Respiratory Modulation of Muscle Sympathetic Nerve Activity in Patients With Chronic Heart Failure

Goso, Yukiko; Asanoi, Hidetsugu; Ishise, Hisanari; Kameyama, Tomoki; Hirai, Tadakazu; Nozawa, Takashi; Takashima, Shutaro; Umeno, Ken; Inoue, Hiroshi

doi:10.1161/hc2901.093111

Cited by 109 publications

(96 citation statements)

References 41 publications

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“…It is believed that the lung inflation exerts a modulatory influence on central sympathetic neural outflow under resting conditions. 13,14 Some investigators also found that slow-breathing increases the baroreflex sensibility in hypertensives, normotensives 15 and also in patients with chronic heart failure, 16 what explains good results after 8 weeks of practice at home. Grossman et al 1 speculated that the repeated response to acute slow-and regular-breathing reverses the vascular pathology associated with hypertension, which is partially determined by the vascular tone, which is controlled by the sympathetic activity, and in this study, we observed that at least the peripheral sympathetic activity is reduced during slow-breathing exercises.…”

Section: Discussionmentioning

confidence: 98%

Sympathetic nerve activity is decreased during device-guided slow breathing

et al. 2010

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It is known that slow breathing (o10 breaths min -1 ) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n¼14) or while subjects listened to calm music (n¼13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16 ± 3 beats per minute (b.p.m) to 5.5 ± 1.8 b.p.m (Po0.05), calm music did not affect this variable. Both interventions reduced systolic (À6 and À4 mm Hg for both) and diastolic BPs (À4 mm Hg and À3 mm Hg, respectively) and did not affect the HR (À1 and À2 b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (À8 bursts min -1 ). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

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Section: Discussionmentioning

confidence: 98%

Sympathetic nerve activity is decreased during device-guided slow breathing

et al. 2010

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“…These include inhibition of sympathetic outflow during exhalation and arteriolar vasodilatation, [33][34][35][36] which may be of benefit to patients with hypertension and congestive heart failure. 37,38 This may not be the case in diabetic patients due to autonomic dysfunction. 39 Neuropathy, a common complication in diabetes, is caused by damage to the blood vessels that supply the nerve fibres and might be expected to reduce the benefit provided by the device.…”

Section: Discussionmentioning

confidence: 99%

Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

et al. 2008

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The objective of the study was to evaluate the efficacy of device-guided breathing to lower blood pressure (BP) in hypertensive type II diabetic patients. A randomized controlled trial was carried out in four urban family practice clinics in Israel. Non-insulin-dependent diabetic, hypertensive patients with uncontrolled BP, receiving antihypertensive therapy or those non-medicated were enrolled. Baseline characteristics of the 66 patients who completed the study (33 intervention and 33 control) were: 62% men, age 62±8 years (mean±s.d.); body mass index 29±5 kg/m 2 ; systolic BP 148±11 mm Hg and diastolic BP 81 ± 9 mm Hg. The intervention group used a device (RESPeRATE), which interactively guides the user towards slow and regular breathing by synchronizing respiration voluntarily to musical tones for 15 min daily for an 8-week period. The control group continued with their regular treatment. BP was measured in the clinic at baseline, after 4 weeks and at 8 weeks.Medication was unchanged for 4 weeks prior to and during the study period. The main outcome measure was the office BP change from baseline to the end of the 8-week period. BP was reduced in the treatment group (mean ± s.e.) systolic À10.0 ± 1.8 mm Hg and diastolic À3.6 ± 1.3 mm Hg (Po0.0001 and Po0.01), but not in the controls þ 1.6±2.1 and À1.0±1.4 mm Hg P40.4 and P40.4, respectively. Test for between group difference Po0.0001 and P ¼ 0.08. The subjects were highly compliant with the treatment, performing 75% of the requested exercise sessions. Greater BP reduction was observed with increased compliance with device usage (P ¼ 0.01 and P ¼ 0.001). It is concluded that self-treatment with device-guided breathing at home for 8 weeks by non-insulin-dependent diabetic patients was associated with a substantial reduction in office systolic BP.

