Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
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A Preliminary Study on the Circadian Rhythm of Autonomic Nervous System in Patients Admitted to Intensive Care Unit, Using the Heart Rate Variability

심박변이도를 이용한 중환자실 입원 환자의 자율신경계 일중변동성에 대한 예비연구

  • Oh, Jooyoung (Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology) ;
  • Cho, Dongrae (Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology) ;
  • Kim, Jongin (Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology) ;
  • Park, Jaesub (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Heo, Jaeseok (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Kim, Jae-Jin (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Na, Se Hee (Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Shin, Cheung Soo (Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Boreom (Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology) ;
  • Park, Jin Young (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine)
  • 오주영 (광주과학기술원 융합기술원 의생명공학과) ;
  • 조동래 (광주과학기술원 융합기술원 의생명공학과) ;
  • 김종인 (광주과학기술원 융합기술원 의생명공학과) ;
  • 박재섭 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 허재석 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 김재진 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 라세희 (연세대학교 의과대학 강남세브란스병원 마취통증의학교실) ;
  • 신증수 (연세대학교 의과대학 강남세브란스병원 마취통증의학교실) ;
  • 이보름 (광주과학기술원 융합기술원 의생명공학과) ;
  • 박진영 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소)
  • Received : 2016.11.01
  • Accepted : 2016.12.22
  • Published : 2017.02.28
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Abstract

Objectives A normal circadian rhythm of autonomic nervous system function stands for the daily change of sympathetic and parasympathetic modulation, which can be measured by heart rate variability (HRV). Generally, patients in the intensive care unit (ICU) are prone to sleep-wake cycle dysregulation, therefore, it may have an influence on the circadian rhythm of autonomic nervous system. This study was designed to interpret possible dysregulation of autonomic nervous system in ICU patients by using HRV. Methods HRV was assessed every 3 hours in 21 ICU patients during a 7-minute period. The statistical differences of HRV features between the morning (AM 6 : 00-PM 12 : 00), and the afternoon (PM 12 : 00-PM 18 : 00) periods were evaluated in time domain and frequency domain. Results Patients showed significantly increased normalized power of low frequencey (nLF), absolute power of low frequencey (LF)/absolute power of high frequencey (HF) in the afternoon period as compared to the morning period. However, normalized power of high frequency (nHF) was significantly decreased in the afternoon period. There was no statistically significant difference between the morning period and the afternoon period in the time domain analysis. Conclusions The increased sympathetic tone in the afternoon period supports possible dysregulation in the circadian rhythm of autonomic nervous system in ICU patients. Future studies can help to interpret the association between autonomic dysregulation and negative outcomes of ICU patients.

