Applied Psychophysiology and Biofeedback

, Volume 42, Issue 2, pp 97–105 | Cite as

Maladaptive Cardiac Autonomic Control during a Stress Reactivity Assessment Among Primary Care Patients with Metabolic Syndrome

  • Jonathan C. MitchellEmail author
  • Joyce Paulson
  • Maria Cannarozzi
  • Sandra M. Neer
  • Jeffrey E. Cassisi


Metabolic syndrome (MetS) comprises a constellation of metabolic abnormalities that substantially increase risk for chronic illnesses. Autonomic dysregulation is closely linked to MetS, and while pathophysiological models often address chronic stress exposure, none have examined how such physiological contributions operate situationally, in a clinical setting. We used ambulatory impedance cardiography to examine indicators of cardiac autonomic control (CAC) in a sample of 50 adult primary care patients with and without MetS. Indices of independent sympathetic and parasympathetic cardiovascular control in primary care outpatients were measured during a brief stress reactivity assessment. We compared interdependent CAC features, including cardiac autonomic balance (i.e., sympathovagal reciprocity) and cardiac autonomic regulation (i.e., sympathovagal coactivation) and found significant differences among MetS participants as compared to healthy controls. In particular, cardiac autonomic regulation scores were higher among MetS patients when discussing medication concerns, and cardiac autonomic balance scores were lower among MetS patients when discussing daily stressors. These results suggest that patients meeting criteria for MetS demonstrate momentary variations in CAC depending on personally relevant health topics. The potential for future research is discussed with a focus on prospective data collection to enhance diagnostic procedures and treatment monitoring.


