Eight weeks of device-guided slow breathing decreases sympathetic nervous reactivity to stress in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is characterized by increased risk for developing hypertension and cardiovascular disease. We recently showed that device-guided slow breathing (DGB) acutely lowers blood pressure (BP) and muscle sympathetic activity (MSNA) and improves baroreflex sensitivity (BRS) in PTSD. The aim of this study was to assess the long-term benefits of DGB on autonomic function at rest and during stress. We hypothesized that long-term DGB improves arterial BRS and lowers BP and MSNA in PTSD. Twenty-five veterans with PTSD were studied and randomized to either 8 wk of daily DGB ( n = 12) or 8 wk of sham device (Sham; n = 13). BP, heart rate (HR), and MSNA were measured at rest and during mental math. Arterial BRS was assessed using the modified Oxford technique. Resting MSNA, BP, and heart rate (HR) remained comparable before and after 8 wk in both groups (DGB and Sham). Likewise, the change in sympathetic and cardiovagal BRS was not different between the groups. Interestingly, DGB significantly decreased MSNA reactivity to mental math when expressed as burst frequency ( P = 0.012) or burst incidence ( P = 0.008) compared with Sham, suggesting a sustained effect of DGB on sympathetic reactivity to stress in PTSD. Contrary to our hypothesis, long-term DGB did not lower systolic BP, diastolic BP, or HR responses to stress compared with Sham. Likewise, pulse pressure reactivity after 8 wk ( P = 0.121) was also comparable. In summary, these data suggest that long-term use of DGB may lead to a sustained dampening of sympathetic reactivity to mental stress in PTSD.

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Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00098.2018 ◽

2018 ◽

Vol 315 (1) ◽

pp. H141-H149 ◽

Cited By ~ 12

Author(s):

Ida T. Fonkoue ◽

Paul J. Marvar ◽

Seth D. Norrholm ◽

Melanie L. Kankam ◽

Yunxiao Li ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Sympathetic Activity ◽

Baroreflex Sensitivity ◽

Sympathetic Nerve Activity ◽

Sham Group ◽

Stress Disorder ◽

Burst Frequency ◽

Nerve Activity ◽

Slow Breathing

Patients with posttraumatic stress disorder (PTSD) have elevated sympathetic nervous system reactivity and impaired sympathetic and cardiovagal baroreflex sensitivity (BRS). Device-guided slow breathing (DGB) has been shown to lower blood pressure (BP) and sympathetic activity in other patient populations. We hypothesized that DGB acutely lowers BP, heart rate (HR), and improves BRS in PTSD. In 23 prehypertensive veterans with PTSD, we measured continuous BP, ECG, and muscle sympathetic nerve activity (MSNA) at rest and during 15 min of DGB at 5 breaths/min ( n = 13) or identical sham device breathing at normal rates of 14 breaths/min (sham; n = 10). Sympathetic and cardiovagal BRS was quantified using pharmacological manipulation of BP via the modified Oxford technique at baseline and during the last 5 min of DGB or sham. There was a significant reduction in systolic BP (by −9 ± 2 mmHg, P < 0.001), diastolic BP (by −3 ± 1 mmHg, P = 0.019), mean arterial pressure (by −4 ± 1 mmHg, P = 0.002), and MSNA burst frequency (by −7.8 ± 2.1 bursts/min, P = 0.004) with DGB but no significant change in HR ( P > 0.05). Within the sham group, there was no significant change in diastolic BP, mean arterial pressure, HR, or MSNA burst frequency, but there was a small but significant decrease in systolic BP ( P = 0.034) and MSNA burst incidence ( P = 0.033). Sympathetic BRS increased significantly in the DGB group (−1.08 ± 0.25 to −2.29 ± 0.24 bursts·100 heart beats−1·mmHg−1, P = 0.014) but decreased in the sham group (−1.58 ± 0.34 to –0.82 ± 0.28 bursts·100 heart beats−1·mmHg−1, P = 0.025) (time × device, P = 0.001). There was no significant difference in the change in cardiovagal BRS between the groups (time × device, P = 0.496). DGB acutely lowers BP and MSNA and improves sympathetic but not cardiovagal BRS in prehypertensive veterans with PTSD. NEW & NOTEWORTHY Posttraumatic stress disorder is characterized by augmented sympathetic reactivity, impaired baroreflex sensitivity, and an increased risk for developing hypertension and cardiovascular disease. This is the first study to examine the potential beneficial effects of device-guided slow breathing on hemodynamics, sympathetic activity, and arterial baroreflex sensitivity in prehypertensive veterans with posttraumatic stress disorder.

