European Journal of Applied Physiology

, Volume 115, Issue 3, pp 521–530 | Cite as

Respiratory sinus arrhythmia stabilizes mean arterial blood pressure at high-frequency interval in healthy humans

  • Maja Elstad
  • Lars Walløe
  • Nathalie L. A. Holme
  • Elke Maes
  • Marianne Thoresen
Original Article

Abstract

Purpose

Arterial blood pressure variations are an independent risk factor for end organ failure. Respiratory sinus arrhythmia (RSA) is a sign of a healthy cardiovascular system. However, whether RSA counteracts arterial blood pressure variations during the respiratory cycle remains controversial. We restricted normal RSA with non-invasive intermittent positive pressure ventilation (IPPV) to test the hypothesis that RSA normally functions to stabilize mean arterial blood pressure.

Methods

Ten young volunteers were investigated during metronome-paced breathing and IPPV. Heart rate (ECG), mean arterial blood pressure and left stroke volume (finger arterial pressure curve) and right stroke volume (pulsed ultrasound Doppler) were recorded, while systemic and pulmonary blood flow were calculated beat-by-beat. Respiratory variations (high-frequency power, 0.15–0.40 Hz) in cardiovascular variables were estimated by spectral analysis. Phase angles and correlation were calculated by cross-spectral analysis.

Results

The magnitude of RSA was reduced from 4.9 bpm2 (95 % CI 3.0, 6.2) during metronome breathing to 2.8 bpm2 (95 % CI 1.1, 5.0) during IPPV (p = 0.03). Variations in mean arterial blood pressure were greater (2.3 mmHg2 (95 % CI 1.4, 3.9) during IPPV than during metronome breathing (1.0 mmHg2 [95 % CI 0.7, 1.3]) (p = 0.014). Respiratory variations in right and left stroke volumes were inversely related in the respiratory cycle during both metronome breathing and IPPV.

Conclusions

RSA magnitude is lower and mean arterial blood pressure variability is greater during IPPV than during metronome breathing. We conclude that in healthy humans, RSA stabilizes mean arterial blood pressure at respiratory frequency.

Keywords

Heart rate variability Cardiac stroke volume Spectral analysis Blood pressure variability Intermittent positive pressure ventilation 

Abbreviations

CO

Cardiac output

HR

Heart rate measured from ECG

IPPV

Intermittent positive pressure ventilation

L-CO

Cardiac output from the left cardiac ventricle

L-SV

Stroke volume from the left cardiac ventricle, estimated from blood pressure wave

MAP

Mean arterial blood pressure

R-CO

Cardiac output from the right cardiac ventricle

RE, RESP

Respiration

RSA

Respiratory sinus arrhythmia

R-SL

Stroke length from the pulmonary artery

R-SV

Stroke volume from the right cardiac ventricle, estimated from ultrasound Doppler

