http://apsychoserver.psych.arizona.edu/JJBAReprints/PSYC501A/Readings/PorgesBioPsychology_2007.pdf

The polyvagal perspective

Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anat...

Pathophysiology of Sleep Apnea

The study of individual differences in emotional responding can provide considerable insight into interpersonal dynamics and the etiology of psychopathology. Heart rate variability (HRV) analysis is emerging as an objective measure of regulated emotional responding (generating emotional responses of appropriate timing and magnitude). This review provides a theoretical and empirical rationale for the use of HRV as an index of individual differences in regulated emotional responding. Two major theoretical frameworks that articulate the role of HRV in emotional responding are presented, and relevant empirical literature is reviewed. The case is made that HRV is an accessible research tool that can increase the understanding of emotion in social and psychopathological processes.

http://tir-training.de/wp-content/uploads/2015/09/Bradley-Appelhans-Luecken-HRV_emotional-regulation.pdf

Heart Rate Variability as an Index of Regulated Emotional Responding

The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009)

/pdf/the-japanese-society-of-hypertension-guidelines-for-the-ruw2o2jwbh.pdf

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61622-0.pdf

Obstructive sleep apnoea and its cardiovascular consequences

Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm?

Background The primary mechanisms of respiratory sinus arrhythmia (RSA) are understood to be the modulation of cardiac vagal efferent activity by the central respiratory drive and the lung inflation reflex, and the degree of RSA increases with cardiac vagal activity. However, it is unclear whether RSA serves an active physiological role or merely reflects a passive cardiovascular response to respiratory input. We hypothesized that RSA benefits pulmonary gas exchange by matching perfusion to ventilation within each respiratory cycle. Methods and Results In seven anesthetized dogs, a model simulating RSA was made. After elimination of endogenous autonomic activities, respiration-linked heartbeat fluctuations were generated by electrical stimulation of the right cervical vagus during negative pressure ventilation produced by phrenic nerve stimulation (diaphragm pacing). The vagal stimulation was performed in three conditions: phasic stimulation during expiration (artificial RSA) and during inspiration (inver...

Respiratory Sinus Arrhythmia A Phenomenon Improving Pulmonary Gas Exchange and Circulatory Efficiency

https://journal.chestnet.org/article/S0012-3692(16)35771-3/pdf

Cardiac Hypertrophy in Obstructive Sleep Apnea Syndrome

A hypothesis is presented that explains the physiological reasons why the magnitude of respiratory sinus arrhythmia (RSA) appears to correlate with cardiac vagal tone The hypothesis is that RSA is an intrinsic resting function of the cardiopulmonary system Although RSA is mediated by respiratory modulation of cardiac vagal outflow and its magnitude is used as an index of cardiac vagal activity, RSA itself reflects cardiorespiratory interaction RSA is universally observed among vertebrates throughout the evolution, suggesting that it may bear an intrinsic physiological role Recent studies have shown that RSA improves pulmonary gas exchange efficiency by matching alveolar ventilation and capillary perfusion throughout respiration cycle This suggests that in resting animals and humans, RSA could save cardiac and respiratory energy by suppressing unnecessary heartbeats during expiration and ineffective ventilation during waning phases of perfusion Furthermore, evidence is accumulating for possible dissociation between the magnitude of RSA and vagal control of heart rate, suggesting separated and independent regulations for respiratory modulation of cardiac vagal outflow from those for cardiac vagal tone By our hypothesis, the apparent associations between RSA and cardiac vagal tone are explained as indirect consequences; ie, whenever the cardiac vagal tone changes in response to the resting level of the cardiopulmonary system, RSA appears to change parallel to it Our hypothesis seems more consistent with both physiological and clinical evidence about RSA than that presuming RSA is an index of cardiac vagal activity

Hypothesis: respiratory sinus arrhythmia is an intrinsic resting function of cardiopulmonary system

Individuals with obstructive sleep apnea syndrome (OSAS) are at high risk for cardiovascular morbidity and mortality. The effects of OSAS severity and nocturnal continuous positive airway pressure (CPAP) on daytime baroreflex sensitivity (BRS) and nitric oxide (NO) production were investigated in OSAS patients. Fifty-one consecutive males with OSAS and 29 age-matched healthy men underwent the Valsalva test and standard polysomnography. Patients with an apnea-hypopnea index (AHI) of >or=20 episodes per hour were randomized to receive CPAP treatment for 3 months (n=14) or no such treatment (n=19). The BRS index measured from the overshoot phase (phase IV) of the Valsalva maneuver and plasma NO concentration were significantly lower, whereas the AHI, oxygen desaturation time, arousal index, percentage of sleep stage 1, and systolic blood pressure were significantly greater, in patients with an AHI of >or=20/h than in those with an AHI of <20/h or in controls. The 24-h urinary excretion of norepinephrine was significantly reduced and the plasma NO concentration was significantly increased after one night of CPAP. The BRS index for phase IV and the Valsalva ratio were significantly increased in the CPAP group after the 3-month treatment period but remained unchanged in the non-CPAP group of OSAS patients. The daytime BRS index and NO production were thus inversely related to the severity of OSAS, and successful CPAP treatment improved these parameters in patients with moderate to severe OSAS. CPAP may therefore reduce the risk of cardiovascular complications due to endothelial dysfunction or increased sympathetic activity.

/pdf/continuous-positive-airway-pressure-improves-daytime-ukfenh1fq1.pdf

Continuous Positive Airway Pressure Improves Daytime Baroreflex Sensitivity and Nitric Oxide Production in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome

Fumihiko Yasuma

Papers

Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm?

Respiratory Sinus Arrhythmia A Phenomenon Improving Pulmonary Gas Exchange and Circulatory Efficiency

Cardiac Hypertrophy in Obstructive Sleep Apnea Syndrome

Hypothesis: respiratory sinus arrhythmia is an intrinsic resting function of cardiopulmonary system

Continuous Positive Airway Pressure Improves Daytime Baroreflex Sensitivity and Nitric Oxide Production in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome