Robust circadian rhythm in heart rate and its variability: influence of exogenous melatonin and photoperiod

Diurnal 24-Hour Rhythm in Ambulatory Heart Rate Variability during the Day Shift in Rotating Shift Workers

Circadian variation in cardiac autonomic nervous system activity and behavior during the day shifts of shift workers has not hitherto been clarified. This study examined diurnal 24-h variation in heart rate variability (HRV), sleep-wake cycle, physical activity, and food intake during the day shift in rotating shift workers. The subjects were female nurses and caregivers working at a health care facility (14 day workers and 13 rotating shift workers). Each subject was asked to undergo 24-h electrocardiograph and step count recordings. Coarse graining spectral analysis was used for approximately 10-min segments of HRV (600 beats) to derive the total power (TOT: >0.04 Hz), integrated power in the low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: >0.15 Hz) ranges, the ratio of HF power to TOT (HF nu), and the ratio of LF power to HF power (LF/HF). Double cosinor analysis was used to obtain 24-h and 12-h period variations in variables of HRV and physical activity. While no difference was found in the acrophases of either period for step counts or in the 12-h period of HRV variables between the groups, the acrophases of the 24-h period for HRV variables were delayed by 1.3 to 5.5 h in rotating shift workers, and their differences in HF power, HF nu, and LF/HF reached a significant level ( p < 0.05). On the days of the experiment, retiring time, waking up time, total time in bed, sleep efficiency, and mealtimes and energy intake for each diet did not differ between the groups. These results suggest that there is a possibility of an abnormal phase angle between circadian variation in cardiac autonomic nervous system activity and the sleep-wake cycle during the day shift in shift workers.

Influence of dietary behavior on the circadian rhythm of the autonomic nervous system as assessed by heart rate variability

BACKGROUND

Misalignment of circadian systems is detrimental to human health. However, only a few studies have examined the influence of late meals on the human circadian system. The purpose of this study was to investigate whether delayed meals affect circadian rhythm as assessed by heart rate variability (HRV).

METHODS

Seven healthy men (aged 22.4±0.4years) participated in this study, which involved delaying mealtimes by 5h for two weeks. Prior to this study, the regular mealtimes of participants were at 08:00, 13:00, and 18:00 (Baseline). During the intervention, each meal was provided at 13:00, 18:00 and 23:00 (Late mealtimes). Circadian variation was assessed by HRV based on R-R intervals calculated from a pulse at the rising phase of each spike in the QRS complex in a 24-h electrocardiograph record. The ratio of low frequency (LF) to high frequency (HF) power (LF/HF) and the ratio of HF power to total power (%HF) were calculated using spectral analysis. The phase and amplitude of HRV variables in a 24-h period were mathematically obtained with double cosinor analysis.

RESULTS

The acrophase and amplitude for LF power, HF power and %HF in a 24-h period were not significantly different between Baseline and Late mealtimes. On the other hand, the acrophase significantly differed between Baseline and Late mealtimes for heart rate (95%CI, 1.1-3.8h), standard deviation of R-R intervals (95%CI, 2.5-4.4h) and LF/HF (95%CI, 1.1-2.3h).

CONCLUSIONS

Our findings suggest that delayed mealtimes shift the phase of circadian rhythm of the autonomic nervous system.

Classifying fMRI-derived resting-state connectivity patterns according to their daily rhythmicity

The vast majority of biological functions express rhythmic fluctuations across the 24-hour day. We investigated the degree of daily modulation across fMRI (functional Magnetic Resonance Imaging) derived resting-state data in 15 subjects by evaluating the time courses of 20 connectivity patterns over 8h (4 sessions). For each subject, we determined the chronotype, which describes the relationship between the individual circadian rhythm and the local time. We could therefore analyze the daily time course of the connectivity patterns controlling for internal time. Furthermore, as the participants' scan times were staggered as a function of their chronotype, we prevented sleep deprivation and kept time awake constant across subjects. Individual functional connectivity within each connectivity pattern was defined at each session as connectivity strength measured by a mean z-value and, in addition, as the spatial extent expressed by the number of activated voxels. Highly rhythmic connectivity patterns included two sub-systems of the Default-Mode Network (DMN) and a network extending over sensori-motor regions. The network characterized as the most stable across the day is mainly associated with processing of executive control. We conclude that the degree of daily modulation largely varies across fMRI derived resting-state connectivity patterns, ranging from highly rhythmic to stable. This finding should be considered when interpreting results from fMRI studies.