Sympathovagal activity Cardiac autonomic balance Cardiac autonomic regulation Impedance cardiography 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Berntson, G. G., Cacioppo, J. T., & Quigley, K. S. (1993). Cardiac psychophysiology and autonomic space in humans: Empirical perspectives and conceptual implications. Psychological Bulletin, 114(2), 296–322.CrossRefPubMedGoogle Scholar
  2. Berntson, G. G., Cacioppo, J. T., Quigley, K. S., & Fabro, V. T. (1994). Autonomic space and psychophysiological response. Psychophysiology, 31(1), 44–61.CrossRefPubMedGoogle Scholar
  3. Berntson, G. G., Norman, G. J., Hawkley, L. C., & Cacioppo, J. T. (2008). Cardiac autonomic balance versus cardiac regulatory capacity. Psychophysiology, 45(4), 643–652.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Berntson, G. G., Quigley, K. S., & Lozano, D. (2007). Cardiovascular psychophysiology. In J. T. Cacioppo, L. G. Tassinary & G. G. Berntson (Eds.), Handbook of Psychophysiology (pp. 182–210). New York: Cambridge University Press.CrossRefGoogle Scholar
  5. Blascovich, J. J. (2008). Challenge, threat, and health. In J. Y. Shah & W. L. Gardner (Eds.), Handbook of motivational science (pp. 481–493). New York: Guilford Press.Google Scholar
  6. Blascovich, J. J., & Tomaka, J. (1996). The biopsychosocial model of arousal regulation. Advances in Experimental Social Psychology, 28(1), 1–51.CrossRefGoogle Scholar
  7. Canale, M. P., di Villahermosa, S. M., Martino, G., Rovella, V., Noce, A., … & Di Daniele, N. (2013). Obesity-related metabolic syndrome: Mechanisms of sympathetic overactivity. International Journal of Endocrinology, 2013(1), 1–12.CrossRefGoogle Scholar
  8. Carthy, E. R., White, L., Russell, F. D., Holmes, M., Leicht, A. S., … & Askew, C. D. (2015). Cardiovascular responsiveness to sympathoexcitatory stress in subjects with and without mild hypertension. Clinical Physiology and Functional Imaging, 35(2), 150–158.CrossRefPubMedGoogle Scholar
  9. Chandola, T., Brunner, E., & Marmot, M. (2006). Chronic stress at work and the metabolic syndrome: Prosp ective study. British Medical Journal, 332(7540), 521–526.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Flaa, A., Aksnes, T. A., Kjeldsen, S. E., Eide, I., & Rostrup, M. (2008). Increased sympathetic reactivity may predict insulin resistance: An 18-year follow-up study. Metabolism: Clinical and Experimental, 57(10), 1422–1427.Google Scholar
  11. Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., … & Costa, F. (2006). Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Current Opinion in Cardiology, 21(1), 1–6.CrossRefPubMedGoogle Scholar
  12. Guerra, S., Boscari, F., Avogaro, A., Di Camillo, B., Sparacino, G., & de Kreutzenberg, S. V. (2011). Hemodynamics assessed via approximate entropy analysis of impedance cardiography time series: Effect of metabolic syndrome. American Journal of Physiology, 301(2), H592–H598.PubMedGoogle Scholar
  13. Guseman, E. H., Pfeiffer, K. A., Carlson, J. J., Stansbury, K., & Eisenmann, J. C. (2016). Physical activity does not attenuate the relationship between daily cortisol and metabolic syndrome in obese youth. Journal of Pediatric Endocrinology and Metabolism, 29(1), 63–70.Google Scholar
  14. Hjemdahl, P. (2002). Stress and the metabolic syndrome: An interesting but enigmatic association. Circulation, 106(21), 2634–2636.CrossRefPubMedGoogle Scholar
  15. Janczura, M., Bochenek, G., Nowobilski, R., Dropinski, J., Kotula-Horowitz, K., Laskowicz, B., …& Domagala, T. (2015). The relationship of metabolic syndrome with stress, coronary heart disease and pulmonary function—an occupational cohort-based study. PLoS ONE, 10(8), e0133750.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Kirschbaum, C., Pirke, K. M., & Hellhammer, D. H. (1993). The ‘Trier Social Stress Test’–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28(1–2), 76–81.PubMedGoogle Scholar
  17. Krzesinski, P., Gielerak, G. G., & Kowal, J. J. (2013). A “patient-tailored” treatment of hypertension with use of impedance cardiography: A randomized, prospective and controlled trial. Medical Science Monitor, 19, 242–250.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Lambert, G. W., Straznicky, N. E., Lambert, E. A., Dixon, J. B., & Schlaich, M. P. (2010). Sympathetic nervous activation in obesity and the metabolic syndrome–causes, consequences and therapeutic implications. Pharmacology & Therapeutics, 126(2), 159–172.CrossRefGoogle Scholar
