Abstract P206: Improvement Of Autonomic Function, Sleep, Depression, Anxiety, And Stress In Military Personnel With Traumatic Stress After Use Of A Closed Loop Neurotechnology

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Catherine Tegeler ◽  
Lindsay Howard ◽  
Kenzie L Brown ◽  
Faiza Asif-Fraz ◽  
Dawn C Kellar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Traumatic Stress ◽  
Baroreflex Sensitivity ◽  
Primary Outcome ◽  
Closed Loop ◽  
Autonomic Function ◽  
Brain Activity ◽  
Acoustic Stimulation ◽  
Beneficial Effects ◽  
Symptom Scores

Introduction: Symptoms associated with military-related traumatic stress (MTS) include insomnia, depression, anxiety, and impaired autonomic control. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is a noninvasive, closed-loop acoustic stimulation technology that identifies dominant brain frequencies and translates them in real time into audible tones of variable pitch and timing, to support self-optimization of brain activity. Objective: Evaluate changes in autonomic and symptoms scores after use of HIRREM in subjects enrolled in a pilot study for MTS. Methods: Thirty-two service members or Veterans (1 female), mean (SD) age 40.8 (6.4), with MTS symptoms for 7.3 years (3.9), received 19.2 (1.0) HIRREM sessions over 12 days. Continuous recordings of blood pressure and heart rate, for analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV), were done at V1 and V2. Symptom inventories collected before (Visit 1, V1), immediately after (primary outcome, V2, n = 32), and at 1, 3, and 6 months after completion of HIRREM included traumatic stress (PCL-M), insomnia (ISI), depression (CES-D), and anxiety (GAD-7). Paired t-tests were performed. Results: HIRREM improved BRS measured as HF alpha (10.8 ms/mmHg, 2.5, p<0.001), Sequence Down (7.3 ms/mmHg, 2.1, p<0.001), Sequence Up (7.6 ms/mmHg, 2.4, p=0.001), and Sequence All (7.3 ms/mmHg, 1.8, p<0.001), as well as HRV; SDNN (14.1 ms, 3.6, p=0.005), rMSSD (12.8 ms, 2.6, p<0.05). MAP dropped 2.7 mmHg, 1.2, p<0.05 and SAP dropped 5.9 mmHg, 1.8, p=0.007. Mean symptom scores were reduced at V2; PCL-M [-12.9 (± 9.1), p<0.001], ISI [-6.3 (± 5.0), p<0.001], CES-D [-13.7 (±9.2), p<0.001], and GAD-7 [-6.7. (± 4.7), p<0.001]. Symptom scores improved 1-month post-HIRREM for all measures, and clinically relevant and significant benefits persist at 3 and 6 months. Conclusions: These results suggest improved autonomic cardiovascular regulation and statistically significant reduction in scales associated with the use of HIRREM for symptoms of MTS. Controlled trials could provide important insights regarding both the mechanisms associated with the beneficial effects of HIRREM, and the functional disturbances underlying MTS.

Abstract P625: Improvement of Autonomic Function and C-Reactive Protein in Military Personnel with Traumatic Stress After Use Of a Closed Loop Neurotechnology

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Hossam A Shaltout ◽  
Catherine L Tegeler ◽  
Charles H Tegeler
Keyword(s):  
Heart Rate ◽  
Traumatic Stress ◽  
Closed Loop ◽  
Brain Activity ◽  
Renin Angiotensin System ◽  
Acoustic Stimulation ◽  
Total Power ◽  
C Reactive Protein ◽  
Beneficial Effects ◽  
Reactive Protein

