Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
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The Relationship between Heart Rate Variability and Symptoms in Subjects with Chronic Posttraumatic Stress Disorder

만성 외상 후 스트레스 장애 환자에서 심박변이도와 증상과의 상관관계 : 외상증상과 심박변이도 관계

  • Park, Jinsoo (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Kang, Sukhoon (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Park, Joo Eon (Department of Psychiatry, Keyo Hospital) ;
  • Choi, Jin Hee (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • So, Hyung Seok (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Kim, Kiwon (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Choi, Hayun (Department of Psychiatry, Veteran Health Service Medical Center)
  • 박진수 (한국보훈복지의료공단 중앙보훈병원) ;
  • 강석훈 (한국보훈복지의료공단 중앙보훈병원) ;
  • 박주언 (의료법인 계요의료재단 계요병원) ;
  • 최진희 (한국보훈복지의료공단 중앙보훈병원) ;
  • 소형석 (한국보훈복지의료공단 중앙보훈병원) ;
  • 김기원 (한국보훈복지의료공단 중앙보훈병원) ;
  • 최하연 (한국보훈복지의료공단 중앙보훈병원)
  • Received : 2020.03.24
  • Accepted : 2020.10.13
  • Published : 2020.10.30
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Abstract

Objective : Heart rate variability (HRV) is known to reflect autonomic nervous system activity. Individuals with posttraumatic stress disorder (PTSD) are reported to have lower HRVs. We attempted to find HRV indices with head up tilt position that reflect the symptoms well in order to evaluate PTSD symptoms. Methods : Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. HRV was measured in the head-up tilt position. We collected data regarding heart rate (HR), standard deviation of the NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), log low-frequency (LNLF) and log high-frequency (LNHF). Results : The value of LNHF was different according to presence or absence of PTSD after head-up tilt position. In the findings of the association between PTSD symptoms and HRV indices as based on head-up tilt, LNHF had a significant correlation with the total score of PCL-5. Conclusion : The reduction of the high-frequency component of HRVs in the PTSD group might reflect more PTSD symptoms.