  19. Lee, Y., & Pratley, R. E. (2005). The evolving role of inflammation in obesity and the metabolic syndrome. Current Diabetes Reports, 5(1), 70–75.CrossRefPubMedGoogle Scholar
  20. Licht, C. M. M., de Geus, E. J. C., & Penninx, B. W. J. H. (2013). Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome. Journal of Clinical Endocrinology & Metabolism, 98(6), 2484–2493.CrossRefGoogle Scholar
  21. Licht, C. M. M., Vreeburg, S. A., Dortland, A. K. B. V.., Giltay, E. J., … & Penninx, B. W. J. H. (2010). Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities. Journal of Clinical Endocrinology & Metabolism, 95(5), 2458–2466.CrossRefGoogle Scholar
  22. Lozano, D. L., Norman, G., Knox, D., Wood, B. L., Miller, B. D., … & Berntson, G. G. (2007). Where to B in dZ/dt. Psychophysiology, 44(1), 113–119.CrossRefPubMedGoogle Scholar
  23. Malliani, A. (2005). Heart rate variability: From bench to bedside. European Journal of Internal Medicine, 16(1), 12–20.CrossRefPubMedGoogle Scholar
  24. Manganelli, F., Betocchi, S., Ciampi, Q., Storto, G., Losi, M. A., … & Chiariello, M. (2002). Comparison of hemodynamic adaptation to orthostatic stress in patients with hypertrophic cardiomyopathy with or without syncope and in vasovagal syncope. American Journal of Cardiology, 9(12), 1405–1410.CrossRefGoogle Scholar
  25. Marcus, Y., Segev, E., Shefer, G., Sack, J., Tal, B., Yaron, M., …& Stern, N. (2016). Multidisciplinary treatment of the metabolic syndrome lowers blood pressure variability independent of blood pressure control. Journal of Clinical Hypertension, 18(1), 19–24.CrossRefPubMedGoogle Scholar
  26. Masuo, K., Mikami, H., Ogihara, T., & Tuck, M. L. (1997). Sympathetic nerve hyperactivity precedes hyperinsulinemia and blood pressure elevation in a young, nonobese Japanese population. American Journal of Hypertension, 10(1), 77–83.CrossRefPubMedGoogle Scholar
  27. McGrady, A. (2010). The effects of biofeedback in diabetes and essential hypertension. Cleveland Clinic Journal of Medicine, 77(Suppl 3), S68–S71.CrossRefPubMedGoogle Scholar
  28. Miller, J. G., Kahle, S., Lopez, M., & Hastings, P. D. (2015). Compassionate love buffers stress-reactive mothers from fight-or-flight parenting. Developmental Psychology, 51(1), 36–43. doi: 10.1037/a0038236.CrossRefPubMedGoogle Scholar
  29. Ordaz, S., & Luna, B. (2012). Sex differences in physiological reactivity to acute psychosocial stress in adolescence. Psychoneuroendocrinology, 37(8), 1135–1157.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Quintana, D. S., Kemp, A. H., Alvares, G. A., & Guastella, A. J. (2013). A role for autonomic cardiac control in the effects of oxytocin on social behavior and psychiatric illness. Frontiers in Neuroscience, 7(1), 48.PubMedPubMedCentralGoogle Scholar
  31. Sherwood, A. (1993). Use of impedance cardiography in cardiovascular reactivity research. In J. J. Blascovich & E. S. Katkin (Eds.), Cardiovascular reactivity to psychological stress and disease (pp. 157–199). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  32. Sherwood, A., Allen, M. T., Fahrenberg, J., Kelsey, R. M., Lovallo, W. R., & van Doornen, L. J. P. (1990). Methodological guidelines for impedance cardiography. Psychophysiology, 27(1), 1–23.CrossRefPubMedGoogle Scholar
  33. Sloan, R. P., Shapiro, P. A., Bagiella, E., Fishkin, P. E., Gorman, J. M., & Myers, M. M. (1995). Consistency of heart rate and sympathovagal reactivity across different autonomic contexts. Psychophysiology, 32(5), 452–459.CrossRefPubMedGoogle Scholar
  34. Stoney, C. M., Davis, M. C., & Matthews, K. A. (1987). Sex differences in physiological responses to stress and in coronary heart disease: A causal link? Psychophysiology, 24(2), 127–131.CrossRefPubMedGoogle Scholar
  35. Tabachnick, B. G., & Fidell, L. S. (2013). Using Multivariate Statistics. (6th ed.). Boston, MA: Pearson.Google Scholar
  36. Wahba, I. M., & Mak, R. H. (2007). Obesity and obesity-initiated metabolic syndrome: Mechanistic links to chronic kidney disease. Clinical Journal of the American Society of Nephrology, 2(3), 550–562.CrossRefPubMedGoogle Scholar
  37. Wakkee, M., Thio, H. B., Prens, E. P., Sijbrands, E. J. G., & Neumann, H. A. M. (2006). Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients. Atherosclerosis, 190(1), 1–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Psychology, College of SciencesUniversity of Central FloridaOrlandoUSA
  2. 2.UCF Health, College of MedicineUniversity of Central FloridaOrlandoUSA

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