scholarly journals Sex differences in integrated neurocardiovascular control of blood pressure following acute intermittent hypercapnic hypoxia

2020 ◽  
Vol 319 (6) ◽  
pp. R626-R636
Author(s):  
Dain W. Jacob ◽  
Elizabeth P. Ott ◽  
Sarah E. Baker ◽  
Zachariah M. Scruggs ◽  
Clayton L. Ivie ◽  
...  
Keyword(s):  
Sex Differences ◽  
Sleep Apnea ◽  
Young Women ◽  
Baroreflex Sensitivity ◽  
Muscle Sympathetic Nerve Activity ◽  
Female Rats ◽  
Sympathetic Control ◽  
Before And After ◽  
Hypercapnic Hypoxia ◽  
Blood Pressures

Repetitive hypoxic apneas, similar to those observed in sleep apnea, result in resetting of the sympathetic baroreflex to higher blood pressures (BP). This baroreflex resetting is associated with hypertension in preclinical models of sleep apnea (intermittent hypoxia, IH); however, the majority of understanding comes from males. There are data to suggest that female rats exposed to IH do not develop high BP. Clinical data further support sex differences in the development of hypertension in sleep apnea, but mechanistic data are lacking. Here we examined sex-related differences in the effect of IH on sympathetic control of BP in humans. We hypothesized that after acute IH we would observe a rise in muscle sympathetic nerve activity (MSNA) and arterial BP in young men ( n = 30) that would be absent in young women ( n = 19). BP and MSNA were measured during normoxic rest before and after 30 min of IH. Baroreflex sensitivity (modified Oxford) was evaluated before and after IH. A rise in mean BP following IH was observed in men (+2.0 ± 0.7 mmHg, P = 0.03), whereas no change was observed in women (−2.7 ± 1.2 mmHg, P = 0.11). The elevation in MSNA following IH was not different between groups (4.7 ± 1.1 vs. 3.8 ± 1.2 bursts/min, P = 0.65). Sympathetic baroreflex sensitivity did not change after IH in either group ( P > 0.05). Our results support sex-related differences in the effect of IH on neurovascular control of BP and show that any BP-raising effects of IH are absent in young women. These data enhance our understanding of sex-specific mechanisms that may contribute to BP changes in sleep apnea.

428 Baroreflex sensitivity during handgrip in obstructive sleep apnea with and without CPAP

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A169-A170
Author(s):  
Amrita Pal ◽  
Fernando Martinez ◽  
Ravi Aysola ◽  
Ronald Harper ◽  
Luke Henderson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Baroreflex Sensitivity ◽  
Muscle Sympathetic Nerve Activity ◽  
Cross Sectional Study ◽  
Autonomic Regulation ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Healthy Control ◽  
Significant Measure

Abstract Introduction Obstructive sleep apnea (OSA) disrupts multiple aspect of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS. Methods We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR and their variabilities: BPV and HRV (sympathetic-vagal). Results Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p < 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p < 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups. Conclusion BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage. Support (if any) NR-017435, HL135562

432 Brain Structure and Baroreflex Sensitivity Associations in Obstructive Sleep Apnea with and without CPAP

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A171-A171
Author(s):  
Amrita Pal ◽  
Fernando Martinez ◽  
Ravi Aysola ◽  
Ronald Harper ◽  
Luke Henderson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Baroreflex Sensitivity ◽  
Muscle Sympathetic Nerve Activity ◽  
Cross Sectional Study ◽  
Autonomic Regulation ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Healthy Control ◽  
Significant Measure

Abstract Introduction Obstructive sleep apnea (OSA) disrupts multiple aspects of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS. Methods We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR, and their variabilities: BPV and HRV (sympathetic-vagal). Results Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p < 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p < 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR, and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups. Conclusion BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage. Support (if any) NR-017435, HL135562

scholarly journals Altered baroreflex sensitivity in young women with a family history of hypertension

