The structural equation model fit was acceptable [root mean square error of approximation = 0.050 (90% CI = .036, .066), comparative fit index = .970, Tucker Lewis Index = 0.929], with adiposity having both significant direct (β = 0.208, p = 0.018) and indirect (β = -.217, p = .041) effects on PEP through GI. Adiposity displayed no significant direct effect on RMSSD. CS displayed a significant pathway (β = -0.524, p = 0.035) on RMSSD, but the indirect effect of WC on RMSSD through CS did not reach statistical significance (β = -0.094, p = 0.137). These results suggest that adiposity's relation to ANS activity is multifaceted, as increased central adiposity had opposing direct and indirect effects on markers of sympathetic activity in this population of older adults.

To describe early effects of sympathetic (SNS) and parasympathetic nervous system (PSNS) activities measured by heart rate (HR) and respiratory rate variabilities simultaneously with noninvasive hemodynamic patterns in patients with blunt and penetrating trauma. Descriptive study of 168 monitored trauma patients in a level I university-run trauma service. We studied HR and respiratory rate variability by spectral analysis as a measure of autonomic nervous system (ANS) activity in severe blunt and penetrating injuries beginning shortly after their admission to the emergency department. The low frequency area is the area under the HR spectral analysis curve within the frequency range of 0.04 Hz to 0.10 Hz. This area primarily reflects the tone of the SNS as mediated by the vagus nerve. The respiratory frequency area, sometimes referred to as the high frequency area, is a 0.12 Hz-wide frequency range centered around the fundamental respiratory frequency defined by the peak mode of the respiratory activity power spectrum. It is indicative of vagal outflow reflecting PSNS activity. The low frequency area/respiratory frequency area, or L/R ratio, reflects the balance of the SNS and the PSNS. ANS was studied simultaneously with noninvasive hemodynamic patterns after blunt and penetrating thoracic or abdominal injury beginning shortly after admission. We measured cardiac index by bioimpedance, HR, and mean arterial pressure (MAP) to evaluate cardiac function, pulse oximetry (SapO2) to reflect changes in respiratory function, and transcutaneous oxygen indexed to fractional inspired oxygen (PtcO2/FIO2) to reflect tissue perfusion. ANS activity markedly increased especially in the nonsurvivors at 12 hours to 24 hours after admission. Compared with survivors, the nonsurvivors had lower MAP, CI, and PtcO2/FIO2 values associated with increased ANS activity. In the nonsurvivors, low flow, low MAP, and reduced tissue perfusion were associated with pronounced increases in PSNS and lesser increases in SNS activity. In the survivors, higher CI, MAP, and PtcO2/FIO2 values were associated with lesser increases in both PSNS and SNS activities.

Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years

PurposeIt is well known that the autonomic nervous system (ANS) activity is impaired in patients with Crohn’s disease (CD). Heart rate variability (HRV), a non-invasive and repeatable measurement, was used to assess ANS activity. The relationships between disease activity and HRV need to be elucidated. Our study also aimed to explore the relationship between HRV parameters and systemic inflammatory biomarkers, and to establish an assessment model using HRV, a non-invasive tool, to assess endoscopic activity in CD.Patients and methodsA total of 84 CD patients (44 active CD and 40 in remission) were enrolled at The First Affiliated Hospital of Nanjing Medical University from January 2022 to December 2022. All patients underwent HRV examination and endoscopy. Clinical data, including demographic variables, disease activity and course, medications, and laboratory data, were collected. Binary logistic regression analysis was used to identify the factors associated with endoscopic activity, based on which the nomogram model was established.ResultsCompared with patients in endoscopic remission, active CD patients had significantly ratio of low frequency to high frequency (LF/HF) (p < 0.001), lower standard deviation of all normal–normal (SDNN) intervals (p = 0.002), and high-frequency HRV (HF) (p = 0.011), suggesting that parasympathetic activity was reduced in active CD patients. In addition, SDNN and HF were negatively correlated with the simple endoscopic score for CD (SES-CD). Meanwhile, HR and LF/HF were found to be independent risk factors for endoscopic disease activity by univariate and binary logistic regression. A regression model was established: HRV assessment of endoscopic active = −8.335 + 0.918LF/HF + 0.084HR (C-index: 0.803, 95% confidence interval [CI]:0.710–0.896).ConclusionThe parasympathetic activity was reduced in active CD patients. Furthermore, the significant correlations between HRV parameters and inflammatory biomarkers underscore that HRV not only reflects endoscopic activity but also mirrors the systemic inflammatory burden in CD. Thus, HRV can potentially be developed into a simple, non-invasive tool for comprehensively assessing disease activity and inflammation in CD.