Correlation of heart rate variability and circadian markers in humans

The frequency of adverse cardiovascular events is greater in the morning compared to its 24-hour average. A circadian variation in the regulation of the cardiovascular system could contribute to this increased cardiovascular risk in the morning. Indeed, circadian rhythms have been shown for a wide array of physiological processes. Using an ultradian sleep-wake cycle (USW) procedure, we sought to determine how heart rate (HR) and heart rate variability (HRV) correlate with the well-characterized circadian rhythms of cortisol and melatonin secretion. Specific HRV components, namely the low frequency (LF) power, high frequency (HF) power, and the LF:HF ratio can be used as markers of the autonomic modulation of the heart. Cross-correlation between HRV parameters and hormonal rhythms demonstrated that mean RR interval is significantly phase-advanced relative to salivary cortisol and urinary 6-sulfatoxy-melatonin (UaMt6s). Parasympathetic modulation of the heart (HF power) was phase-advanced relative to cortisol, but was in-phase with UaMt6s levels. Maximal correlation of the sympathovagal balance (the LF:HF ratio) had no significant lag compared to cortisol secretion and UaMt6s excretion. The protective effect of the parasympathetic nervous system at night, combined with the putative risk associated with the sympathetic nervous system peaking in the morning, could be associated with the increased cardiovascular risk observed in the morning hours.

Abnormal sleep-cardiovascular system interaction in narcolepsy with cataplexy: effects of hypocretin deficiency in humans

STUDY OBJECTIVE

Narcolepsy with cataplexy (NC) is associated with loss of hypocretin neurons in the lateral hypothalamus involved in the circadian timing of sleep and wakefulness, and many biologic functions including autonomic control. The authors investigated whether chronic lack of hypocretin signaling alters cardiovascular control during sleep in humans.

DESIGN

Comparison of 24-hr circadian rhythms, day-night, time- and state-dependent changes of blood pressure (BP) and heart rate (HR) in drug-free patients with NC and control subjects.

SETTING

University hospital.

PATIENTS OR PARTICIPANTS

Ten drug-free patients with NC (9 men, 1 woman) and 12 control subjects (9 men, 3 women).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Daytime BP was comparable in patients with NC and controls, but patients with NC displayed a nighttime nondipping BP pattern. The 24-hr circadian rhythmicity of BP and HR was normal in both groups. Systolic BP during nighttime rapid eye movement sleep was significantly increased in the NC group. The 24-hr HR was significantly higher in the NC group but the day-night and state-dependent HR modulations were intact. The nighttime BP pattern coupled in the NC group with increased sleep fragmentation and a higher prevalence of arousals, periodic limb movements in sleep (PLMS), and PLMS arousals. In an analysis of the sleep/cardiovascular interaction in the periods after sleep onset and preceding morning awakening, only PLMS were consistently associated with the blunted nighttime decrease in BP in the NC group.

CONCLUSIONS

Hypocretin deficiency in humans may couple with an altered nighttime BP regulation that can be associated with an increased cardiovascular risk. This finding may be the result not only of the hypocretinergic deficiency per se but also of the altered sleep/wake regulation characterizing NC.

Heart rate variability can be used to estimate sleepiness-related decrements in psychomotor vigilance during total sleep deprivation

STUDY OBJECTIVES

To assess whether changes in psychomotor vigilance during sleep deprivation can be estimated using heart rate variability (HRV).

DESIGN

HRV, ocular, and electroencephalogram (EEG) measures were compared for their ability to predict lapses on the Psychomotor Vigilance Task (PVT).

SETTING

Chronobiology and Sleep Laboratory, Duke-NUS Graduate Medical School Singapore.

PARTICIPANTS

Twenty-four healthy Chinese men (mean age ± SD = 25.9 ± 2.8 years).

INTERVENTIONS

Subjects were kept awake continuously for 40 hours under constant environmental conditions. Every 2 hours, subjects completed a 10-minute PVT to assess their ability to sustain visual attention.

MEASUREMENTS AND RESULTS

During each PVT, we examined the electrocardiogram (ECG), EEG, and percentage of time that the eyes were closed (PERCLOS). Similar to EEG power density and PERCLOS measures, the time course of ECG RR-interval power density in the 0.02-0.08-Hz range correlated with the 40-hour profile of PVT lapses. Based on receiver operating characteristic curves, RR-interval power density performed as well as EEG power density at identifying a sleepiness-related increase in PVT lapses above threshold. RR-interval power density (0.02-0.08 Hz) also classified subject performance with sensitivity and specificity similar to that of PERCLOS.