2019 ◽  
Vol 121 (3) ◽  
pp. 1011-1017 ◽  
Author(s):  
Evan L. Matthews ◽  
Kelly N. Sebzda ◽  
Megan M. Wenner
Keyword(s):  
Family History ◽  
Young Women ◽  
Baroreflex Sensitivity ◽  
Valsalva Maneuver ◽  
Muscle Sympathetic Nerve Activity ◽  
Positive Family History ◽  
The Future ◽  
History Of ◽  
Family History Of Hypertension ◽  
Important Marker

A positive family history of hypertension (+FH) is a risk factor for the future development of hypertension. Hypertension is associated with reductions in baroreflex sensitivity (BRS). Therefore, we hypothesized that young women with a +FH [ n = 12, 22 ± 1 yr, body mass index (BMI) 21 ± 1 kg/m2, mean arterial pressure (MAP) 79 ± 1 mmHg] would have lower BRS compared with young women without a family history of hypertension (−FH) ( n = 13, 22 ± 1 yr, BMI 21 ± 1 kg/m2, MAP 77 ± 2 mmHg, all P > 0.05 between groups). Continuous measurements of muscle sympathetic nerve activity, blood pressure, and electrocardiogram derived R-R interval were recorded at rest and during a Valsalva maneuver. Both cardiovagal BRS and vascular sympathetic BRS were assessed. Resting cardiovagal BRS was reduced in the +FH women (all sequences: −FH 32.3 ± 3.7 vs. +FH 20.2 ± 2.9 ms/mmHg, P = 0.02). Cardiovagal BRS during phase IV (−FH 16.5 ± 2.7 vs. +FH 7.6 ± 1.3 ms/mmHg, P < 0.01) but not phase II (−FH 5.5 ± 0.9 vs. +FH 5.0 ± 0.8 ms/mmHg, P = 0.67) of the Valsalva maneuver was also lower in the +FH women. Vascular sympathetic BRS at rest (−FH −2.38 ± 0.7 vs. +FH −2.33 ± 0.3 bursts· min−1·mmHg−1, P = 0.58) and during the Valsalva (−FH −0.74 ± 0.23 vs. +FH −0.66 ± 0.18 bursts·15 s−1·mmHg−1, P = 0.79) were not different between groups. These data suggest that healthy young women with a positive family history of hypertension have reduced cardiovagal BRS. This may be one mechanism contributing to the increased incidence of hypertension in this population later in life. NEW & NOTEWORTHY Having a family history of hypertension increases the risk of developing future hypertension. Reductions in baroreflex function have been demonstrated in hypertension and are an important marker for future cardiovascular disease. We show that young women with a family history of hypertension have lower cardiovagal baroreflex sensitivity. This alteration in autonomic function may be one mechanism contributing to the future incidence of hypertension in this patient population.

scholarly journals Within-breath sympathetic baroreflex sensitivity is modulated by lung volume but unaffected by acute intermittent hypercapnic hypoxia in men

2020 ◽  
Vol 319 (1) ◽  
pp. H213-H221
Author(s):  
Massimo Nardone ◽  
André L. Teixeira ◽  
Anthony V. Incognito ◽  
Tyler D. Vermeulen ◽  
Brooke M. Shafer ◽  
...  
Keyword(s):  
Lung Volume ◽  
Baroreflex Sensitivity ◽  
Sympathetic Nerve Activity ◽  
Muscle Sympathetic Nerve Activity ◽  
Nerve Activity ◽  
Lung Volumes ◽  
Hypercapnic Hypoxia ◽  
Spontaneously Breathing ◽  
Resting Muscle ◽  
Insight Into

In resting spontaneously breathing men, the present study observed that sympathetic baroreflex sensitivity (BRS) was higher during low versus high lung volumes but not different between inspiration and expiration. High- but not low-lung volume BRS was negatively associated with resting muscle sympathetic nerve activity (MSNA). Acute intermittent hypercapnic hypoxia increased resting MSNA and diastolic blood pressure, without altering within-breath BRS. These findings provide novel insight into mechanisms controlling within-breath modulation of MSNA in humans.