Objective: Evaluate changes in autonomic cardiovascular control and inflammatory markers associated with use of High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM) in subjects enrolled in a pilot study for symptoms of military-related traumatic stress (MTS). Introduction: Symptoms associated with MTS include insomnia, depression, anxiety, activated inflammatory response and impaired autonomic control. HIRREM is a noninvasive, closed-loop acoustic stimulation technology that identifies dominant brain frequencies and translates them in real time into audible tones of variable pitch and timing, to support self-updating and self-optimization of brain activity. Methods: Eighteen service members or Veterans (1 female), mean (SD) age 40.9 (7.0), with MTS symptoms for 6 years (3.4), received 19.5 (1.1) HIRREM sessions over 12 days. Continuous recordings of blood pressure and heart rate, for analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV), were done before and immediately after completion of the HIRREM intervention. Blood samples were also collected (n = 14) for measurement of catecholamines, cytokines, C-reactive protein and the renin angiotensin system (RAS) components. Paired t-tests were performed. After HIRREM, there was improved BRS measured as HF alpha (9.6 ms/mmHg, SE 3.1, p = 0.005), Sequence Down (7.6 ms/mmHg, 2.4, p = 0.005), Sequence Up (8.4 ms/mmHg, 3.0, p = 0.01), and Sequence All (7.6 ms/mmHg, 2.2, p = 0.002), as well as HRV; SDNN (12.0 ms, 3.5, p = 0.02), rMSSD (13.2 ms, 3.0, p < 0.001), LF power (1023.0 ms 2 , 346, p = 0.007), HF power (398.0 ms 2 , 142.0, p = 0.01), and total power (1420.8 ms 2 , 450.8, p = 0.005). C-reactive protein (36%, p = 0.057) was also reduced. There were no significant changes in the catecholamine, cytokines or RAS. There were no adverse events or dropouts. Conclusions: These interim results suggest improved autonomic cardiovascular regulation, across multiple measures of BRS and HRV, and reduction in CRP associated with the use of HIRREM for symptoms of MTS. Confirmation of these results in a larger cohort may provide important insights regarding both the mechanisms associated with the beneficial effects of HIRREM, and the functional disturbances underlying MTS.

scholarly journals Pilot Trial of a Noninvasive Closed-Loop Neurotechnology for Stress-Related Symptoms in Law Enforcement: Improvements in Self-Reported Symptoms and Autonomic Function

2020 ◽  
Vol 9 ◽  
pp. 216495612092328
Author(s):  
Catherine L Tegeler ◽  
Hossam A Shaltout ◽  
Sung W Lee ◽  
Sean L Simpson ◽  
Lee Gerdes ◽  
...  
Keyword(s):  
Heart Rate ◽  
Law Enforcement ◽  
Real Time ◽  
Traumatic Stress ◽  
Closed Loop ◽  
Autonomic Function ◽  
Randomized Clinical Trials ◽  
Pilot Trial ◽  
Self Report ◽  
Law Enforcement Personnel

Background Law enforcement officers have decreased life expectancy, attributed to work-related exposure to traumatic stress and circadian disruption. Autonomic dysregulation is reported with traumatic stress and chronic insomnia. Objective We explore potential benefits for reduced symptoms related to stress and insomnia and improved autonomic function associated with open label use of high-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®), in a cohort of sworn law enforcement personnel. Methods Closed-loop noninvasive therapies utilizing real-time monitoring offer a patient-centric approach for brain-based intervention. HIRREM® is a noninvasive, closed-loop, allostatic, neurotechnology that echoes specific brain frequencies in real time as audible tones to support self-optimization of brain rhythms. Self-report symptom inventories done before and after HIRREM included insomnia (ISI), depression (CES-D), traumatic stress (PCL-C), anxiety (GAD-7), perceived stress (PSS), and quality of life (EQ-5D). Ten-minute recordings of heart rate and blood pressure allowed analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV). Results Fifteen participants (1 female), mean (SD) age 45.7 (5.6), received 12.2 (2.7) HIRREM sessions, over 7.9 in-office days. Data were collected at baseline, and at 22.8 (9.2), and 67.2 (14.1) days after intervention. All symptom inventories improved significantly ( P < .01), with durability for 2 months after completion of the intervention. The use of HIRREM was also associated with significant increases ( P < .001) in HRV measured as rMSSD and BRS measured by high-frequency alpha index. There were no serious adverse events or drop outs. Conclusion These pilot data provide the first report of significant symptom reductions, and associated improvement in measures of autonomic cardiovascular regulation, with the use of HIRREM in a cohort of law enforcement personnel. Randomized clinical trials are warranted.