Physiology of brain death is characterized by major disturbances of autonomic nervous system (ANS) activity which can lead to graft dysfunction. These findings exhibit the importance of early diagnosis of brain death to improve transplantation outcome. The aim of this prospective study was to assess whether heart rate variability (HRV) analysis, a noninvasive method to investigate ANS activity in comatose patients, could achieve this goal. A total of 14 brain-injured patients were included in the study as soon as they exhibited the clinical signs of imminent brain death. The electrocardiogram was then recorded from two leads with a Holter digital monitor. The clinical diagnosis of brain death was considered after an autonomic storm had occurred. HRV was assessed from 6 h before to 6 h after brain death in both time domain and spectral analysis, estimating either global ANS activity (index of variability, total power), parasympathetic activity (percentage of delta of R-R interval >50 ms, root mean square for successive interval differences, LnHF) or sympathetic activity (LnLF). Hourly averages of these variables were compared by using one-way analysis of variance. To assess whether HRV could per se diagnose brain death, receiver operating characteristic curves were generated for total power, root mean square for successive interval differences, and LnHF. We observed, for 6 h before brain death, a progressive extinction of the influence of the ANS on cardiovascular regulation. There was no activity in the two components of the ANS as soon as brain death occurred. HRV analysis appeared to be a very sensitive but a less specific method of diagnosing brain death. A total of 14 brain-injured patients with the clinical criteria of imminent brain death were enrolled for electrocardiogram recording and heart rate variability analysis (a noninvasive method to investigate autonomic nervous system activity). For 6 h before brain death, we observed a progressive extinction of autonomic nervous system activity which was not present as soon as brain death was clinically evoked.

Power spectral analysis of fetal heart rate variability has been proposed to provide a non-invasive estimate of autonomic balance. However, there are few systematic data before birth. We therefore examined developmental changes in the frequency power spectrum at very low (0-0.04 Hz), low (0.04-0.15 Hz) and high frequencies (0.15-0.4 Hz), as well as the ratio of low- to high-frequency power (LF/HF), in chronically catheterized, healthy fetal sheep at 0.6 (n = 8), 0.7 (n = 7) and 0.8 gestational age (ga; n = 11). In a second study, 0.8 ga fetuses received either atropine (4.8 mg bolus, then 4.8 mg h(-1) for 30 min, n = 6) or 6-hydroxydopamine (20 mg ml(-1) at 2.5 ml h(-1) for 3 h; n = 9). Data were analysed by sleep state, defined by low-voltage-high-frequency (LV) or high-voltage-low-frequency (HV) EEG. Total spectral power increased with gestational age (P < 0.05), while LF/HF decreased from 0.6 to 0.7 ga. At 0.8 ga, heart rate and LF/HF were significantly higher during HV than LV sleep (P < 0.05). Consistent with this, although total spectral power was not significantly greater during HV sleep, there was a significant interaction between sleep state and frequency band (P = 0.02). Both atropine (P = 0.05) and 6-hydroxydopamine (P < 0.05) were associated with an overall reduction in spectral power but no significant effect on the LF/HF ratio. This study does not support substantial, consistent differences between the frequencies of sympathetic and parasympathetic activity in late-gestation fetal sheep.

The present study investigates how coordination between stress responsivity of the parasympathetic nervous system (PNS) and sympathetic nervous system (SNS) moderates the prospective effects of marital conflict on internalizing and externalizing symptoms across adolescence. Although an important avenue for psychophysiological research concerns how PNS and SNS responses jointly influence adjustment in the context of stress, these processes have rarely been studied in adolescence or longitudinally. Participants were 252 youth (53% female, 66% European American, 34% African American) who participated in laboratory assessments when they were 16, 17, and 18 years old. PNS activity (measured via respiratory sinus arrhythmia [RSA]) and SNS activity (measured via skin conductance level [SCL]) were assessed during a resting baseline and in response to a laboratory-based challenge (star tracing). Parents and adolescents both reported on marital conflict and adolescents reported on their internalizing and externalizing symptoms. At higher levels of marital conflict, coactivation of PNS and SNS activity, characterized by increased RSA and increased SCL from baseline to challenge, predicted elevated internalizing symptoms and an increase in externalizing behavior across adolescence. Coinhibition, or decreased activity across both systems, also predicted an increase in internalizing symptoms over time. At lower levels of marital conflict, internalizing and externalizing symptoms were relatively low. Findings extend primarily cross-sectional work with younger children by demonstrating that coordination between the two branches of the autonomic nervous system (ANS) moderates the longitudinal effects of marital conflict on psychological and behavioral maladjustment among adolescents. (PsycINFO Database Record

In this study we evaluated, in 10 sevoflurane-anesthetized pigs undergoing abdominal surgery, different techniques for measuring autonomic nervous system (ANS) activity: ANSiscope index, spectral analysis of heart-rate variability, hemodynamic variables, and plasma catecholamines and cortisol levels. Animals underwent a 120-min anesthesia during which unilateral ovariectomy was performed. Cardiovascular and respiratory responses were monitored. ANSiscope indices (ANSindex sympathetic, ANSindex parasympathetic and balANSindex) were used to monitor ANS activity. Spectral analysis was performed using an autoregressive model with a parametric method. The low frequency (LF) and high frequency (HF) components were used to interpret the power spectral density of short-term electrocardiograms (ECGs). The relationship LF/(LF+HF) reflects sympathetic activity, HF/(LF+HF) indicates parasympathetic activity, and the LF/HF ratio gives the predominance of the system. Plasma concentrations of adrenaline, noradrenaline, and cortisol were determined at different times. Correlation (P < 0.01) was found between the balANSindex and adrenaline levels and between LF/HF ratio and plasma adrenaline concentrations. Moreover, a significant (P < 0.01) correlation was found between the balANSindex and LF/HF ratio. However, no correlation was seen between the registered ANSiscope indices and hemodynamic variables. The correlation seen in this study suggests that the balANSindex could be a useful tool to monitor ANS activity during anesthesia and surgery.