CONCLUSIONS

The ECG carries information about a person's vigilance state. Hence, HRV measures could potentially be used to predict when an individual is at increased risk of attentional failure. Our results suggest that HRV monitoring, either alone or in combination with other physiologic measures, could be incorporated into safety devices to warn drowsy operators when their performance is impaired.

Quantitative assessment of physiological and behavioural parameters in healthy dairy cows evoked by transcutaneous electrical nerve stimulation of the udder

The pain and distress associated with transcutaneous electrical nerve stimulation (TENS) of the udder was evaluated by treating 20 healthy dairy cows with an electrical udder stimulator. This generated a sequence of pulses (frequency: 160±10% impulses per second, duration 250 μs) and provided voltage ranges from 0 to 10 volts (±10%). Trials took place on three consecutive days, twice daily after morning and evening milking. Daily sessions were divided into two periods: (1) control (sham treatment) and (2) treatment (real treatment). Physiological (heart rate, respiratory rate, and plasma cortisol concentration) as well as ethological parameters (kicking, weight shifting, and looking backwards to udder) were defined as pain-indicating parameters and observed. Evaluation of data showed that only one parameter (kicking) was significantly increased during real treatment compared to sham treatment. It is concluded that the TENS therapy tested in this study can evoke changes in behaviour (increased kicking) consistent with an experience of pain in some cows.

Heart-rate variability in women during 40-hour prolonged wakefulness

Heart-rate variability patterns of 18 women during a 40-h constant routine of prolonged wakefulness under controlled laboratory conditions were analyzed. The authors tested the circadian timing of the autonomic nervous system and the relationship between the sympathetic and vagal branches in women with both a functional disorder of vascular regulation (main symptom: cold hands and feet) and prolonged sleep onset and controls without these symptoms. Spectral analysis of R-R intervals during paced breathing episodes revealed significantly lower power values in the high-frequency band (HF; 0.15-0.4 Hz) but not in the low-frequency band (LF; 0.04-0.15 Hz), leading to a significantly elevated LF/HF ratio in the former group. A significant circadian rhythm in LF power and heart rate occurred in both groups, and a significant correlation was found between sleepiness and sympathovagal balance (r = .53, p < .05). These findings indicate not only an autonomic imbalance in the first group compared with controls, but also two strategies of the autonomic nervous system to fight against fatigue in women. One implies circadian control and the other homeostatic control, and both are reflected by the LF/HF ratio.

Circadian control of mouse heart rate and blood pressure by the suprachiasmatic nuclei: behavioral effects are more significant than direct outputs

Background

Diurnal variations in the incidence of events such as heart attack and stroke suggest a role for circadian rhythms in the etiology of cardiovascular disease. The aim of this study was to assess the influence of the suprachiasmatic nucleus (SCN) circadian clock on cardiovascular function.

Methodology/Principal Findings

Heart rate (HR), blood pressure (BP) and locomotor activity (LA) were measured in circadian mutant (Vipr2^−/−) mice and wild type littermates, using implanted radio-telemetry devices. Sleep and wakefulness were studied in similar mice implanted with electroencephalograph (EEG) electrodes. There was less diurnal variation in the frequency and duration of bouts of rest/activity and sleep/wake in Vipr2^−/− mice than in wild type (WT) and short “ultradian” episodes of arousal were more prominent, especially in constant conditions (DD). Activity was an important determinant of circadian variation in BP and HR in animals of both genotypes; altered timing of episodes of activity and rest (as well as sleep and wakefulness) across the day accounted for most of the difference between Vipr2^−/− mice and WT. However, there was also a modest circadian rhythm of resting HR and BP that was independent of LA.

Conclusions/Significance

If appropriate methods of analysis are used that take into account sleep and locomotor activity level, mice are a good model for understanding the contribution of circadian timing to cardiovascular function. Future studies of the influence of sleep and wakefulness on cardiovascular physiology may help to explain accumulating evidence linking disrupted sleep with cardiovascular disease in man.