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“…Respiration works to regulate properties of muscle contraction via the ANS [25]. In fact, breathing pattern, depth, and possibly starting lung volume all affect sympathetic nerve activity.…”

Section: Influence Of Respiratory Rhythm On the Autonomic Nervous Systemmentioning

confidence: 99%

“…In fact, breathing pattern, depth, and possibly starting lung volume all affect sympathetic nerve activity. Reciprocal actions on sympathetic tone occur during deep breathing with inspiration suppressing, and expiration enhancing this input [25]. Suppression of sympathetic input can be enhanced by increases in tidal volume during inspiration, suggesting that SAR mechanoreceptor loading can provide significant input into the regulation of sympathetic control during the resulting period of expiration [25,26].…”

Section: Influence Of Respiratory Rhythm On the Autonomic Nervous Systemmentioning

confidence: 99%

Widespread depolarization during expiration: A source of respiratory drive?

Jerath¹,

Crawford²,

Barnes

et al. 2015

Medical Hypotheses

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a b s t r a c tRespiration influences various pacemakers and rhythms of the body during inspiration and expiration but the underlying mechanisms are relatively unknown. Understanding this phenomenon is important, as breathing disorders, breath holding, and hyperventilation can lead to significant medical conditions. We discuss the physiological modulation of heart rhythm, blood pressure, sympathetic nerve activity, EEG, and other changes observed during inspiration and expiration. We also correlate the intracellular mitochondrial respiratory metabolic processes with real-time breathing and correlate membrane potential changes with inspiration and expiration. We propose that widespread minor hyperpolarization occurs during inspiration and widespread minor depolarization occurs during expiration. This depolarization is likely a source of respiratory drive. Further knowledge of intracellular and extracellular ionic changes associated with respiration will enhance our understanding of respiration and its role as a modulator of cellular membrane potential. This could expand treatment options for a wide range of health conditions, such as breathing disorders, stress-related disorders, and further our understanding of the Hering-Breuer reflex and respiratory sinus arrhythmia.Ó 2014 Elsevier Ltd. All rights reserved. IntroductionIn addition to gas exchange and oxygenation of the blood, respiration in the lungs can regulate multiple physiological processes throughout the body. Studies of the cardiovascular system, the peripheral nervous system, and the central nervous system provide evidence that respiratory patterns can exert a significant and immediate influence on a wide range of bodily functions, including changes in blood pressure and sympathovagal balance. Patterned respiration can regulate blood pressure and heart rate [1], as well as regulate rhythmic centers of the brain that control cardiovascular output [2,3]. While the majority of these findings have demonstrated the impact of respiration on cardiac output and other processes in isolated preparations, little work has focused on respiration's direct influence on membrane potential.This article reviews the current understanding of respiration as a regulator of cardiovascular physiology and nervous system function. More specifically, we discuss the role of respiratory rhythm and rate on both systemic and local control of these systems. We describe the role of pulmonary stretch receptors (with a focus on slowly adapting receptors) in converting breathing patterns into a functional, multi-faceted, mechanism that allows respiration to communicate with, and direct various aspects of cardiovascular and nervous system physiology. We propose a hypothesis in which inspiration and expiration are associated with transient increases and decreases in membrane potential that may underlie these widespread changes and how these membrane potential changes may underlie the chaotic dynamics of rhythmic breathing.Many studies focus on the brainstem as the primary modulator of resp...

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Respiratory Modulation of Muscle Sympathetic Nerve Activity in Patients With Chronic Heart Failure

Cited by 109 publications

References 41 publications

Sympathetic nerve activity is decreased during device-guided slow breathing

Sympathetic nerve activity is decreased during device-guided slow breathing

Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

Widespread depolarization during expiration: A source of respiratory drive?

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