Abstract P602: Reduced Symptoms And Improved Heart Rate Variability Associated With Use Of Closed-Loop Noninvasive Neurotechnology By Migraineurs

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Catherine L Tegeler ◽  
Hossam A Shaltout ◽  
Charles H Tegeler
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Baroreflex Sensitivity ◽  
Closed Loop ◽  
Acoustic Stimulation ◽  
Sympathetic Tone ◽  
Autonomic Balance ◽  
Open Label ◽  
Serious Adverse Events ◽  
Neuropsychological Disorders

Introduction: Migraine is associated with impaired autonomic function, reduced heart rate variability (HRV), increased sympathetic activity, and symptoms of insomnia and depression. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM) is a noninvasive, closed-loop acoustic stimulation neurotechnology that identifies dominant brain frequencies and translates them into audible tones, to support self-optimization of brain rhythms. Objective: We have reported use of HIRREM is associated with improved autonomic balance in a diverse cohort. We explored for effects of HIRREM in a cohort with self-reported migraine enrolled in an IRB-approved open label feasibility study of HIRREM for diverse neuropsychological disorders. Methods: Fifty-two subjects (42 female), mean (SD) age 38.0 (18.6), received 15.9 (3.9) HIRREM sessions (90-120 minutes each) over 9.0 (2.7) days of in-office intervention. Outcomes collected before (V1), and 13.6 (14.4) days after HIRREM completion (V2) included measures of autonomic regulation (baroreflex sensitivity, BRS, and HRV), inventories for insomnia (ISI), depression (CES-D), traumatic stress (PCL-C), and headache (MIDAS). Paired t-tests were performed. Measures of BRS and HRV (n=52) improved from V1 to V2, including HF Alpha (+8.0 ms/mmHg (SE 2.2), p<0.0012), SDNN (+6.1 ms (1.9), p=0.002), and rMSSD ms (+7.6 (2.5), p=0.004). Sympathetic tone to blood vessels and mean arterial pressure were significantly reduced. There were improvements in symptoms at V2, including ISI (n=52): -6.2 (5.7), p<0.0001; CES-D (n=38): -8.0 (9.8), p<0.0001; PCL-C (n=30): -8.2 (11.3); p<0.001; and MIDAS (n=33): -14.9 (41.7), p<0.01). No serious adverse events were reported. Conclusions: This exploratory study shows improved measures of autonomic balance, reduced sympathetic tone, improved sleep and mood. Data suggest that HIRREM is a promising intervention that merits further investigation to mitigate the myriad effects of migraine

Effect of anaesthetic and choice of neuromuscular blocker on vagal control of heart rate under laboratory animal experimental conditions

2017 ◽  
Vol 52 (3) ◽  
pp. 280-291
Author(s):  
Divya Sarma Kandukuri ◽  
Jacqueline K Phillips ◽  
Mark Tahmindjis ◽  
Cara M Hildreth
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Laboratory Animal ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Isoflurane Anaesthesia ◽  
Blocking Agents

Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats. Pancuronium produced a profound vagolytic response characterized by tachycardia, reduction in heart rate variability and baroreflex sensitivity under urethane anaesthesia, and with minimal effect under isoflurane anaesthesia. Conversely, cisatracurium produced no evidence of vagolytic action under either urethane or isoflurane anaesthesia. Therefore, for studies interested in examining autonomic function, particularly baroreflex or vagal function, neuromuscular blockade would be best achieved using cisatracurium.

scholarly journals Effect of 48 h Fasting on Autonomic Function, Brain Activity, Cognition, and Mood in Amateur Weight Lifters

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Rima Solianik ◽  
Artūras Sujeta ◽  
Asta Terentjevienė ◽  
Albertas Skurvydas
Keyword(s):  
Heart Rate ◽  
Cognitive Functions ◽  
Autonomic Function ◽  
Brain Activity ◽  
Autonomic Response ◽  
Mental Flexibility ◽  
Frontal Brain ◽  
Before And After ◽  
Weight Lifters ◽  
Calorie Diet