Reproducibility and seasonal variation of ambulatory short-term heart rate variability in healthy subjects during a self-selected rest period and during sleep

Although ambulatory measurements of heart rate variability (HRV) are widely used, the reproducibility and seasonal variation of ambulatory sampled short-term HRV measurements in healthy participants has not been investigated before. In the present study we collected ambulatory ECGs from 19 healthy participants monthly for 12 months, and for a sub-group of 12 participants weekly for one month. Frequency-domain HRV-metrics were calculated for 5 min ECG segments during (i) a 15-min self-selected rest period (awake period), and (ii) a 30-min sleep period starting 45 min after estimated sleep onset. Total, within- and between-subject coefficient of variation (CV) and seasonal variation were estimated for ln (TP), ln (LFP), ln (HFP), ln (LF/HF), LFnu, HFnu, the mean heart period and the ECG derived respiratory frequency.The within- and between-subject CV varied considerably between different variables, from < 10% for ln (TP) and ln (LFP) to >100% for ln (LF/HF). Within- and between-subject CV of ln (HFP), LFnu and HFnu were 10-40%. A weak, but significant, seasonal variation was found for ln (TP) (p = 0.05), ln (LFP) (p<0.05) and the respiratory frequency (p<0.01), but the seasonal variation did not affect the within-subject CV. Furthermore, sample size calculations demonstrated that the reproducibility was sufficient for ambulatory HRV measurements to be used to study autonomic cardiac regulation in healthy populations.

Effects of circadian disruption on the cardiometabolic system

The presence of day-night variations in cardiovascular and metabolic functioning is well known. However, only recently it has been shown that cardiovascular and metabolic processes are not only affected by the behavioral sleep/wake cycle but are partly under direct control of the master circadian pacemaker located in the suprachiasmatic nucleus (SCN). Heart rate, cardiac autonomic activity, glucose metabolism and leptin-involved in appetite control-all show circadian variation (i.e., under constant behavioral and environmental conditions). This knowledge of behavioral vs. circadian modulation of cardiometabolic function is of clinical relevance given the morning peak in adverse cardiovascular incidents observed in epidemiological studies and given the increased risk for the development of diabetes, obesity, and cardiovascular disease in shift workers. We will review the evidence for circadian control of cardiometabolic functioning, as well its sensitivity to light and melatonin, and discuss potential implication for therapy.

Physiology and pharmacology of melatonin in relation to biological rhythms

Melatonin is an evolutionarily conserved molecule that serves a time-keeping function in various species. In vertebrates, melatonin is produced predominantly by the pineal gland with a marked circadian rhythm that is governed by the central circadian pacemaker (biological clock) in the suprachiasmatic nuclei of the hypothalamus. High levels of melatonin are normally found at night, and low levels are seen during daylight hours. As a consequence, melatonin has been called the "darkness hormone". This review surveys the current state of knowledge regarding the regulation of melatonin synthesis, receptor expression, and function. In particular, it addresses the physiological, pathological, and therapeutic aspects of melatonin in humans, with an emphasis on biological rhythms.

PER3 polymorphism and cardiac autonomic control: effects of sleep debt and circadian phase

A variable number tandem repeat polymorphism in the coding region of the circadian clock PERIOD3 (PER3) gene has been shown to affect sleep. Because circadian rhythms and sleep are known to modulate sympathovagal balance, we investigated whether homozygosity for this PER3 polymorphism is associated with changes in autonomic nervous system (ANS) activity during sleep and wakefulness at baseline and after sleep deprivation. Twenty-two healthy participants were selected according to their PER3 genotype. ANS activity, evaluated by heart rate (HR) and HR variability (HRV) indexes, was quantified during baseline sleep, a 40-h period of wakefulness, and recovery sleep. Sleep deprivation induced an increase in slow-wave sleep (SWS), a decrease in the global variability, and an unbalance of the ANS with a loss of parasympathetic predominance and an increase in sympathetic activity. Individuals homozygous for the longer allele (PER3(5/5)) had more SWS, an elevated sympathetic predominance, and a reduction of parasympathetic activity compared with PER3(4/4), in particular during baseline sleep. The effects of genotype were strongest during non-rapid eye movement (NREM) sleep and absent or much smaller during REM sleep. The NREM-REM cycle-dependent modulation of the low frequency-to-(low frequency + high frequency) ratio was diminished in PER3(5/5) individuals. Circadian phase modulated HR and HRV, but no interaction with genotype was observed. In conclusion, the PER3 polymorphism affects the sympathovagal balance in cardiac control in NREM sleep similar to the effect of sleep deprivation.