SV

Stroke volume

Notes

Acknowledgments

We are grateful for the technical assistance from Torun Flatebø and Thomas R. Wood. Maja Elstad is financed by the Norwegian Research Council. The present study also received funding from S. G. Sønneland Foundation, Oslo.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Ben-Tal A, Shamailov SS, Paton JF (2014) Central regulation of heart rate and the appearance of respiratory sinus arrhythmia: New insights from mathematical modeling. Math Biosci. doi:10.1016/j.mbs.2014.06.015 PubMedGoogle Scholar
  2. Ben-Tal A, Shamailov SS, Paton JF (2012) Evaluating the physiological significance of respiratory sinus arrhythmia: looking beyond ventilation-perfusion efficiency. J Physiol (Lond) 590(Pt 8):1989–2008CrossRefGoogle Scholar
  3. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC (1993) The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 88(3):927–934CrossRefPubMedGoogle Scholar
  4. Bogert LWJ, van Lieshout JJ (2005) Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger. Exp Physiol 90(4):437–446CrossRefPubMedGoogle Scholar
  5. Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL (1999) Human responses to upright tilt: a window on central autonomic integration. J Physiol (Lond) 517(Pt 2):617–628CrossRefPubMedCentralGoogle Scholar
  6. Cooper HE, Clutton-Brock TH, Parkes MJ (2004) Contribution of the respiratory rhythm to sinus arrhythmia in normal unanesthetized subjects during positive-pressure mechanical hyperventilation. AJP Heart Circ Physiol 286(1):H402–H411CrossRefGoogle Scholar
  7. Eckberg DL, Karemaker JM (2009) Point counterpoint: respiratory sinus arrhythmia is due to a central mechanism vs. respiratory sinus arrhythmia is due to the baroreflex mechanism. J Appl Physiol 106(5):1740–1750CrossRefPubMedGoogle Scholar
  8. Elstad M (2012) Respiratory variations in pulmonary and systemic blood flow in healthy humans. Acta Physiol (Oxf) 205(3):341–348CrossRefGoogle Scholar
  9. Elstad M, Toska K, Chon KH, Raeder EA, Cohen RJ (2001) Respiratory sinus arrhythmia: opposite effects on systolic and mean arterial pressure in supine humans. J Physiol (Lond) 536(Pt 1):251–259CrossRefGoogle Scholar
  10. Freyschuss U, Melcher A (1975) Sinus arrhythmia in man: influence of tidal volume and oesophageal pressure. Scand J Clin Lab Invest 35(6):487–496CrossRefPubMedGoogle Scholar
  11. Freyschuss U, Melcher A (1976) Respiratory sinus arrhythmia in man: relation to right ventricular output. Scand J Clin Lab Invest 36(5):407–414CrossRefPubMedGoogle Scholar
  12. Garcia AJ 3rd, Koschnitzky JE, Dashevskiy T, Ramirez JM (2013) Cardiorespiratory coupling in health and disease. Auton Neurosci Basic Clin 175(1–2):26–37CrossRefGoogle Scholar
  13. Guz A, Innes JA, Murphy K (1987) Respiratory modulation of left ventricular stroke volume in man measured using pulsed Doppler ultrasound. J Physiol 393:499–512CrossRefPubMedCentralPubMedGoogle Scholar
  14. Hatle L, Angelsen BrAJ (1982) Doppler ultrasound in cardiology: physical principles and clinical applications. Lea and Febiger, PhiladelphiaGoogle Scholar
  15. Hayano J, Yasuma F, Okada A, Mukai S, Fujinami T (1996) Respiratory sinus arrhythmia. A phenomenon improving pulmonary gas exchange and circulatory efficiency. Circulation 94(4):842–847CrossRefPubMedGoogle Scholar
  16. Hoffman JIE, Guz A, Charlier AA, Wilcken DEL (1965) Stroke volume in conscious dogs; effect of respiration, posture, and vascular occlusion. J Appl Physiol 20(5):865–877PubMedGoogle Scholar
  17. Hollander M, Wolfe DA (1999) Nonparametric statistical methods. Wiley, New York, NYGoogle Scholar
  18. Lahiri MK, Kannankeril PJ, Goldberger JJ (2008) Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 51(18):1725–1733CrossRefPubMedGoogle Scholar
  19. Larsen PD, Trent EL, Galletly DC (1999) Cardioventilatory coupling: effects of IPPV. Br J Anaesth 82(4):546–550CrossRefPubMedGoogle Scholar
  20. Lopes TC, Beda A, Granja-Filho PC, Jandre FC, Giannella-Neto A (2011) Cardio-respiratory interactions and relocation of heartbeats within the respiratory cycle during spontaneous and paced breathing. Physiol Meas 32(9):1389–1401CrossRefPubMedGoogle Scholar
  21. Mardia KV (1972) Statistics of directional data. Probability and mathematical statistics. Academic Press Inc. (London) Ltd, LondonGoogle Scholar
