Abstract P207: Sleep Hygiene As An Intervention To Improve Autonomic Function

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Michael Vazquez ◽  
Huan Yang ◽  
Rammy Dang ◽  
Monika Haack ◽  
Janet Mullington
Keyword(s):  
Autonomic Function ◽  
Positive Impact ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Sleep Hygiene ◽  
Wait List Control ◽  
Sleep Timing ◽  
Autonomic Testing ◽  
Hospital Stays ◽  
Resting Period

Introduction: Insufficient sleep is associated with increased heart rate (HR) and blood pressure (BP). Exaggerated cardiovascular reactivity to the cold pressor test (CPT) has been linked to an increased incidence of hypertension. This project investigates the effects of improved sleep hygiene on autonomic function at rest and in response to CPT. We hypothesize a decrease in BP and HR at rest, and attenuated BP and HR response during CPT. Methods: Fifty participants (59.8 ± 1.5 years; 31 women) completed 3 overnight in-hospital stays in which they had continuous ECG and beat-to-beat BP monitoring. The first stay (S1) was a baseline control; the second stay (S2) was a 4-week wait-list control; the third stay (S3) followed an 8-week randomly assigned intervention that used sleep hygiene approaches along with scheduling to either A) stabilize sleep timing, or B) stabilize and extend the bed period. This study is still ongoing, so we are blind to the specific arm that the participants were randomized to. During each stay, autonomic testing was performed about four hours after the participant awoke, including a 5-minute resting period where breathing was controlled (BL), a 3-minute resting period where breathing was not controlled (CPT BL), and 2-minute CPT when participants then submerged their hand in 3°C water. Linear mixed models analyzing the changes in HR and systolic BP (SBP) across the three stays were used. Results: During the 5-minute BL, HR did not significantly decrease from S1 to S2 (p=.310) but did significantly decrease by 2 bpm from S2 to S3 (p=.006). SBP decreased by 7 mmHg from S1 to S2 (p=.022) but did not significantly decrease from S2 to S3 (p=.907). During CPT in all stays, HR and SBP significantly increased compared to CPT BL (p<0.05). There was a significant stay x test interaction effect in HR (interaction, p=.042), but not in SBP (interaction p=.361). Conclusion: While we are still blind to condition, both arms actively improve sleep hygiene. These preliminary data suggest that stabilization of sleep timing and possibly duration, has a positive impact on autonomic function as seen through the decreases in HR at rest and during CPT.

061 Sleep Hygiene as an Intervention to Lower Blood Pressure

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A25-A26
Author(s):  
Michael Vazquez ◽  
Huan Yang ◽  
Rammy Dang ◽  
Monika Haack ◽  
Janet Mullington
Keyword(s):  
Blood Pressure ◽  
Positive Impact ◽  
Sleep Hygiene ◽  
Science Center ◽  
Wait List Control ◽  
Sleep Timing ◽  
Lower Blood ◽  
Hospital Stays ◽  
Underlying Mechanisms ◽  
The Relationship

Abstract Introduction Insufficient sleep has been shown to increase the risk of a person developing hypertension. Impaired baroreflex sensitivity (BRS) is one of the known underlying mechanisms involved that is responsible for increasing blood pressure (BP). This project investigates the relationship between sleep, BRS, and BP during Valsalva’s Maneuver (VM). Methods Fifty participants (59.8 ± 1.5 years; 31 women) completed 3 overnight in-hospital stays. The first stay (S1) was a baseline control; the second stay (S2) followed a 4-week wait-list control condition; the third stay (S3) followed an 8-week randomly assigned intervention that used sleep hygiene approaches and scheduling to either A) stabilize sleep timing, or B) stabilize and extend the bed period. The study is still ongoing, and we are blind to whether participants were randomized to arm A or B of the study. A linear regression model analyzing the R-R Interval (RRI) and corresponding systolic BP was used to calculate the BRS function and the maximum change in SBP (BPMax) during Early Phase II (EPII) of VM. Results There was an increasing BRS trend across the three stays during EPII (p=.051). There was no significant increase between S1 and S2 (p=.876), but BRS significantly increased following 8 weeks of intervention at S3 compared to S1 (p=0.033) and S2 (p=0.037). There was also a significant decrease in BPMax across the three stays during EPII (p&lt;.001). There was no significant decrease in EPII BPMax between S1 and S2 (p=.325), but BPMax significantly decreased in S3 compared to S1 (p&lt;0.001) and S2 (p=0.002). Conclusion While we are still blind to condition, both conditions are considered active as they both involve stabilizing the sleep period using sleep hygiene. These preliminary data suggest that stabilization of sleep timing and possibly duration, has a positive impact on BP regulation. Support (if any) NIH (R01HL125379 to Dr. Janet Mullington), Harvard Catalyst, Harvard Clinical and Translational Science Center (UL1TR001102).