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Women are more likely than men to experience long-term posttraumatic stress disorder after major trauma

PsycEXTRA Dataset ◽

10.1037/e556512006-017 ◽

2003 ◽

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Major Trauma ◽

Stress Disorder

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Heart Rate Variability Intervention for Posttraumatic Stress Disorder Symptoms Preoperatively in Patients Undergoing CABG Surgery

PsycEXTRA Dataset ◽

10.1037/e666142011-001 ◽

2011 ◽

Author(s):

Emily Voelkel ◽

Tam K. Dao ◽

James J. Mahoney ◽

Cashuna T. Huddleston ◽

Emily Wear ◽

...

Keyword(s):

Heart Rate ◽

Posttraumatic Stress Disorder ◽

Heart Rate Variability ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Cabg Surgery ◽

Posttraumatic Stress Disorder Symptoms

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Investigating Heart Rate Patterns During Hyperarousal Events Among Veterans Who Have Posttraumatic Stress Disorder (PTSD)

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101051 ◽

2021 ◽

Vol 10 (1) ◽

pp. 91-91

Author(s):

Mahnoosh Sadeghi ◽

Farzan Sasangohar ◽

Sudeep Hegde ◽

Anthony McDonald

Keyword(s):

Heart Rate ◽

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder

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Different Patterns of Mental Health Outcomes among Road Traffic Crash Survivors: A Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041564 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1564

Author(s):

Jelena Kovacevic ◽

Ivica Fotez ◽

Ivan Miskulin ◽

Davor Lesic ◽

Maja Miskulin ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Mental Disorders ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Road Traffic ◽

Sociodemographic Factors ◽

Road Traffic Crash ◽

Traffic Crash ◽

Factors Associated ◽

Before And After

This study aimed to investigate factors associated with the symptoms of mental disorders following a road traffic crash (RTC). A prospective cohort of 200 people was followed for 6 months after experiencing an RTC. The cohort was comprised of uninjured survivors and injured victims with all levels of road traffic injury (RTI) severity. Multivariable logistic regression analyses were performed to evaluate the associations between the symptoms of depression, posttraumatic stress disorder and anxiety one and six months after the RTC, along with sociodemographic factors, health status before and after the RTC, factors related to the RTI and factors related to the RTC. The results showed associations of depression, anxiety, and posttraumatic stress disorder symptoms with sociodemographic factors, factors related to the health status before and after the RTC and factors related to the RTC. Factors related to the RTI showed associations only with depression and posttraumatic stress disorder symptoms. Identifying factors associated with mental disorders following an RTC is essential for establishing screening of vulnerable individuals at risk of poor mental health outcomes after an RTC. All RTC survivors, regardless of their RTI status, should be screened for factors associated with mental disorders in order to successfully prevent them.

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Abstract P127: Posttraumatic Stress Disorder and Risk for Coronary Heart Disease: A Meta-analytic Review

Circulation ◽

10.1161/circ.127.suppl_12.ap127 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Donald Edmondson ◽

Ian M Kronish ◽

Jonathan A Shaffer ◽

Louise Falzon ◽

Matthew M Burg

Keyword(s):

Posttraumatic Stress Disorder ◽

Coronary Heart Disease ◽

Heart Disease ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Meta Analysis ◽

Cochrane Library ◽

Forest Plot ◽

Increased Risk ◽

Analytic Review

Context: Recent evidence suggests that posttraumatic stress disorder (PTSD) may be associated with increased risk for coronary heart disease (CHD). Objective: To determine the association of PTSD to incident CHD using systematic review and meta-analysis. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and through manual search of reference lists. Study Selection: Prospective cohort studies that assessed PTSD in participants free of CHD and assessed subsequent CHD or cardiac-specific mortality. Data Extraction: We extracted estimates of the association of PTSD to incident CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HR), and a random-effects model was used to pool results. Data Synthesis: Five studies met our inclusion criteria (N= 401,712); 4 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.53 (95% CI, 1.27-1.84) before adjustment for depression. The pooled HR estimate for the 4 depression-adjusted estimates (N= 362,388) was 1.22 (95% CI, 1.05-1.42). Conclusion: PTSD is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. Figure 1. Forest plot of association of PTSD to incident MI or cardiac mortality Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the aggregate estimate, and its lateral points indicate confidence intervals for this estimate.

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