  22. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JMM, Fox KAA (1998) Prospective study of heart rate variability and mortality in chronic heart failure : results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart). Circulation 98(15):1510–1516CrossRefPubMedGoogle Scholar
  23. Olsen CO, Tyson GS, Maier GW, Davis JW, Rankin JS (1985) Diminished stroke volume during inspiration: a reverse thoracic pump. Circulation 72(3):668–679CrossRefPubMedGoogle Scholar
  24. Parati G, Mancia G, Di Rienzo M, Castiglioni P, Taylor JA, Studinger P (2006) Point: cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol 101(2):676–682CrossRefPubMedGoogle Scholar
  25. Peters J, Fraser C, Stuart RS, Baumgartner W, Robotham JL (1989) Negative intrathoracic pressure decreases independently left ventricular filling and emptying. Am J Phyiol Heart Circ Physiol 257(1):H120–H131Google Scholar
  26. Robotham JL, Rabson J, Permutt S, Bromberger-Barnea B (1979) Left ventricular hemodynamics during respiration. J Appl Physiol 47(6):1295–1303PubMedGoogle Scholar
  27. Santamore WP, Amoore JN (1994) Buffering of respiratory variations in venous return by right ventricle: a theoretical analysis. Am J Physiol 267(6 Pt 2):H2163–H2170PubMedGoogle Scholar
  28. Sasano N, Vesely AE, Hayano J, Sasano H, Somogyi R, Preiss D, Miyasaka K, Katsuya H, Iscoe S, Fisher JA (2002) Direct effect of Pa-CO2 on respiratory sinus arrhythmia in conscious humans. Am J Physiol Heart Circ Physiol 282(3):H973–H976PubMedGoogle Scholar
  29. Saul JP, Berger RD, Chen MH, Cohen RJ (1989) Transfer function analysis of autonomic regulation. II. Respiratory sinus arrhythmia. Am J Physiol Heart Circ Physiol 256(1 Pt 2):H153–H161Google Scholar
  30. Saul JP, Cohen RJ, Levy MN, Schwartz PJ (1994) Respiratory sinus arrhythmia. In: Vagal control of the heart: experimental basis and clinical implications. Futura Publishing Co. Inc., Armonk, pp 511–536Google Scholar
  31. Schafer A, Vagedes J (2013) How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. Int J Cardiol 166(1):15–29CrossRefPubMedGoogle Scholar
  32. Sin PYW, Webber MR, Galletly DC, Ainslie PN, Brown SJ, Willie CK, Sasse A, Larsen PD, Tzeng YC (2010) Interactions between heart rate variability and pulmonary gas exchange efficiency in humans. Exp Physiol 95(7):788–797CrossRefPubMedGoogle Scholar
  33. Tan CO, Taylor JA (2010) Does respiratory sinus arrhythmia serve a buffering role for diastolic pressure fluctuations? Am J Physiol Heart Circ Physiol 298(5):H1492–H1498CrossRefPubMedCentralPubMedGoogle Scholar
  34. Task Force of the European Society of C, the North American Society of Pacing E (1996) Heart rate variability : Standards of measurement, physiological interpretation, and clinical use. Circulation 93(5):1043–1065CrossRefGoogle Scholar
  35. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G, Schillaci G, De Caterina R (2007) Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension 50(2):325–332CrossRefPubMedGoogle Scholar
  36. Taylor JA, Eckberg DL (1996) Fundamental relations between short-term RR interval and arterial pressure oscillations in humans. Circulation 93(8):1527–1532CrossRefPubMedGoogle Scholar
  37. Toska K, Eriksen M (1993) Respiration-synchronous fluctuations in stroke volume, heart rate and arterial pressure in humans. J Physiol (Lond) 472:501–512CrossRefGoogle Scholar
  38. Triedman JK, Saul JP (1994) Blood pressure modulation by central venous pressure and respiration: buffering effects of the heart rate reflexes. Circulation 89:169–179CrossRefPubMedGoogle Scholar
  39. Tzeng YC, Sin PYW, Galletly DC (2009) Human sinus arrhythmia: inconsistencies of a teleological hypothesis. Am J Physiol Heart Circ Physiol 296(1):H65–H70CrossRefPubMedGoogle Scholar
  40. Van Lieshout JJ, Toska K, van Lieshout EJ, Eriksen M, Walloe L, Wesseling KH (2003) Beat-to-beat noninvasive stroke volume from arterial pressure and Doppler ultrasound. Eur J Appl Physiol 90(1–2):131–137CrossRefPubMedGoogle Scholar
  41. Yli-Hankala A, Porkkala T, Kaukinen S, Hakkinen V, Jantti V (1991) Respiratory sinus arrhythmia is reversed during positive pressure ventilation. Acta Physiol Scand 141(3):399–407CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Maja Elstad
    • 1
  • Lars Walløe
    • 1
  • Nathalie L. A. Holme
    • 1
  • Elke Maes
    • 1
  • Marianne Thoresen
    • 1
  1. 1.Department of Physiology, Institute of Basic Medical SciencesUniversity of OsloOsloNorway

Personalised recommendations