Changes in heart rate variability during vasomotor symptoms among midlife women.
Changes in heart rate variability during vasomotor symptoms among midlife women.
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DOI：
10.1097/gme.0000000000000586
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Jennings JR
中科院分区：
文献类型：
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作者：
Thurston RC;Matthews KA;Chang Y;Santoro N;Barinas-Mitchell E;von Känel R;Landsittel DP;Jennings JR
大多数中年女性都会出现血管舒缩症状，但对其生理机能仍知之甚少。这项研究测试了在清醒和睡眠期间监测的大量女性样本中，心脏迷走神经控制是否会因血管舒缩症状而急剧下降。 215 名年龄在 40-60 岁且有血管舒缩症状证据的不吸烟女性被纳入研究。女性无临床心血管疾病或心律失常病史；或使用胰岛素、β受体阻滞剂、钙通道阻滞剂或影响血管舒缩症状的药物。女性接受 24 小时动态生理监测（胸骨皮肤电导）和自我报告（电子日记）血管舒缩症状测量；心率变异性（心电图）；和呼吸频率。在线性混合模型中测试了血管舒缩症状期间相对于血管舒缩症状之前和之后时期的呼吸性窦性心律失常评估的心脏迷走神经控制的变化。与 VMS 之前 (b(SE)=.13(.004), p<.0001) 和之后 (b(SE)=.13(.004), p<.0001) 相比，在生理测量的血管舒缩症状期间观察到呼吸性窦性心律失常显着减少，并根据年龄、种族、体重指数、睡眠/觉醒进行调整。对于不知道自己的血管舒缩症状并持续控制呼吸频率的女性，观察到其下降。相互作用表明，呼吸性窦性心律失常的减少在睡眠期间和年轻女性中最为明显。在大量女性样本中，生理测量的血管舒缩症状伴随着心脏迷走神经控制的抑制。无论是否报告血管舒缩症状，都会观察到变化，这些变化在睡眠期间最为明显，并且在年轻女性中最为明显。这些发现有助于理解血管舒缩症状生理学。
Most midlife women report vasomotor symptoms, yet their physiology remains poorly understood. This study tested whether acute decreases in cardiac vagal control would occur with vasomotor symptoms in a large sample of women monitored during wake and sleep. 215 nonsmoking women ages 40–60 with evidence of vasomotor symptoms were included. Women were free of a history of clinical cardiovascular disease or arrhythmia; or use of insulin, beta blockers, calcium channel blockers, or medications impacting vasomotor symptoms. Women underwent 24 hours of ambulatory monitoring for physiological (sternal skin conductance) and self-report (electronic diary) measurement of vasomotor symptoms; heart rate variability (electrocardiogram); and respiratory rate. Changes in cardiac vagal control as assessed by respiratory sinus arrhythmia during vasomotor symptoms relative to periods preceding and following vasomotor symptoms were tested in linear mixed models. Significant decreases in respiratory sinus arrhythmia were observed during physiologically-measured vasomotor symptoms relative to periods preceding (b(SE)=.13(.004), p<.0001) and following the VMS (b(SE)=.13(.004), p<.0001), adjusted for age, race, body mass index, sleep/wake. Decreases were observed for women not aware of their vasomotor symptoms, and persisted controlling for respiration rate. Interactions indicated that respiratory sinus arrhythmia decreases were most pronounced during sleep and for younger women. Physiologically-measured vasomotor symptoms were accompanied by an inhibition of cardiac vagal control in a large sample of women. Changes were observed irrespective of whether the vasomotor symptoms were reported, were most pronounced during sleep, and were greatest among younger women. These findings contribute to the understanding of vasomotor symptom physiology.