Objectives.The acute fasting-induced cardiovascular autonomic response and its effect on cognition and mood remain debatable. Thus, the main purpose of this study was to estimate the effect of a 48 h, zero-calorie diet on autonomic function, brain activity, cognition, and mood in amateur weight lifters.Methods.Nine participants completed a 48 h, zero-calorie diet program. Cardiovascular autonomic function, resting frontal brain activity, cognitive performance, and mood were evaluated before and after fasting.Results.Fasting decreased (p<0.05) weight, heart rate, and systolic blood pressure, whereas no changes were evident regarding any of the measured heart rate variability indices. Fasting decreased (p<0.05) the concentration of oxygenated hemoglobin and improved (p<0.05) mental flexibility and shifting set, whereas no changes were observed in working memory, visuospatial discrimination, and spatial orientation ability. Fasting also increased (p<0.05) anger, whereas other mood states were not affected by it.Conclusions.48 h fasting resulted in higher parasympathetic activity and decreased resting frontal brain activity, increased anger, and improved prefrontal-cortex-related cognitive functions, such as mental flexibility and set shifting, in amateur weight lifters. In contrast, hippocampus-related cognitive functions were not affected by it.

scholarly journals 346 Baroreflex sensitivity and autonomic function in Takotsubo syndrome long after the acute phase

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Martina Zinelli ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Phase ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Left Ventricular ◽  
Sympathetic Tone ◽  
Coronary Syndrome ◽  
History Of ◽  
Acute Event

Abstract Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P &lt; 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.

scholarly journals Functional Brain Network Changes Following Use of an Allostatic, Closed-Loop, Acoustic Stimulation Neurotechnology for Military-Related Traumatic Stress

2018 ◽  
Vol 29 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Sung W. Lee ◽  
Paul J. Laurienti ◽  
Jonathan H. Burdette ◽  
Catherine L. Tegeler ◽  
Ashley R. Morgan ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Closed Loop ◽  
Acoustic Stimulation ◽  
Brain Network ◽  
Functional Brain ◽  
Functional Brain Network

Enhanced open-loop but not closed-loop cardiac baroreflex sensitivity during orthostatic stress in humans

2011 ◽  
Vol 301 (5) ◽  
pp. R1591-R1598 ◽  
Author(s):  
Toshinari Akimoto ◽  
Jun Sugawara ◽  
Daisuke Ichikawa ◽  
Nobuyuki Terada ◽  
Paul J. Fadel ◽  
...  
Keyword(s):  
Heart Rate ◽  
Transfer Function ◽  
White Noise ◽  
Baroreflex Sensitivity ◽  
Closed Loop ◽  
Low Frequency ◽  
Open Loop ◽  
Orthostatic Stress ◽  
Arterial Baroreflex ◽  
Transfer Function Gain

The neural interaction between the cardiopulmonary and arterial baroreflex may be critical for the regulation of blood pressure during orthostatic stress. However, studies have reported conflicting results: some indicate increases and others decreases in cardiac baroreflex sensitivity (i.e., gain) with cardiopulmonary unloading. Thus the effect of orthostatic stress-induced central hypovolemia on regulation of heart rate via the arterial baroreflex remains unclear. We sought to comprehensively assess baroreflex function during orthostatic stress by identifying and comparing open- and closed-loop dynamic cardiac baroreflex gains at supine rest and during 60° head-up tilt (HUT) in 10 healthy men. Closed-loop dynamic “spontaneous” cardiac baroreflex sensitivities were calculated by the sequence technique and transfer function and compared with two open-loop carotid-cardiac baroreflex measures using the neck chamber system: 1) a binary white-noise method and 2) a rapid-pulse neck pressure-neck suction technique. The gain from the sequence technique was decreased from −1.19 ± 0.14 beats·min−1·mmHg−1 at rest to −0.78 ± 0.10 beats·min−1·mmHg−1 during HUT ( P = 0.005). Similarly, closed-loop low-frequency baroreflex transfer function gain was reduced during HUT ( P = 0.033). In contrast, open-loop low-frequency transfer function gain between estimated carotid sinus pressure and heart rate during white-noise stimulation was augmented during HUT ( P = 0.01). This result was consistent with the maximal gain of the carotid-cardiac baroreflex stimulus-response curve (from 0.47 ± 0.15 beats·min−1·mmHg−1 at rest to 0.60 ± 0.20 beats·min−1·mmHg−1 at HUT, P = 0.037). These findings suggest that open-loop cardiac baroreflex gain was enhanced during HUT. Moreover, under closed-loop conditions, spontaneous baroreflex analyses without external stimulation may not represent open-loop cardiac baroreflex characteristics during orthostatic stress.

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