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New-generation positional therapy in patients with positional central sleep apnea. Eur Arch Otorhinolaryngol 2019; 276:2611-2619. [DOI: 10.1007/s00405-019-05545-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/03/2019] [Indexed: 11/27/2022]
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Cardiac and Peripheral Autonomic Responses to Orthostatic Stress During Transcutaneous Vagus Nerve Stimulation in Healthy Subjects. J Clin Med 2019; 8:jcm8040496. [PMID: 30979068 PMCID: PMC6517949 DOI: 10.3390/jcm8040496] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/28/2022] Open
Abstract
Previous studies showed that transcutaneous vagus nerve stimulation (tVNS) modulates the autonomic nervous system (ANS) in resting condition. However, the autonomic regulation in response to an orthostatic challenge during tVNS in healthy subjects remains unknown. We tested the hypothesis that tVNS reduces heart rate (HR) and alters the responsivity of ANS to orthostatic stress in healthy subjects. In a randomized and cross-over trial, thirteen healthy subjects underwent two experimental sessions on different days: (1) tVNS and (2) control. Using a tVNS device, an auricular electrode was placed on the left cymba conchae of the external ear; an electric current with a pulse frequency of 25 Hz and amplitude between 1 and 6 mA was applied. For the assessment of ANS, the beat-to-beat HR and systolic arterial pressure (SAP) were analyzed using linear and nonlinear approaches during clinostatic and orthostatic conditions. In clinostatic conditions, tVNS reduced HR (p < 0.01), SAP variability (p < 0.01), and cardiac and peripheral sympathetic modulation (p < 0.01). The responsivity of the peripheral sympathetic modulation to orthostatic stress during tVNS was significantly higher when compared to the control session (p = 0.03). In conclusion, tVNS reduces the HR and affects cardiac and peripheral autonomic control and increases the responses of peripheral autonomic control to orthostatic stress in healthy subjects.
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Bayraktar MF, Ozeke O. Serial echocardiographic changes with different body positions and sleeping side preference in heart failure patients. Echocardiography 2018; 35:1132-1137. [DOI: 10.1111/echo.13888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Muhammed Fatih Bayraktar
- Department of Cardiology; Turkiye Yuksek Ihtisas Training and Research Hospital; Health Sciences University; Ankara Turkey
| | - Ozcan Ozeke
- Department of Cardiology; Turkiye Yuksek Ihtisas Training and Research Hospital; Health Sciences University; Ankara Turkey
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Sasaki K, Haga M, Bao S, Sato H, Saiki Y, Maruyama R. The Cardiac Sympathetic Nerve Activity in the Elderly Is Attenuated in the Right Lateral Decubitus Position. Gerontol Geriatr Med 2017; 3:2333721417708071. [PMID: 28516131 PMCID: PMC5419066 DOI: 10.1177/2333721417708071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives: The aim of this study was to evaluate the effect of the supine, left lateral decubitus, and right lateral decubitus positions on autonomic nervous activity in elderly adults by using spectral analysis of heart rate variability (HRV). Method: Forty-five adults aged 73.6 ± 5.7 years were enrolled. After lying in the supine position, all participants moved to the lateral decubitus positions in a random order and maintained the positions for 10 min, while electrocardiographic data were recorded to measure HRV. Results: The lowest heart rate continued for 10 min when participants were in the left lateral decubitus position compared with the other two positions (p < .001), while the HRV indexes remained unchanged. The low-frequency HRV to high-frequency HRV ratio (LF/HF) for the right lateral decubitus position was significantly lower than that for the other positions. Discussion: The right lateral decubitus position may attenuate sympathetic nerve activity in elderly adults.
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Affiliation(s)
| | - Mayu Haga
- Tohoku University School of Medicine, Sendai, Japan
| | - Sarina Bao
- Tohoku University School of Medicine, Sendai, Japan
| | - Haruka Sato
- Tohoku University School of Medicine, Sendai, Japan
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Sasaki K, Haga M, Endo Y, Fujiwara J, Maruyama R. Left Recumbent Position Decreases Heart Rate without Alterations in Cardiac Autonomic Nervous System Activity in Healthy Young Adults. TOHOKU J EXP MED 2017; 241:309-318. [PMID: 28442640 DOI: 10.1620/tjem.241.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Some studies have reported that recumbent position may have advantages in patients with heart disease and in pregnancy. However, it remains controversial whether recumbent position affects autonomic nervous system activity and hemodynamics in healthy adults. The aim of this study was to evaluate alterations in heart rate variability (HRV) and hemodynamics in the supine, left recumbent and right recumbent positions in healthy young adults. A total of 80 participants aged 22.8 ± 3.1 years were enrolled in this observational study. Fifty-eight volunteers (29 men and 29 women) maintained the supine position followed by the left and right recumbent positions, while electrocardiographic data were recorded for spectral analysis of HRV to assess cardiac vagal nerve and sympathetic nerve activities. The heart rate (HR) was significantly lower in the left recumbent position than in the other positions. There were no statistically significant differences in HRV among the three positions. Considering the possibility that the echographic procedure affects autonomic nervous system (ANS) activity, the other 22 participants (11 men and 11 women) underwent an echographic evaluation of hemodynamics in the heart and inferior vena cava (IVC) across the three positions. Although a low HR was also observed, there were no statistically significant differences in the IVC or the heart blood volume between the supine and the left recumbent positions. A postural change to the left recumbent position does not affect the cardiac blood circulation or ANS activity, though it does decrease HR in healthy young adults. This finding indicates that the lower HR in the left recumbent position is not attributable to the ANS activity.