Keywords

References

  1. Stein PK, Lundequam EJ, Clauw D, Freedland KE, Carney RM, Domitrovich PP. Circadian and ultradian rhythms in cardiac autonomic modulation. Conf Proc IEEE Eng Med Biol Soc 2006;1:429-432.
  2. Robinson BF, Epstein SE, Beiser GD, Braunwald E. Control of heart rate by the autonomic nervous system. Studies in man on the interrelation between baroreceptor mechanisms and exercise. Circ Res 1966;19:400-411. https://doi.org/10.1161/01.RES.19.2.400
  3. Quintana DS, Guastella AJ, Outhred T, Hickie IB, Kemp AH. Heart rate variability is associated with emotion recognition: direct evidence for a relationship between the autonomic nervous system and social cognition. Int J Psychophysiol 2012;86:168-172. https://doi.org/10.1016/j.ijpsycho.2012.08.012
  4. Boudreau P, Dumont G, Kin NM, Walker CD, Boivin DB. Correlation of heart rate variability and circadian markers in humans. Conf Proc IEEE Eng Med Biol Soc 2011;2011:681-682.
  5. Malik M. Heart rate variability. Ann Noninvasive Electrocardiol 1996;1:151-181. https://doi.org/10.1111/j.1542-474X.1996.tb00275.x
  6. Boudreau P, Yeh WH, Dumont GA, Boivin DB. A circadian rhythm in heart rate variability contributes to the increased cardiac sympathovagal response to awakening in the morning. Chronobiol Int 2012;29:757-768. https://doi.org/10.3109/07420528.2012.674592
  7. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Crit Care Nurs Clin North Am 2012;24:201-213. https://doi.org/10.1016/j.ccell.2012.03.006
  8. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med 2012;27:97-111. https://doi.org/10.1177/0885066610394322
  9. Mistraletti G, Carloni E, Cigada M, Zambrelli E, Taverna M, Sabbatici G, et al. Sleep and delirium in the intensive care unit. Minerva Anestesiol 2008;74:329-333.
  10. Sohn JH, Na SH, Shin CS, Sohn I, Oh JY, An JS, et al. Impact of delirium on clinical outcomes in intensive care unit patients: an observational study in a Korean General Hospital. J Korean Neuropsychiatric Association 2014;53:418-425. https://doi.org/10.4306/jknpa.2014.53.6.418
  11. Haimovich B, Calvano J, Haimovich AD, Calvano SE, Coyle SM, Lowry SF. In vivo endotoxin synchronizes and suppresses clock gene expression in human peripheral blood leukocytes. Crit Care Med 2010;38:751-758. https://doi.org/10.1097/CCM.0b013e3181cd131c
  12. Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 2001;163:451-457. https://doi.org/10.1164/ajrccm.163.2.9912128
  13. Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000;117:809-818. https://doi.org/10.1378/chest.117.3.809
  14. Toublanc B, Rose D, Glerant JC, Francois G, Mayeux I, Rodenstein D, et al. Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients. Intensive Care Med 2007;33:1148-1154. https://doi.org/10.1007/s00134-007-0659-2
  15. Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 2009;35:796-809. https://doi.org/10.1007/s00134-009-1396-5
  16. Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et al. Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med 2002;30:746-752. https://doi.org/10.1097/00003246-200204000-00004
  17. Alexopoulou C, Kondili E, Vakouti E, Klimathianaki M, Prinianakis G, Georgopoulos D. Sleep during proportional-assist ventilation with load-adjustable gain factors in critically ill patients. Intensive Care Med 2007;33:1139-1147. https://doi.org/10.1007/s00134-007-0630-2
  18. Olofsson K, Alling C, Lundberg D, Malmros C. Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients. Acta Anaesthesiol Scand 2004;48:679-684. https://doi.org/10.1111/j.0001-5172.2004.00401.x
  19. Billings ME, Watson NF. Circadian dysrhythmias in the intensive care unit. Crit Care Clin 2015;31:393-402. https://doi.org/10.1016/j.ccc.2015.03.006
  20. Wieske L, Kiszer E, Verhamme C, Van Schaik IN, Schultz MJ, Horn J. Examination of the autonomic nervous system in the ICU: a pilot study. Crit Care 2012;16(Suppl 1):297. https://doi.org/10.1186/cc10904
  21. Dworschak M, Lorenzl N, Rapp HJ. Diminished circadian rhythm of heart rate variability after aortic surgery appears to be independent of myocardial ischemia. Jpn Heart J 2003;44:645-654. https://doi.org/10.1536/jhj.44.645
  22. Evans S, Seidman LC, Tsao JC, Lung KC, Zeltzer LK, Naliboff BD. Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children. J Pain Res 2013;6:449-457.
  23. Sztajzel J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 2004;134:514-522.
  24. Seifert G, Kanitz JL, Pretzer K, Henze G, Witt K, Reulecke S, et al. Improvement of circadian rhythm of heart rate variability by eurythmy therapy training. Evid Based Complement Alternat Med 2013;2013:564340.
  25. Bilan A, Witczak A, Palusinski R, Myslinski W, Hanzlik J. Circadian rhythm of spectral indices of heart rate variability in healthy subjects. J Electrocardiol 2005;38:239-243. https://doi.org/10.1016/j.jelectrocard.2005.01.012
  26. Chakko S, Mulingtapang RF, Huikuri HV, Kessler KM, Materson BJ, Myerburg RJ. Alterations in heart rate variability and its circadian rhythm in hypertensive patients with left ventricular hypertrophy free of coronary artery disease. Am Heart J 1993;126:1364-1372. https://doi.org/10.1016/0002-8703(93)90535-H
  27. Malik M, Camm AJ. Heart rate variability: from facts to fancies. J Am Coll Cardiol 1993;22:566-568. https://doi.org/10.1016/0735-1097(93)90065-9
  28. Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 1997;34:623-648. https://doi.org/10.1111/j.1469-8986.1997.tb02140.x
  29. Zhang LF, Wang SY, Niu YG. [Recent advances in multi-variate and multi-dimensional analysis of heart rate variability and blood pressure variability]. Space Med Med Eng (Beijing) 2002;15:157-162.
  30. Zaal IJ, van der Kooi AW, van Schelven LJ, Oey PL, Slooter AJ. Heart rate variability in intensive care unit patients with delirium. J Neuropsychiatry Clin Neurosci 2015;27:e112-e116. https://doi.org/10.1176/appi.neuropsych.13090213
  31. Billman GE. Heart rate variability-a historical perspective. Front Physiol 2011;2:86.
  32. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF. Sleep in the intensive care unit. Am J Respir Crit Care Med 2015;191:731-738. https://doi.org/10.1164/rccm.201411-2099CI
  33. Beltrami FG, Nguyen XL, Pichereau C, Maury E, Fleury B, Fagondes S. Sleep in the intensive care unit. J Bras Pneumol 2015;41:539-546. https://doi.org/10.1590/s1806-37562015000000056
  34. Hardin KA. Sleep in the ICU: potential mechanisms and clinical implications. Chest 2009;136:284-294. https://doi.org/10.1378/chest.08-1546
  35. Bellapart J, Boots R. Potential use of melatonin in sleep and delirium in the critically ill. Br J Anaesth 2012;108:572-580. https://doi.org/10.1093/bja/aes035
  36. Chan MC, Spieth PM, Quinn K, Parotto M, Zhang H, Slutsky AS. Circadian rhythms: from basic mechanisms to the intensive care unit. Crit Care Med 2012;40:246-253. https://doi.org/10.1097/CCM.0b013e31822f0abe
  37. Mendonca GV, Heffernan KS, Rossow L, Guerra M, Pereira FD, Fernhall B. Sex differences in linear and nonlinear heart rate variability during early recovery from supramaximal exercise. Appl Physiol Nutr Metab 2010;35:439-446. https://doi.org/10.1139/H10-028
  38. Tory K, Horvath E, Suveges Z, Fekete A, Sallay P, Berta K, et al. Effect of propranolol on heart rate variability in patients with end-stage renal disease: a double-blind, placebo-controlled, randomized crossover pilot trial. Clin Nephrol 2004;61:316-323. https://doi.org/10.5414/CNP61316
  39. Park SG, Chung BH, Lee SW, Park JK, Park K, Cheon J, et al. Alphablocker treatment response in men with lower urinary tract symptoms based on sympathetic activity: prospective, multicenter, openlabeled, observational study. Int Neurourol J 2015;19:107-112. https://doi.org/10.5213/inj.2015.19.2.107