Cold pressor test protocol to evaluate cardiac autonomic function

2006 ◽  
Vol 31 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Jennifer L Wirch ◽  
Larry A Wolfe ◽  
Tracey L Weissgerber ◽  
Gregory A.L Davies
Keyword(s):  
Nervous System ◽  
Autonomic Function ◽  
Parasympathetic Nervous System ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cardiac Autonomic Function ◽  
Pressor Test ◽  
Lateral Decubitus ◽  
Sympathetic Nervous ◽  
Frequency Power

The primary objective of this study was to develop a cold pressor test (CPT) protocol to evaluate cardiac autonomic function. Secondary objectives were to assess CPT protocol reliability and to examine gender differences in response to orthostatic stress and the CPT. Healthy, normotensive men and women (n = 12 per group) completed 2 trials on different days in the left lateral decubitus and standing postures and during a 6 min CPT (hand immersion while seated). Measurements included R-R interval, blood pressure, ventilatory responses, spontaneous baroreflex sensitivity, and heart rate variability indices. During the CPT, blood pressure and the sympathetic nervous system (SNS) indicator increased significantly and low-frequency power, high-frequency power (normalized for tidal volume), and the parasympathetic nervous system (PNS) indicator decreased significantly. Standing caused significant increases in the SNS indicator and decreases in the R-R interval in both genders. The PNS indicator was higher in women than in men in the left lateral decubitus posture. The 6 min hand-immersion CPT provoked cardiac sympathetic activation and parasympathetic withdrawal; however, it is best suited to studies with a repeated measures design, as analysis of reliability suggests that responses are highly variable between individuals. Performing the CPT in the left lateral decubitus position may prevent vasovagal responses.Key words: cold pressor test, sympathetic nervous system, parasympathetic nervous system, gender, posture.

Development Of A Cold Pressor Test Protocol To Evaluate Cardiac Autonomic Function

2005 ◽  
Vol 37 (Supplement) ◽  
pp. S232
Author(s):  
Jennifer L. Wirch ◽  
Larry A. Wolfe ◽  
Tracey L. Weissgerber ◽  
Gregory A. L. Davies
Keyword(s):  
Autonomic Function ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cardiac Autonomic Function ◽  
Test Protocol ◽  
Pressor Test

Comparison of heart rate measurement protocols used during autonomic function tests

1981 ◽  
Vol 51 (2) ◽  
pp. 516-519 ◽  
Author(s):  
W. B. Baun ◽  
A. Jackson ◽  
R. W. Patton ◽  
P. B. Raven
Keyword(s):  
Heart Rate ◽  
Autonomic Function ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Primary Concern ◽  
Time Intervals ◽  
Pressor Test ◽  
Autonomic Changes ◽  
Hand Test ◽  
Averaging Time

The five most used cold pressor test heart rate protocols were compared to the true R-R interval responses recorded during a cold hand test. Forty-one nonsmoking male volunteers between 18 and 55 yr were given a cold hand pressor test. Heart rate was evaluated by averaging the R-R interval within 2-, 5-, 6-, 10-, and 30-s time intervals and by the true R-R interval measurement. No significant physiological differences existed at rest; however, during stress the maximum values obtained were successively diminished the greater the time utilized to average the heart rate pressure (P less than 0.05). During recovery an underestimation of the true response was observed that increased as the averaging time increased (P less than 0.05). Comparison between the R-R interval measure and the 6-s average data indicated a 18% decrease in the time of peak response. Therefore, the responses recorded with the 6-s averaged data were less sensitive and obscured the rapidity of autonomic changes. Hence, when sensitivity and absolute response are a primary concern in determining autonomic function, measurements should include R-R interval measures of heart rate or the average of the number of R-R intervals in 2-s time blocks.

Development Of A Cold Pressor Test Protocol To Evaluate Cardiac Autonomic Function

2005 ◽  
Vol 37 (Supplement) ◽  
pp. S232
Author(s):  
Jennifer L. Wirch ◽  
Larry A. Wolfe ◽  
Tracey L. Weissgerber ◽  
Gregory A. L. Davies
Keyword(s):  
Autonomic Function ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cardiac Autonomic Function ◽  
Test Protocol ◽  
Pressor Test

Defective Reflex Control of Heart Rate in Dialysis Patients: Evidence for an Afferent Autonomic Lesion

1982 ◽  
Vol 63 (3) ◽  
pp. 285-292 ◽  
Author(s):  
C. Zoccali ◽  
M. Ciccarelli ◽  
Q. Maggiore
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Autonomic Function ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Valsalva Manoeuvre ◽  
Dialysis Patients ◽  
Pressor Test ◽  
Reflex Control ◽  
Deep Breathing Test

1. To localize the site of autonomic abnormality in patients undergoing haemodialysis, tests of overall autonomic function based on either changes in blood pressure (posture, sustained handgrip) or heart rate (Valsalva manoeuvre, 30:15 ratio, deep breathing test) were used. Integrity of the sympathetic efferent arc was examined by using the cold pressor test and the parasympathetic efferent arc by the atropine test. Eighteen patients and 12 control subjects were studied. 2. Changes in blood pressure on standing, sustained handgrip and in the cold pressor test were the same in the two groups. 3. In contrast, 11 patients had abnormal results in at least two of the three heart-rate-based tests. 4. Three of the 11 dialysis patients with evidence of autonomic involvement showed abnormal responses to atropine, indicating an efferent parasympathetic lesion, whereas the majority had a normal response to the atropine test, suggesting an afferent lesion only. 5. Evidence of autonomic involvement was not associated with hypertension nor confined to patients with dialysis hypotension.

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