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Affiliation(s)
- Konosuke Sasaki
- Department of Health Sciences, Tohoku University Graduate School of Medicine
| | - Mayu Haga
- Department of Health Sciences, Tohoku University Graduate School of Medicine
| | - Yoichi Endo
- Division of Clinical Physiological Laboratory, Tohoku University Hospital
| | - Junko Fujiwara
- Division of Clinical Physiological Laboratory, Tohoku University Hospital
| | - Ryoko Maruyama
- Department of Health Sciences, Tohoku University Graduate School of Medicine
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Goya S, Wada T, Shimada K, Hirao D, Fukushima R, Yamagishi N, Shimizu M, Tanaka R. Effects of postural change on transesophageal echocardiography views and parameters in healthy dogs. J Vet Med Sci 2017; 79:380-386. [PMID: 27980234 PMCID: PMC5326945 DOI: 10.1292/jvms.16-0323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of the present study is to investigate the effect of postural change on
transesophageal echocardiography (TEE) views and parameters of interest anesthesia
monitoring in healthy dogs. Twelve Beagle dogs were anesthetized and randomly positioned
in one of four postures: right lateral-recumbency, left lateral-recumbency, supine
position and prone position. After examinations in one posture, the same examination was
demonstrated in another posture and repeated in all postures. In each posture, several
standard TEE views were demonstrated: longitudinal cranial-esophageal aorta
long-axis-view, transverse middle-esophageal mitral valve long-axis-view and transgastric
middle short-axis-view. Additionally, echocardiographic parameters were attempted to
measure, and direct blood pressure monitoring was performed in each view. As a result,
oriented views, except for transgastric middle short-axis-view, could be obtained in all
postures. Stroke volume and peak early diastolic velocity of mitral inflow were lower in
supine position compared with those in right and left lateral-recumbency. Heart rate (HR)
and systemic vascular resistance were higher in supine position compared with those in
right and left lateral-recumbency. Left ventricular pre-ejection period/left ventricular
ejection time corrected and uncorrected by HR were higher in supine position compared with
those in right and left lateral-recumbency. In conclusion, longitudinal cranial-esophageal
aorta long-axis-view and transverse middle-esophageal mitral valve long-axis-view provide
useful information of interest anesthesia monitoring, because of their views enable to
certainly obtain TEE parameters in various postures. Furthermore, TEE parameters allow to
detect the changes of preload, afterload and HR that occur in supine position dogs.
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Affiliation(s)
- Seijirow Goya
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-0052, Japan
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Atalla A, Carlisle TW, Simonds AK, Cowie MR, Morrell MJ. Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing. Sleep Med 2017; 34:217-223. [PMID: 28431823 DOI: 10.1016/j.sleep.2016.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/28/2016] [Accepted: 11/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with heart failure (HF) and sleep disordered breathing (SDB) are typically not sleepy, unlike patients without heart failure. Previous work in HF patients with obstructive SDB suggested that sleepiness was associated with a reduction in daytime activity. The consequences of predominately central SDB on sleepiness in HF are less well understood. The aim of this study was to test the hypothesis that subjective sleepiness is associated with reduced daytime activity in HF patients with central SDB, compared to those without SDB. METHODS The Epworth Sleepiness Scale (ESS), nocturnal polysomnography, and 14 days of wrist watch actigraphy were used to assess subjective daytime sleepiness, nocturnal sleep and breathing, and 24-h activity levels, respectively. RESULTS A total of 54 patients with HF were studied, nine had obstructive SDB and were removed from further analysis. Of the patients, 23 had HF with predominantly central SDB (HF-CSA; apnea-hypopnea index (AHI) median 20.6 (IQR 12.9-40.2)/h), and 22 had noSDB (HF-noSDB; AHI 3.7 (2.5-5.9)/h). The median patient age was 68 years (range 59-73 years). There were no significant differences either in ESS score (HF-CSA; 8 [4-10] vs. HF-noSDB; 8 (6-12); p = 0.49) or in duration of daytime activity (HF-CSA 14.5 (14.1-15.2) and HF-noSDB 15.1 (14.4-15.3) hours; p = 0.10) between the groups. CONCLUSION HF patients with predominately central SDB are not subjectively sleepy compared to those without SDB, despite reduced sleep quality. We speculate that the lack of sleepiness (based on ESS score) may be due to increased sympathetic nerve activity, although further studies are needed due to the small number (n = 5) of sleepy HF-CSA patients. Daytime activity was not different between HF-noSDB and HF-CSA patients.
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Affiliation(s)
- Angela Atalla
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; Respiratory NIHR Biomedical Research Unit at Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College London, London, UK.
| | - Thomas W Carlisle
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK; Respiratory NIHR Biomedical Research Unit at Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Anita K Simonds
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK; Respiratory NIHR Biomedical Research Unit at Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Martin R Cowie
- Department of Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; Cardiovascular NIHR Biomedical Research Unit at Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK; Respiratory NIHR Biomedical Research Unit at Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College London, London, UK
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Nakai Y, Fujita M, Nin K, Noma S, Teramukai S. Relationship between duration of illness and cardiac autonomic nervous activity in anorexia nervosa. Biopsychosoc Med 2015; 9:12. [PMID: 25908939 PMCID: PMC4407323 DOI: 10.1186/s13030-015-0032-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background The mortality rate associated with anorexia nervosa (AN) is high, and death is mainly attributable to cardiac events. A wide range of autonomic nervous system disturbances may be mechanisms underlying the increased cardiovascular mortality and sudden death of patients with AN. Heart rate variability (HRV) has been proven to be a reliable noninvasive method for quantitative assessment of sympathetic and parasympathetic regulation of heart rate (HR). The longer the duration of illness of AN patients, the higher the mortality rate. However, there have been few reports on the relationship between the duration of illness and HRV in AN. Hence, the aims of this study were to compare the cardiac autonomic nervous activity (CANA) of female patients with AN and age-matched female controls and to evaluate the relationship between the duration of illness and the CANA of the AN patients. Methods We studied 14 female patients with AN and 22 age-matched healthy women. Beat-to-beat heart rate variability, recorded in a supine position, was investigated using power spectral analysis. Result Mean heart rate was positively correlated with normalized high-frequency (HF: 0.15 to 0.40 Hz) power and negatively correlated with the low-frequency (LF: 0.04 to 0.15 Hz)/HF power (LF/HF) ratio of the controls. On the other hand, duration of illness was negatively correlated with normalized HF power and positively correlated with the LF/HF ratio of the AN patients. Conclusions These results suggest that, given that the LF/HF ratio is an estimate of cardiac sympathovagal balance, anorectic patients with a long illness duration display lower vagal tone (parasympathetic withdrawal) and high sympathetic tone.
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Affiliation(s)
- Yoshikatsu Nakai
- Kyoto Institute of Health Sciences, Miyako Bldg. 502, Karasuma Oike Agaru Higashigawa, Nakagyo-ku, Kyoto 604-0845 Japan
| | - Masatoshi Fujita
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuko Nin
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Kim HJ, Yi K. Comparison of Intraocular Pressures According to Position Using Icare Rebound Tonometer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.7.1049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hae Jin Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kayoung Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Oylumlu M, Dogan A, Ozer O, Yuce M, Ercan S, Davutoglu V. Effects of lying position on P-wave dispersion in patients with heart failure. Med Princ Pract 2014; 23:556-60. [PMID: 25195606 PMCID: PMC5586930 DOI: 10.1159/000365510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/26/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion (PWD) in patients with heart failure (HF). SUBJECTS AND METHODS Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram (ECG) recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. RESULTS After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration (100.0 ± 14.5 and 84.7 ± 16.2 ms; p = 0.001) and a significant decrease in PWD (41.7 ± 8.0 and 24.1 ± 7.1 ms; p < 0.0001). After the left lateral decubitus position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 40.2 ± 9.7 ms; p = 0.606). After the supine position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 39.7 ± 9.4 ms; p = 0.427). CONCLUSION Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored.
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Affiliation(s)
- Muhammed Oylumlu
- Department of Cardiology, Dumlupinar University School of Medicine, Kutahya, Turkey
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Shibasaki K, Ogawa S, Yamada S, Iijima K, Eto M, Kozaki K, Toba K, Akishita M, Ouchi Y. Association of decreased sympathetic nervous activity with mortality of older adults in long-term care. Geriatr Gerontol Int 2013; 14:159-66. [PMID: 23879364 DOI: 10.1111/ggi.12074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 02/04/2023]
Abstract
AIM To investigate the relationship between physical function, mortality and autonomic nervous activity measured by heart rate variability of elderly in long-term care. METHODS Cross-sectional and longitudinal studies were carried out at hospitals and health service facilities for the elderly in Nagano prefecture, Japan, from July 2007 to March 2011. A total of 105 long-term care older adults and 17 control older adults with independent physical function were included. The Functional Independence Measure (FIM) and Barthel Index were determined as indices of physical function. Twenty-four-hour Holter monitoring was carried out. From RR intervals in electrocardiograms, heart rate and standard deviations of all NN intervals in all 5-min segments of the entire recording, power spectral density, low frequency, high frequency and low frequency/high frequency (LF/HF) were calculated. RESULTS FIM score and Barthel Index were 46 ± 26 and 30 ± 31, respectively, in long-term care elderly. FIM and Barthel index were significantly correlated with heart rate and the standard deviations of all NN intervals after adjustment for age, sex, cardiovascular risk factors and FIM. Furthermore, LF/HF was significantly decreased in long-term care elderly compared with control elderly after adjustment for covariates. In addition, decrease in LF/HF was an independent risk factor for mortality. CONCLUSION Low LF/HF activity was observed in long-term care elderly and was related to an increase of overall mortality.
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Affiliation(s)
- Koji Shibasaki
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Yoo C, Lee JY. Body position and eye pressure. Ophthalmology 2012. [PMID: 23207028 DOI: 10.1016/j.ophtha.2012.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Malihi M, Sit AJ. Author reply. Ophthalmology 2012. [DOI: 10.1016/j.ophtha.2012.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Sleep medicine is a relatively new scientific specialty. Sleep is an important topic in Islamic literature, and the Quran and Hadith discuss types of sleep, the importance of sleep, and good sleep practices. Islam considers sleep as one of the signs of the greatness of Allνh (God) and encourages followers to explore this important sign. The Quran describes different types of sleep, and these correspond with sleep stages identified by modern science. The Quran discusses the beneficial effects of sleep and emphasizes the importance of maintaining a pattern of light and darkness. A mid-day nap is an important practice for Muslims, and the Prophet Muhammad peace be upon him (pbuh) promoted naps as beneficial. In accordance with the practice and instructions of Muhammad (pbuh), Muslims have certain sleep habits and these sleep habits correspond to some of the sleep hygiene rules identified by modern science. Details during sleep include sleep position, like encouraging sleep on the right side and discouraging sleep in the prone position. Dream interpretation is an established science in the Islamic literature and Islamic scholars have made significant contributions to theories of dream interpretation. We suggest that sleep scientists examine religious literature in general and Islamic literature in particular, to understand the views, behaviors, and practices of ancient people about the sleep and sleep disorders. Such studies may help to answer some unresolved questions in sleep science or lead to new areas of inquiry.
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Affiliation(s)
- Ahmed S Bahammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ogura C, Ono K, Miyamoto S, Ikai A, Mitani S, Sugimoto N, Tanaka S, Fujita M. L/T-type and L/N-type calcium-channel blockers attenuate cardiac sympathetic nerve activity in patients with hypertension. Blood Press 2012; 21:367-71. [PMID: 22747420 DOI: 10.3109/08037051.2012.694200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sympathetic nerve activity is augmented by calcium-channel blocker treatment as a result of decreased blood pressure. Dihydropyridine calcium-channel blockers are divided into three different types. The purpose of the present study was to investigate whether treatment effects on hemodynamics, cardiac autonomic nerve activity and plasma norepinephrine levels differ among amlodipine (L type), efonidipine (L + T type) and cilnidipine (L + N type). We enrolled 14 hypertensive patients (seven males, seven females, 70 ± 6 years old) undergoing a monotherapy of amlodipine, efonidipine or cilnidipine into this prospective, open-labeled, randomized, crossover study. At baseline and every 6 months of the treatment period, we repeated the evaluation of hemodynamics, spectral analysis of heart rate variability and plasma norepinephrine levels. Blood pressure and pulse rate were comparable among the three treatments. The low-frequency (LF)/high-frequency (HF) power ratio, an index of cardiac sympathovagal balance, was significantly lower with efonidipine and cilnidipine than with amlodipine, while the HF/total power ratio, an index of cardiac vagal activity, revealed the opposite results. There was no significant correlation between the LF/HF ratio and plasma norepinephrine levels. Antihypertensive monotherapy with efonidipine or cilnidipine attenuates cardiac sympathetic nerve activity more effectively than amlodipine monotherapy.
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Affiliation(s)
- Chika Ogura
- Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto606 - 8507, Japan
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Sleep apnea, heart failure, and sleep position. Sleep Breath 2011; 16:933-5. [PMID: 22068748 DOI: 10.1007/s11325-011-0611-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 12/24/2022]
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de Araujo BS, Reichert R, Eifer DA, Soder SA, Dos Santos MBS, Clausell N, Beck-da-Silva L. Trepopnea may explain right-sided pleural effusion in patients with decompensated heart failure. Am J Emerg Med 2011; 30:925-931.e2. [PMID: 21665407 DOI: 10.1016/j.ajem.2011.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 03/21/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Physicians often overlook trepopnea as a symptom, and its prevalence and clinical repercussions are not usually described. We propose that trepopnea is a common symptom in heart failure (HF) and, because of patient avoidance of left lateral decubitus position, contributes to the greater prevalence of right-sided pleural effusion in patients with HF. Accordingly, this study aimed to determine trepopnea prevalence and to evaluate the association of trepopnea and the laterality of pleural effusion in decompensated HF. METHODS Consecutive patients (n = 37) with decompensated HF and evidence of pleural effusion by chest x-ray were included. Data were collected at the emergency department by a standard clinical examination in which patients were specifically asked about the presence of trepopnea and preferred decubitus position while recumbent. Chest x-ray and echocardiographic parameters were recorded. RESULTS Of the 37 patients, 19 (51%) reported trepopnea. Most patients presented with right-sided pleural effusion; only 2 patients (5.4%) presented with left-sided pleural effusion. Patients who reported trepopnea had predominant right-sided pleural effusion more frequently than patients without this symptom (73.7% vs 26.3%; P = .049). The participants that reported trepopnea or avoidance of left lateral decubitus position while recumbent or both had a greater probability of having predominant right-sided pleural effusion (likelihood ratio, 1.85; 95% confidence interval, 1.02-3.35). CONCLUSIONS Trepopnea is a common symptom in patients with decompensated HF and is associated with predominant right-sided pleural effusion in this population. Our results indicate that trepopnea may be a contributory factor for pleural effusion laterality in patients with decompensated HF.
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Affiliation(s)
- Bruno Schneider de Araujo
- Heart Failure and Cardiac Transplantation Unit, Cardiology Division at Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil
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Wolf D, Benz A, Hardt SE, Katus HA, Mereles D. Case reports. Trepopnea associated with paroxysmal severe tricuspid regurgitation triggered at left lateral decubitus position. Echocardiography 2010; 27:E77-9. [PMID: 20849472 DOI: 10.1111/j.1540-8175.2010.01159.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 78-year-old male patient was referred cardiovascular risk evaluation before elective resection of a bronchial carcinoma. A myocardial infarction with a subsequent coronary artery bypass revascularization and a mitral prosthetic valve surgery were known. Left lateral decubitus (LLD) was permanently avoided because of significant trepopnea since several years. No signs of heart failure were found in the physical examination. A mitral valve prosthesis presented normal characteristics at examination. Left ventricular dimensions and function were normal. A severe tricuspid regurgitation could be documented during examination in the LLD, with changing characteristics in dorsal decubitus, when it could be graded as moderate. Trepopnea associated with severe paroxysmal tricuspid regurgitation was never described before in the literature. Sympathetic/parasympathetic modulation of papillary muscles of the tricuspid valve can be proposed as a probable cause of this dynamic valvular dysfunction.
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Affiliation(s)
- David Wolf
- Department of Cardiology, Angiology, and Pneumology, Thoraxklinik Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
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Enhancing the deceleration capacity index of heart rate by modified-phase-rectified signal averaging. Med Biol Eng Comput 2010; 48:399-405. [DOI: 10.1007/s11517-010-0589-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 01/31/2010] [Indexed: 11/25/2022]
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Abstract
Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. Bed rest has molecular and systemic effects, ultimately affecting functional outcomes in healthy individuals as well as in those with acute and critical illnesses. Using empirical sources, the purpose of this article was to describe the consequences of bed rest and immobility, especially consequences with implications for critically ill adults in the intensive care unit. This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/ metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA.
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Siepe M, Rüegg DM, Giraud MN, Python J, Carrel T, Tevaearai HT. Effect of acute body positional changes on the haemodynamics of rats with and without myocardial infarction. Exp Physiol 2008; 90:627-34. [PMID: 15849229 DOI: 10.1113/expphysiol.2005.030148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In humans, the lateral recumbent position has a beneficial effect on haemodynamics. If this effect is substantial in small animals too, there is a risk of misinterpretation in preclinical investigations. Therefore, the aim of this study was to analyse the impact of acute changes in body position on haemodynamics in rats. Healthy rats (n=21) and rats post myocardial infarction (n=20) were randomly positioned supine, prone, or on the right or left side. In each position, we measured haemodynamic parameters by pressure-tip catheter and thermodilution. We found that left ventricular contractility (dP/dtmax) was significantly elevated in both lateral positions as compared to the supine position in healthy rats. In healthy rats and following infarction, cardiac index (CI) and stroke volume index (SVI) were significantly higher in both lateral positions as compared to the supine or prone position. Of importance, if SVI values in the supine position in healthy rats (0.095 +/- 0.003 ml (100 g)(-1)) are compared to SVI values measured in different positions after myocardial infarction, the SVI can be either significantly lower in the supine (0.084 +/- 0.003 ml (100 g)(-1)) or significantly higher in the left lateral position (0.105 +/- 0.003 ml (100 g)(-1)). We conclude that post myocardial infarction and in healthy control rats, important haemodynamic values are increased in lateral positions as compared to prone or supine positions. Analysing haemodynamic data in rats may therefore result in misinterpretation if the body position is inconsistent.
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Affiliation(s)
- Matthias Siepe
- Clinic for Cardiovascular Surgery, DKF MEM C-812, Murtenstrasse 35, 3010 Bern, Switzerland.
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22
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Yang JL, Chen GY, Kuo CD. Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease. Circ J 2008; 72:902-8. [DOI: 10.1253/circj.72.902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jen-Lin Yang
- Biophysics Laboratory, Department of Research and Education, Taipei Veterans General Hospital, and Institute of Traditional Medicine, National Yang-Ming University School of Medicine
| | - Gau-Yang Chen
- Department of Medicine, Ten-Chen General Hospital, Tao-Yuan and Institute of Biomedical Engineering, National Yang-Ming Universitey School of Medicine
| | - Cheng-Deng Kuo
- Biophysics Laboratory, Department of Research and Education, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine
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23
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Takase B, Takeishi Y, Hirai T, Lee JD, Uzui H, Senda S, Miwa K, Hiraoka Y, Kinugawa T, Hosokawa R, Fujita M. Comparative Effects of Amlodipine Monotherapy and Combination Therapy With Betaxolol on Cardiac Autonomic Nervous Activity and Health-Related Quality of Life in Patients With Poorly Controlled Hypertension. Circ J 2008; 72:764-9. [PMID: 18441457 DOI: 10.1253/circj.72.764] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Huang ST, Chen GY, Wu CH, Kuo CD. Effect of disease activity and position on autonomic nervous modulation in patients with systemic lupus erythematosus. Clin Rheumatol 2007; 27:295-300. [DOI: 10.1007/s10067-007-0705-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 07/08/2007] [Accepted: 07/11/2007] [Indexed: 11/28/2022]
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25
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Burr RL. Interpretation of normalized spectral heart rate variability indices in sleep research: a critical review. Sleep 2007; 30:913-9. [PMID: 17682663 PMCID: PMC1978375 DOI: 10.1093/sleep/30.7.913] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The normalized spectral heart rate variability (HRV) measures low-frequency (LF)nu and high-frequency (HF)nu are frequently used in contemporary sleep research studies to quantify modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. The purpose of this tutorial and methodologic critique is to concisely demonstrate the structural algebraic redundancy inherent in the normalized spectral HRV measures with respect to each other, and also with respect to the well-known HRV index of sympathovagal balance, LF:HF ratio. The statistical problems and interpretational paradoxes related to the mathematical definitions of LFnu and HFnu are briefly outlined. Examples of use of normalized spectral HRV measures in recent articles from the sleep-relevant research literature are critically reviewed. LFnu, HFnu, and LF:HF ratio should be considered equivalent carriers of information about sympathovagal balance.
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Affiliation(s)
- Robert L Burr
- School of Nursing, University of Washington, UW Box # 357266, Seattle, Washington 98195-7266, USA.
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26
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Mitani S, Fujita M, Sakamoto S, Shirakawa T. Effect of autogenic training on cardiac autonomic nervous activity in high-risk fire service workers for posttraumatic stress disorder. J Psychosom Res 2006; 60:439-44. [PMID: 16650583 DOI: 10.1016/j.jpsychores.2005.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated the effect of autogenic training (AT) on cardiac autonomic nervous activity in fire services workers with the use of the questionnaire of the Japanese-language version of Impact of Event Scale-Revised (IES-R-J) and indexes of heart rate variability. METHODS We studied 22 male fire services workers who were divided into posttraumatic stress disorder (PTSD)-related stress group (n=10) and control group (n=12). They underwent AT twice or three times a week for 2 months. RESULTS Posttraumatic stress disorder-related stress group showed a significantly higher cardiac sympathetic nervous activity and a significantly lower cardiac parasympathetic nervous activity than control group at baseline. Autogenic training significantly decreased cardiac sympathetic nervous activity and significantly increased cardiac parasympathetic nervous activity in both groups. These changes were accompanied by a significant decrease in the total points of IES-R-J. CONCLUSION Autogenic training is effective for ameliorating the disturbance of cardiac autonomic nervous activity and psychological issues secondary to PTSD.
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Affiliation(s)
- Satoko Mitani
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Public Health, Yoshida-Konoe cho, Sakyo-ku, Kyoto 606-8501, Japan
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27
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Puri GD, Dutta A, Chinnan NK, Thingnam SKS, Sharma SK, Chari P. Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions. Eur J Anaesthesiol 2005; 22:834-8. [PMID: 16225717 DOI: 10.1017/s0265021505001407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio > or = 0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. METHODS Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. RESULTS Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 +/- 29.5 mmHg, SaO2 = 98.1 +/- 1.4%) than in supine (PaO2 = 111.0 +/- 30.6 mmHg, SaO2 = 97.6 +/- 2.2%) and left lateral positions (PaO2 = 109.7 +/- 32.0 mmHg, SaO2 = 97.6 +/- 1.7%; mean +/- SD; P 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). CONCLUSION Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.
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Affiliation(s)
- G D Puri
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India.
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28
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Palermo P, Cattadori G, Bussotti M, Apostolo A, Contini M, Agostoni P. Lateral Decubitus Position Generates Discomfort and Worsens Lung Function in Chronic Heart Failure. Chest 2005; 128:1511-6. [PMID: 16162751 DOI: 10.1378/chest.128.3.1511] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Lateral decubitus position is poorly tolerated by heart failure patients. STUDY OBJECTIVES To evaluated pulmonary function and lung diffusion in heart failure patients in the following five body positions: sitting, prone, supine, and left and right decubitus. SETTING Heart failure unit of a university hospital. SUBJECTS We studied 14 chronic heart failure patients in New York Heart Association class III and 14 healthy volunteers. MEASUREMENTS AND RESULTS After 15 min of a selected position, subjects were evaluated by a discomfort scale, ear oximetry, and pulmonary function, which included FEV1, FVC, vital capacity (VC), alveolar volume, and diffusing capacity of the lung for carbon monoxide (D(LCO)) with subcomponent membrane resistance (DM) and capillary volume. In healthy subjects, we observed a reduction of D(LCO) and capillary volume in both lateral decubiti. Some discomfort was documented in both lateral decubiti when selected positions were compared with the sitting position. In the sitting position, pulmonary function suggested slight restriction ([mean +/- SD] FVC, 89.8 +/- 22.3% predicted; FEV1, 84.7 +/- 16.9% predicted, VC, 88.6 +/- 21.5% predicted; and FEV1/VC, 74 +/- 7) with low D(LCO) (73 +/- 19% predicted). Compared with sitting, lung mechanics were unchanged in prone and supine positions; FEV1, FVC, and FEV1/VC were lower when patients were lying on their side, with unchanged alveolar volume and VC. D(LCO) was similar when comparing sitting, prone, and supine positions, and it was lower in lateral decubitus because of the lower capillary volume (vs sitting) and DM (vs prone and supine). Body position-related FVC and D(LCO) reduction were greatest in the largest hearts (deltaFVC and deltaD(LCO) vs left ventricle diastolic volume R = 0.524, p < 0.05 and R = 0.630, p < 0.02, respectively; deltaFVC and deltaD(LCO) vs cardiothoracic index R = 0.539, p < 0.05 and R = 0.685, p < 0.01, respectively). CONCLUSIONS In heart failure, lateral decubitus airway obstruction and lung diffusion impairment become greater as heart dimensions increase.
