Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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The Change of Heart Rate Variability in Anxiety Disorder after Given Physical or Psychological Stress

불안장애 환자에서 육체적 및 정신적 스트레스 시 심박변이도의 변화

  • Cho, Min-Kyung (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Park, Doo-Heum (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Yu, Jaehak (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Ryu, Seung-Ho (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Ha, Ji-Hyeon (Department of Neuropsychiatry, Konkuk University Medical Center)
  • 조민경 (건국대학교병원 정신건강의학과) ;
  • 박두흠 (건국대학교병원 정신건강의학과) ;
  • 유재학 (건국대학교병원 정신건강의학과) ;
  • 유승호 (건국대학교병원 정신건강의학과) ;
  • 하지현 (건국대학교병원 정신건강의학과)
  • Received : 2014.11.17
  • Accepted : 2014.12.12
  • Published : 2014.12.31
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Abstract

Objectives: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress in anxiety disorder patients. Methods: HRV was measured at resting, upright, and psychological stress states in 60 anxiety disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity. Differences between HRV indices were evaluated using paired t-tests. Gender difference analysis was accomplished with ANCOVA. Results: SDNN (Standard deviation of normal RR intervals) and low frequency/high frequency (LF/HF) were significantly increased, while NN50, pNN50, and normalized HF (nHF) were significantly decreased in the upright position compared to resting state (p < 0.01). SDNN, root mean square of the differences of successive normal to normal intervals, and LF/HF were significantly increased, while nHF was significantly decreased in the psychological stress state compared to resting state (p < 0.01). SDNN, NN50, pNN50 were significantly lower in upright position compared to psychological stress and nVLF, nLF, nHF, and LF/HF showed no significant differences between them. Conclusion: The LF/HF ratio was significantly increased after both physical and psychological stress in anxiety disorder, but did not show a significant difference between these two stresses. Significant differences of SDNN, NN50, and pNN50 without any differences of nVLF, nLF, nHF, and LF/HF between two stresses might suggest that frequency domain analysis is more specific than time domain analysis.

목 적 : 본 연구는 불안장애 환자를 대상으로 안정 시와 기립 시기, 정신적 스트레스 시기에 심박변이도 지수(heart rate variability index, HRV index) 검사를 시행하여 자율신경계 불균형이 육체적 및 정신적 스트레스에서 어떻게 변화되는지 알아보고자 하였다. 방 법 : 불안장애 환자 60명을 대상으로 연구를 수행하였다. 안정 시기, 기립 시기, 정신적 스트레스 자극을 준 시기 동안 각각 심박변이도 지수를 측정하였다. 긴장 정도와 스트레스 정도에 대해 visual analogue scale (VAS) score로 측정하였고, Beck depression inventory (BDI), state trait anxiety inventory-I, II (STAI-I, II)를 사용하여 불안증상과 우울증상의 심각도를 평가하였다. 통계적 검증은 안정 시기와 기립 시기, 안정 시기와 정신적 스트레스 시기 간의 각각의 자율신경계 관련 지수 변화를 보기 위해 paired t-test로 분석하였고, 성별 차이를 보기 위해 ANCOVA로 비교 분석하였다. 결 과 : 안정 시기와 비교하여 기립 시기에서 SDNN, LF/HF의 유의한 증가(p < 0.01) 및 NN50, pNN50, normalized HF(nHF)의 유의한 감소를 보였다(p < 0.01). 안정 시기와 비교하여 스트레스 시기에서 SDNN, RMSSD, LF/HF의 유의한 증가를 보였고(p < 0.01), nHF의 유의한 감소가 있었다(p < 0.01). 기립 시기와 비교하여 스트레스 시기에 SDNN, NN50, pNN50, HF지수가 유의하게 높은 결과를 보였다. 결 론 : 두 스트레스 모두에서 안정 시기와 비교하여 자율신경계의 균형을 나타내는 LF/HF ratio의 유의한 상승을 보였고, 두 스트레스 간 LF/HF ratio의 유의한 차이는 없었다. 두 스트레스 간에 SDNN, NN50, pNN50은 유의한 차이를 보이나, nVLF, nLF, nHF, LF/HF ratio에서는 유의한 차이가 없어 시간 영역 보다 주파수 영역의 지수가 두 스트레스의 비교에 좀더 특이도가 높다고 생각된다.

