Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder
Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder
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DOI：
10.3109/10253890.2012.751369
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发表时间：
2013-05-01
影响因子：
2.3
通讯作者：
Stiedl, Oliver
中科院分区：
文献类型：
--
作者：
Agorastos, Agorastos;Boel, Judith A.;Stiedl, Oliver
受影响的心脏自主调节与心血管疾病的病理生理有关，并与创伤后应激障碍（PTSD）有关。然而，尽管交感神经过度激活在创伤后应激障碍中一再出现，但研究却忽视了副交感神经功能。本研究的目的是长期评估心率（HR）动态及其日变化作为创伤后应激障碍自主神经失衡的指标。由于强直性副交感神经活动是健康状态下心跳间隔波动的长期相关性的基础，我们将非线性（单分形）分析作为评估功能改变的重要和敏感的读数。我们对15名有中度至高度战斗暴露（PTSD: n = 7；战斗对照组：n = 8）的男性受试者进行了24小时的仰卧位心电图记录。在时域和频域上对两个5 h子期的HR动态进行了评估，并采用基于去趋势波动分析的非线性分析。使用结构化访谈评估精神症状，包括临床医生管理的PTSD量表。PTSD受试者的基线HR显著增高，频域LF/HF比值显著增高，昼夜测量差异减弱，白天的标度系数α（快）较高，表明强直性副交感神经活动减弱。昼夜差异的减少和张力副交感神经活动的减弱改变了HR动态，表明中枢神经自主调节失调可能与PTSD中心血管疾病的增加有关。
Affected autonomic heart regulation is implicated in the pathophysiology of cardiovascular diseases and is associated with posttraumatic stress disorder (PTSD). However, although sympathetic hyperactivation has been repeatedly shown in PTSD, research has neglected parasympathetic function. The objective of this study is the long-term assessment of heart rate (HR) dynamics and its diurnal changes as an index of autonomic imbalance in PTSD. Since tonic parasympathetic activity underlies long-range correlation of heartbeat interval fluctuations in the healthy state, we included nonlinear (unifractal) analysis as an important and sensitive readout to assess functional alterations. We conducted electrocardiogram recordings over a 24-h period in 15 deployed male subjects with moderate to high levels of combat exposure (PTSD: n = 7; combat controls: n = 8) in the supine position. HR dynamics were assessed in two 5-h sub-epochs in the time and frequency domains, and by nonlinear analysis based on detrended fluctuation analysis. Psychiatric symptoms were assessed using structured interviews, including the Clinician Administered PTSD Scale. Subjects with PTSD showed significantly higher baseline HR, higher LF/HF ratio in the frequency domain, blunted differences between day and night-time measures, as well as a higher scaling coefficient alpha(fast) during the day, indicating diminished tonic parasympathetic activity. Diminished diurnal differences and blunted tonic parasympathetic activity altering HR dynamics suggest central neuroautonomic dysregulation that could represent a possible link to increased cardiovascular disease in PTSD.