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Affiliation(s)
- Pietro Palermo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, 20138 Milan, Italy
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29
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De Jong MJ, Randall DC. Heart rate variability analysis in the assessment of autonomic function in heart failure. J Cardiovasc Nurs 2005; 20:186-95; quiz 196-7. [PMID: 15870589 DOI: 10.1097/00005082-200505000-00010] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart rate is not static, but rather changes continuously in response to physical and mental demands. In fact, an invariant heart rate is associated with disease processes such as heart failure. Heart rate variability analysis is a noninvasive technique used to quantify fluctuations in heart rate. In this article, the authors review neural control of heart rate, briefly describe heart rate variability, and summarize research data demonstrating that heart failure is associated with altered heart rate variability. In addition, the authors present evidence that heart failure patients with decreased heart rate variability are at risk for future cardiac events, heart transplantations, and death.
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Affiliation(s)
- Marla J De Jong
- College of Nursing, University of Kentucky, Lexington, KY 40536, USA.
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30
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Kim WS, Yoon YZ, Bae JH, Soh KS. Nonlinear characteristics of heart rate time series: influence of three recumbent positions in patients with mild or severe coronary artery disease. Physiol Meas 2005; 26:517-29. [PMID: 15886445 DOI: 10.1088/0967-3334/26/4/016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate the nonlinear characteristics of heart rate variability (HRV) for three recumbent positions: the supine, left lateral and right lateral decubitus positions. Recently, using a linear analyses method (for time and frequency domains), the effect of the right lateral decubitus position on vagal modulation has been found to increase parasympathetic activity and decrease sympathetic modulation. Little is known about the nonlinear dynamics of HRV for the three recumbent positions. Therefore, we studied the correlation dimension (CD), the largest Lyapunov exponent (LLE), the sample entropy (SampEn), the approximate entropy (ApEn) and the exponent alpha of the 1/falpha power spectrum as nonlinear characteristics of HRV. In response to the right lateral decubitus position, the CD, LLE, SampEn and ApEn increased significantly in both coronary artery disease (CAD) and control groups. In the linear analyses, the normalized high-frequency power (nHF) increased in the right lateral decubitus position. The CD, LLE, ApEn and SampEn correlated positively to the nHF. The alpha exponent did not correlate to either linear measure or CD, but correlated negatively to LLE, ApEn and SampEn. Among the three recumbent positions, it was found that the right lateral decubitus position can increase the complexity of the human physiological system and the vagal modulation of the cardiac autonomic nervous system the most.
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Affiliation(s)
- Wuon-Shik Kim
- Human Life Measurement Group, Korea Research Institute of Standards and Science, Daejeon, Korea
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31
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Tambara K, Fujita M, Sumita Y, Miyamoto S, Sekiguchi H, Eiho S, Komeda M. Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: simultaneous recording of ambulatory electrocardiogram and posture. Clin Cardiol 2004; 27:300-3. [PMID: 15188948 PMCID: PMC6654212 DOI: 10.1002/clc.4960270513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self-protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA). HYPOTHESIS Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF. METHODS We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24-h ambulatory electrocardiogram monitoring before and after an 8-week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high-frequency (0.15 to 0.40 Hz) power (nHF) and the low-frequency (0.04 to 0.15 Hz)/high-frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively. RESULTS When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 +/- 20 vs. 52 +/- 19 nu, p = 0.87; LF/HF, 1.39 +/- 1.11 vs. 1.32 +/- 1.32, p =0.93; L, nHF, 28 +/- 13 vs. 47 +/- 19 nu, p = 0.019; LF/HF, 3.34 +/- 2.48 vs. 1.56 +/- 1.39, p = 0.029; S, nHF, 38 +/- 17 vs. 53 +/- 16 nu, p = 0.0023; LF/HF, 2.43 +/- 2.21 vs. 1.03 +/- 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 +/- 30 vs. 18 +/- 24%, p = 0.0018; L, 11 +/- 20 vs. 27 +/- 26%, p = 0.025). CONCLUSIONS In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears after the treatment.
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Affiliation(s)
- Keiichi Tambara
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatoshi Fujita
- College of Medical Technology, Kyoto University, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Sumita
- Clinical Laboratory, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Shoichi Miyamoto
- Division of Cardiology, Takeda Hospital, Kyoto University, Kyoto, Japan
| | - Hiroyuki Sekiguchi
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Shigeru Eiho
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Masashi Komeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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32
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Sakamoto S, Tambara K, Kambara N, Miyamoto S, Tsukamoto T, Fujita M. Right lateral decubitus position reduces QT dispersion in patients with chronic heart failure. J Electrocardiol 2004; 37:201-6. [PMID: 15286933 DOI: 10.1016/j.jelectrocard.2004.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A greater QT dispersion in patients with chronic heart failure (CHF) appears to be a non-invasive marker of susceptibility to malignant ventricular arrhythmias. We evaluated whether QT dispersion in CHF patients is modified by the patients' recumbent position. In 12 CHF patients, and age and sex-matched 12 normal subjects, a single 12-lead surface ECG was recorded in each postural position [left lateral decubitus position (L), supine position (S), and right lateral decubitus position (R)]. In normal subjects, the QT dispersion was comparable in the three recumbent positions [L: 47+/-15 (SD) ms, S: 40+/-9 ms, R: 38+/-14 ms, P=NS]. In contrast, in CHF patients, QT dispersion was significantly shorter in R than those in L and S (L: 93+/-42 ms*, S: 81+/-29 ms*, R: 63+/-24 ms, *P <.05 vs. R). In conclusion, reclining in R reduces the prolonged QT dispersion in CHF patients.