Keywords

References

  1. Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981;213:220-222. https://doi.org/10.1126/science.6166045
  2. Alvares GA, Quintana DS, Kemp AH, Van Zwieten A, Balleine BW, Hickie IB, et al. Reduced heart rate variability in social anxiety disorder: associations with gender and symptom severity. PLoS One 2013;8:e70468. https://doi.org/10.1371/journal.pone.0070468
  3. Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004;93:381-385. https://doi.org/10.1016/j.amjcard.2003.09.065
  4. Boutcher S, Stocker D. Cardiovascular response of young and older males to mental challenge. Journal of Gerontology. series B, J Gerontol B Psychol Sci Soc Sci 1996;51:261-267.
  5. Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet 2007;370:1089-1100. https://doi.org/10.1016/S0140-6736(07)61305-1
  6. Camm AJ, Malik M, Bigger JT, Kleiger RE, Malliani A, Moss AJ, et al. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996;17:354-381. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
  7. Cohen H, Benjamin J, Geva AB, Matar MA, Kaplan Z, Kotler M. Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res 2000;96:1-13. https://doi.org/10.1016/S0165-1781(00)00195-5
  8. Friedman BH, Thayer JF. Autonomic balance revisited: panic anxiety and heart rate variability. J Psychosom Res 1998;44:133-151. https://doi.org/10.1016/S0022-3999(97)00202-X
  9. Harter MC, Conway KP, Merikangas KR. Associations between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci 2003;253:313-320. https://doi.org/10.1007/s00406-003-0449-y
  10. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;59:256-262. https://doi.org/10.1016/0002-9149(87)90795-8
  11. Kleiger RE, Stein PK, Bosner MS, Rottman JN. Time domain measurements of heart rate variability. Cardiol Clin 1992;10:487-498.
  12. Klein E, Cnaani E, Harel T, Braun S, Ben-Haim SA. Altered heart rate variability in panic disorder patients. Biol Psychiatry 1995;37:18-24. https://doi.org/10.1016/0006-3223(94)00130-U
  13. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991;84:482-492. https://doi.org/10.1161/01.CIR.84.2.482
  14. Montano N, Ruscone TG, Porta A, Lombardi F, Pagani M, Malliani A. Power spectrum analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt. Circulation 1994;90:1826-1831. https://doi.org/10.1161/01.CIR.90.4.1826
  15. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010;56:38-46. https://doi.org/10.1016/j.jacc.2010.03.034
  16. Schubert C, Lambertz M, Nelesen RA, Bardwell W, Choi JB, Dimsdale JE. Effects of stress on heart rate complexity--a comparison between short-term and chronic stress. Biol Psychol 2009;80:325-332. https://doi.org/10.1016/j.biopsycho.2008.11.005
  17. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 2010;141:122-131. https://doi.org/10.1016/j.ijcard.2009.09.543
  18. Verkuil B, Brosschot JF, Thayer JF. Cardiac reactivity to and recovery from acute stress: Temporal associations with implicit anxiety. Int J Psychophysiol 2014;92:85-91. https://doi.org/10.1016/j.ijpsycho.2014.03.002
  19. Vogelzangs N, Seldenrijk A, Beekman AT, van Hout HP, de Jonge P, Penninx BW. Cardiovascular disease in persons with depressive and anxiety disorders. J Affect Disord 2010;125:241-248. https://doi.org/10.1016/j.jad.2010.02.112
  20. Yeragani VK, Balon R, Pohl R, Ramesh C, Glitz D, Weinberg P, et al. Decreased R-R variance in panic disorder patients. Acta Psychiatr Scand 1990;81:554-559. https://doi.org/10.1111/j.1600-0447.1990.tb05498.x
  21. Yeragani VK, Pohl R, Berger R, Balon R, Ramesh C, Glitz D, et al. Decreased heart rate variability in panic disorder patients: a study of power-spectral analysis of heart rate. Psychiatry Res 1993;46:89-103. https://doi.org/10.1016/0165-1781(93)90011-5