Sex differences in dynamic blood pressure regulation: beat-by-beat responses to muscle sympathetic nerve activity

2020 ◽  
Vol 319 (3) ◽  
pp. H531-H538 ◽  
Author(s):  
Yasmine Coovadia ◽  
Tessa E. Adler ◽  
Craig D. Steinback ◽  
Graham M. Fraser ◽  
Charlotte W. Usselman
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Young Women ◽  
Sympathetic Nerve ◽  
Sympathetic Nerve Activity ◽  
Muscle Sympathetic Nerve Activity ◽  
Blood Pressure Regulation ◽  
Sympathetic Outflow ◽  
Pressure Regulation ◽  
Nerve Activity

We demonstrate that during acute sympathoinhibition, women demonstrate more sustained increases in blood pressure following sympathetic bursts of activity than men. Likewise, during prolonged sympathetic quiescence, blood pressure is less labile in women than men. This suggests that lower overall blood pressure in young women may not be mediated by smaller beat-by-beat changes in blood pressure in response to sympathetic outflow but may instead be mediated by a lower frequency of sympathetic bursts.

scholarly journals Sex differences regarding the impact of a standardized adaptation session in Colombian patients with obstructive sleep apnea and poor adherence to positive airway pressure devices

2021 ◽  
Vol 70 (3) ◽  
pp. e92729
Author(s):  
María Angélica Bazurto-Zapata ◽  
Fredy Valderrama ◽  
Federico Fernández ◽  
Mauricio González-García
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sex Differences ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Obstructive Sleep ◽  
Before And After ◽  
The Hours ◽  
Adaptation Session ◽  
The Impact

Introduction: Positive airway pressure (PAP) is the most effective treatment for obstructive sleep apnea (OSA) but adherence is poor. The Sleep-disordered breathing clinic of Fundación Neumológica Colombiana (FNC) has a standardized adaptation session (SAS) aimed at patients with difficulties in using PAP devices. Objective: To evaluate the impact of a SAS in short-term adherence to PAP therapy in patients with OSA and to determine sex differences. Materials and methods: Before-after single cohort study conducted in 40 people aged ≥ 18 years with an AHI ≥ 15/hour and treated at the FNC, Bogotá D.C. (Colombia) between 2015 and 2017, and who attended a SAS due to poor adherence to PAP therapy (defined as <4 hours use in 70% of nights). Data on the hours of use of the PAP device and the % of days in which it was used >4 hours were recorded before and after the intervention to evaluate changes in patients’ adherence. Descriptive statistics were used for data analysis. The paired samples t-test was used for the comparison of variables before and after the intervention. Results: A significant increase was observed in the PAP device use (1.8 hours, 95%CI: 1.3-2.3; p<0.001) and in the % of days its use was >4 hours (35.6%, 95%CI: 26.0-45.3; p<0.001); in men the increase was greater in both cases (2.3 hours, 95%CI: 1.7-2.9; p=0.029 and 47.8%, 95%CI: 32.9-62.8; p=0.029). Conclusion: The SAS offered by the FNC, which includes education strategies and the identification and solving of barriers hindering the use of PAP devices, significantly increased the hours of use of the device and the % of days in which it was used more than 4 hours in the study population, in particular in men.