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Affiliation(s)
- Satoko Sakamoto
- School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Miyamoto S, Fujita M, Tambara K, Sekiguchi H, Eiho S, Hasegawa K, Tamaki SI. Circadian variation of cardiac autonomic nervous activity is well preserved in patients with mild to moderate chronic heart failure: effect of patient position. Int J Cardiol 2004; 93:247-52. [PMID: 14975554 DOI: 10.1016/s0167-5273(03)00190-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Revised: 03/24/2003] [Accepted: 04/14/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND It remains unclear whether circadian variation (CV) of cardiac autonomic nervous activity (CANA) is preserved in patients with chronic heart failure (CHF) as in healthy subjects. We have demonstrated that CANA in CHF patients is largely affected by patient recumbent position. METHODS We studied eight mild to moderate CHF patients and eight age, sex-matched healthy subjects. Each subject underwent 24-h ambulatory ECG monitoring. One channel was used to record the CM5 lead, and another to record the signal of patient position from a newly developed, small-sized detector. By using spectral analysis of heart rate variability, frequency-domain measures were calculated. Normalized high-frequency (HF: 0.15-0.40 Hz) power was used as an index of vagal activity and the low frequency (LF: 0.04-0.15 Hz)/HF power ratio was used as an index of sympathovagal balance. These indexes in the same recumbent position were compared between night (2:00-4:00 a.m.) and morning (6:00-8:00 a.m.). RESULTS In healthy subjects, a definite CV of CANA was observed in each recumbent position. In patients with CHF, in each position, normalized HF power was lower in the morning than at night, whereas LF/HF was higher in the morning than at night. Thus, CANA in CHF patients is influenced not only by patient position but also by the time of day. CONCLUSION CV of CANA in mild to moderate CHF patients is well preserved when taking patient position into consideration.
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Affiliation(s)
- Shoichi Miyamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Leung RST, Bowman ME, Parker JD, Newton GE, Bradley TD. Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function. J Am Coll Cardiol 2003; 41:227-30. [PMID: 12535814 DOI: 10.1016/s0735-1097(02)02717-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine whether patients with congestive heart failure (CHF) avoid the left lateral decubitus (LLD) position during sleep and, if so, whether this avoidance would be more pronounced in those with greater degrees of cardiomegaly. BACKGROUND Anecdotal reports suggest that, in patients with CHF, the LLD position is associated with discomfort due to the enlarged apical heart beat and greater degree of dyspnea (trepopnea) than other positions. It has also been suggested that the LLD position is associated with increased sympathetic nervous activity. METHODS A total of 75 patients with CHF and 75 control subjects underwent nocturnal polysomnography with monitoring of body position. Echocardiography was performed in all patients with CHF to determine left ventricular end-diastolic diameter (LVEDD). A total of 40 patients underwent cardiac catheterization from which pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were obtained. RESULTS Patients with CHF spent significantly less time in the LLD position than in the right lateral decubitus position. No such difference was observed among control subjects. Among patients with CHF, those with larger LVEDD, higher PCWP, and lower CO spent less time in the LLD position. CONCLUSIONS Patients with CHF avoid the LLD position spontaneously during sleep. This may be a protective strategy to avoid discomfort from the enlarged apical heart beat or further hemodynamic or autonomic compromise.
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Affiliation(s)
- Richard S T Leung
- Sleep Research Laboratory of the Toronto Rehabilitation Institute, Ontario, Canada
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35
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Abstract
This article will review the recumbent positions of patients with chronic congestive heart failure. The time for the right lateral decubitus position was two-fold longer than that for the supine and left lateral decubitus positions. Sympathetic nervous modulation was most attenuated and parasympathetic tone was most augmented in the right lateral decubitus position. The underlying mechanisms why heart failure patients prefer this position will be discussed. In conclusion, the right lateral decubitus position preferred by patients with chronic congestive heart failure may be a self-protecting mechanism to augment cardiac output and to attenuate the imbalance of cardiac autonomic nervous activity.
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Affiliation(s)
- Masatoshi Fujita
- College of Medical Technology, Kyoto University, 53 Kawaharacho, Shogoin, Kyoto, Japan.
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36
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Miyamoto S, Tambara K, Tamaki SI, Nagaya N, Hasegawa K, Nohara R, Miwa K, Fujita M. Effects of right lateral decubitus position on plasma norepinephrine and plasma atrial natriuretic peptide levels in patients with chronic congestive heart failure. Am J Cardiol 2002; 89:240-2. [PMID: 11792354 DOI: 10.1016/s0002-9149(01)02212-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shoichi Miyamoto
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
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