Keywords

References

  1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic Stress Disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:1048-1060. https://doi.org/10.1001/archpsyc.1995.03950240066012
  2. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study: Brunner/Mazel;1990.
  3. Chung M, Suh I, Jeong I, Kim D, Min K. The prevalence and the analysis of variables in veterans with posttraumatic stress disorder. J Korean Assoc Soc Psychiatry 2002;7:93-102.
  4. Morrison FG, Ressler KJ. From the neurobiology of extinction to improved clinical treatments. Depress Anxiety 2014;31:279-290. https://doi.org/10.1002/da.22214
  5. Benedek DM. Posttraumatic stress disorder from Vietnam to today: the evolution of understanding during Eugene Brody's tenure at the journal of nervous and mental disease. J Nerv Ment Dis 2011;199:544-552. https://doi.org/10.1097/NMD.0b013e318225f0e9
  6. Blechert J, Michael T, Grossman P, Lajtman M, Wilhelm FH. Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder. Psychosom Med 2007;69:935-943. https://doi.org/10.1097/PSY.0b013e31815a8f6b
  7. Dennis PA, Watkins L, Calhoun PS, Oddone A, Sherwood A, Dennis MF, et al. Posttraumatic stress, heart-rate variability, and the mediating role of behavioral health risks. Psychosom Med 2014;76:629. https://doi.org/10.1097/PSY.0000000000000110
  8. Tucker P, Pfefferbaum B, Jeon-Slaughter H, Khan Q, Garton T. Emotional stress and heart rate variability measures associated with cardiovascular risk in relocated Katrina survivors. Psychosom Med 2012;74:160-168. https://doi.org/10.1097/PSY.0b013e318240a801
  9. Shah AJ, Lampert R, Goldberg J, Veledar E, Bremner JD, Vaccarino V. Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biol Psychiatry 2013;73:1103-1110. https://doi.org/10.1016/j.biopsych.2013.01.019
  10. Agorastos A, Boel JA, Heppner PS, Hager T, Moeller-Bertram T, Haji U, et al. Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder. Stress 2013;16:300-310. https://doi.org/10.3109/10253890.2012.751369
  11. Cohen H, Benjamin J, Geva AB, Matar MA, Kaplan Z, Kotler M. Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res 2000;96:1-13. https://doi.org/10.1016/S0165-1781(00)00195-5
  12. Hauschildt M, Peters MJ, Moritz S, Jelinek L. Heart rate variability in response to affective scenes in posttraumatic stress disorder. Biol Psychol 2011;88:215-222. https://doi.org/10.1016/j.biopsycho.2011.08.004
  13. Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, et al. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996;17:354-381. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
  14. Kenny RA, Bayliss J, Ingram A, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986;327:1352-1355. https://doi.org/10.1016/S0140-6736(86)91665-X
  15. Fonkoue IT, Norrholm SD, Marvar PJ, Li Y, Kankam ML, Rothbaum BO, et al. Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2018;315:R1272-R1280. https://doi.org/10.1152/ajpregu.00173.2018
  16. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5(R)): American Psychiatric Pub 2013.
  17. Montano N, Ruscone TG, Porta A, Lombardi F, Pagani M, Malliani A. Power spectrum analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt. Circulation 1994;90:1826-1831. https://doi.org/10.1161/01.CIR.90.4.1826
  18. Heathers JA. Everything hertz: methodological issues in short-term frequency-domain HRV. Front Physiol 2014;5:177. https://doi.org/10.3389/fphys.2014.00177
  19. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress 2015;28:489-498. https://doi.org/10.1002/jts.22059
  20. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The ptsd checklist for dsm-5 (PCL-5). Scale available from the National Center for PTSD at www. ptsd.va.gov 2013.
  21. Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio 1996;78:490-498.
  22. Yook S, Kim Z. A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean J Clin Psychol 1997;16:185-197.
  23. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  24. Guedon-Moreau L, Ducrocq F, Molenda S, Duhem S, Salleron J, Chaudieu I, et al. Temporal analysis of heart rate variability as a predictor of post traumatic stress disorder in road traffic accidents survivors. J Psychiatr Res 2012;46:790-796. https://doi.org/10.1016/j.jpsychires.2012.02.006
  25. Wang Y, Zhao X, O'Neil A, Turner A, Liu X, Berk M. Altered cardiac autonomic nervous function in depression. BMC Psychiatry 2013;13:187. https://doi.org/10.1186/1471-244X-13-187
  26. Lee EAD, Theus SA. Lower heart rate variability associated with military sexual trauma rape and posttraumatic stress disorder. Biol Res Nurs 2012;14:412-418. https://doi.org/10.1177/1099800412454453
  27. Cohen H, Kotler M, Matar MA, Kaplan Z, Miodownik H, Cassuto Y. Power spectral analysis of heart rate variability in posttraumatic stress disorder patients. Biol Psychiatry 1997;41:627-629. https://doi.org/10.1016/S0006-3223(96)00525-2
  28. Cohen H, Kotler M, Matar MA, Kaplan Z, Loewenthal U, Miodownik H, et al. Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biol Psychiatry 1998;44:1054-1059. https://doi.org/10.1016/S0006-3223(97)00475-7
  29. Allen B, Jennings JR, Gianaros PJ, Thayer JF, Manuck SB. Resting high-frequency heart rate variability is related to resting brain perfusion. Psychophysiology 2015;52:277-287. https://doi.org/10.1111/psyp.12321
  30. Dishman RK, Nakamura Y, Garcia ME, Thompson RW, Dunn AL, Blair SN. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Int J Psychophysiol 2000;37:121-133. https://doi.org/10.1016/S0167-8760(00)00085-4
  31. Minassian A, Geyer MA, Baker DG, Nievergelt CM, O'Connor DT, Risbrough VB, et al. Heart rate variability characteristics in a large group of active-duty marines and relationship to posttraumatic stress. Psychosom Med 2014;76:292. https://doi.org/10.1097/PSY.0000000000000056
  32. Reyes del Paso GA, Langewitz W, Mulder LJ, Van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 2013;50:477-487. https://doi.org/10.1111/psyp.12027
  33. Arnold AC, Raj SR. Orthostatic hypotension: a practical approach to investigation and management. Can J Cardiol 2017;33:1725-1728. https://doi.org/10.1016/j.cjca.2017.05.007
  34. Lee H, Kim HA. Orthostatic hypertension: an underestimated cause of orthostatic intolerance. Clin Neurophysiol 2016;127:2102-2107. https://doi.org/10.1016/j.clinph.2015.12.017
  35. Moon E, Lee SH, Kim DH, Hwang B. Comparative study of heart rate variability in patients with schizophrenia, bipolar disorder, posttraumatic stress disorder, or major depressive disorder. Clin Psychopharmacol Neurosci 2013;11:137. https://doi.org/10.9758/cpn.2013.11.3.137
  36. Fonkoue IT, Marvar PJ, Norrholm S, Li Y, Kankam ML, Jones TN, et al. Symptom severity impacts sympathetic dysregulation and inflammation in post-traumatic stress disorder (PTSD). Brain Behav Immun 2020;83:260-269. https://doi.org/10.1016/j.bbi.2019.10.021
  37. Eckberg DL. Sympathovagal balance: a critical appraisal. Circulation 1997;96:3224-3232. https://doi.org/10.1161/01.CIR.96.9.3224
  38. D'Souza JM, Wardle M, Green CE, Lane SD, Schmitz JM, Vujanovic AA. Resting heart rate variability: Exploring associations with symptom severity in adults with substance use disorders and posttraumatic stress. J Dual Diagn 2019;15:2-7. https://doi.org/10.1080/15504263.2018.1526431
  39. Green KT, Dennis PA, Neal LC, Hobkirk AL, Hicks TA, Watkins LL, et al. Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability. J Psychosom Res 2016;82:31-34. https://doi.org/10.1016/j.jpsychores.2016.01.003
  40. Etkin A, Wager TD. Functional neuroimaging of anxiety: a metaanalysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry 2007;164:1476-1488. https://doi.org/10.1176/appi.ajp.2007.07030504
  41. Resstel L, Fernandes K, Correa F. Medial prefrontal cortex modulation of the baroreflex parasympathetic component in the rat. Brain Res 2004;1015:136-144. https://doi.org/10.1016/j.brainres.2004.04.065
  42. Thayer JF, Ahs F, Fredrikson M, Sollers III JJ, Wager TD. A metaanalysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 2012;36:747-756. https://doi.org/10.1016/j.neubiorev.2011.11.009
  43. Bourla A, Mouchabac S, El Hage W, Ferreri F. e-PTSD: an overview on how new technologies can improve prediction and assessment of Posttraumatic Stress Disorder (PTSD). Eur J Psychotraumatol 2018;9(supp1):1424448. https://doi.org/10.1080/20008198.2018.1424448
  44. Tan G, Dao TK, Farmer L, Sutherland RJ, Gevirtz R. Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study. Appl Psychophysiol Biofeedback 2011;36:27-35. https://doi.org/10.1007/s10484-010-9141-y