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

Efektifitas Pendidikan Kesehatan Dengan Metode Ceramah Tentang Vulva Hygiene Terhadap Perilaku Merawat Vulva Hygiene Saat Menstruasi Pada Remaja Putri Kelas VII Di SMPN 1 Gondang Mojokerto

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Titin Dwi Ernawati ◽  
Nikhen Fitrianingtyas Harni ◽  
Jinnani Firdausiyah
Keyword(s):  
Health Education ◽  
Young Women ◽  
Sampling Technique ◽  
Mean Value ◽  
Measurement Tool ◽  
Test Design ◽  
Average Behavior ◽  
Lecture Method ◽  
Before And After ◽  
Post Test

ABSTRAKWanita muda cenderung memiliki perilaku buruk pada kebersihan selama menstruasi. Ketika reproduksi basah dan basah, maka akan meningkatkan keasaman memfasilitasi pertumbuhan jamur. Kondisi seperti gatal pada vulva, area eksternal biasanya terjadi pada wanita muda di masa menstruasi. Perilaku seseorang dipengaruhi oleh tingkat pendidikan dan pengetahuan. Pengetahuan seseorang tentang sesuatu dapat menyebabkan perubahan perilaku. Tujuan penelitian ini adalah untuk menganalisis efektivitas pendidikan kesehatan dengan metode ceramah dalam merawat kebersihan vulva terhadap perilaku kebersihan vulva saat menstruasi pada wanita muda di kelas VII di SMPN 1 Gondang Mojokerto.Jenis penelitian ini adalah pre eksperimental One Group Pre-Post Test Design. Populasi adalah wanita muda di kelas VII di SMPN 1 Gondang Mojokerto. Teknik pengambilan sampel menggunakan total sampling dan diperoleh 21 sampel wanita muda. Alat ukur yang digunakan dalam penelitian ini adalah kuesioner. Analisis data dengan membandingkan perilaku rata-rata memperlakukan kebersihan vulva selama menstruasi sebelum dan sesudah kuliah pendidikan kesehatan.Hasil penelitian sebelum pengobatan (pre-test) menunjukkan nilai rata-rata 9,000 sedangkan penelitian setelah perawatan (post test) menunjukkan nilai rata-rata 14,190. Ada perubahan dalam perilaku rata-rata memperlakukan kebersihan vulva selama menstruasi wanita muda sebelum dan sesudah kuliah pendidikan kesehatan di 5.190.Berdasarkan hasil pendidikan kesehatan dengan metode ceramah efektif untuk meningkatkan perawatan perilaku untuk kebersihan vulva selama menstruasi pada wanita muda. Kuliah pendidikan kesehatan tentang kebersihan vulva dapat digunakan sebagai salah satu cara efektif untuk memperbaiki perilaku kebersihan yang buruk selama menstruasi pada wanita muda.Kata kunci: pendidikan kesehatan, perilaku, kebersihan vulva ABSTRACTYoung women tend to have bad behavior on hygiene during menstruation. When reproduction moist and wet, it will increase the acidity facilitate mold growth. Conditions such as itching of the vulva, the external area usually occurs during young women in the menstrual period. Person's behavior is influenced by the level of education and knowledge. One's knowledge about something can cause behavioral changes. The purpose of the study was to analyze the effectiveness of health education with the lecture method of treating vulva hygiene on the behavior of vulva hygiene during menstruation in young women in class VII at SMPN 1 Gondang MojokertoType of research is pre experimental One Group Pre-Post Test Design. The population was young women in class VII at SMPN 1 Gondang Mojokerto. Sampling technique used total sampling and obtained 21 samples of young women. Measurement tool used in the study was questionnaire. Analysis of the data by comparing the average behavior of treating vulva hygiene during menstruation before and after the health education lecture.The results of the study before treatment (pre-test) showed a mean value of 9,000 while the study after treatment (post test) showed a mean value of 14,190. There is a change in the average behavior of treating vulva hygiene during menstruation young women before and after the health education lecture at 5,190.Based on the results of health education with the lecture method effectively to improved behavioral care for vulva hygiene during menstruation in young women. Health education lecture about hygiene vulva can be used as one of the effective ways to improve the behavior of poor hygiene during menstruation in young women.Key Words: health education, behaviour, vulva hygiene 

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