Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders
Rachel C. LapidusMaria PuhlRayus KuplickiJennifer L. StewartMartin P. PaulusJamie L. RhudyJustin S. FeinsteinSahib S. Khalsa
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Abstract:
Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.Keywords:
Respiratory Rate
Subjects received one of eight treatments: (1) practice at increasing heart rate with heart-rate feedback, (2) practice at decreasing heart rate with heart-rate feedback, (3) practice at increasing heart rate without heart-rate feedback, (4) practice at decreasing heart rate without heart-rate feedback, (5) practice at increasing respiration rate with respiratory feedback, (6) practice at decreasing respiration rate with respiratory feedback, (7) practice at increasing respiration rate with respiratory instructions only, (8) practice at decreasing respiration rate with respiratory instructions only. Heart rate, Respiration rate, and Respiration depth were measured. Analysis indicated that (a) subjects who controlled respiration with respiratory feedback reliably increased and decreased heart rate; (b) subjects who controlled respiration with respiratory instructions only reliably increased but not decreased heart rate; (c) subjects in the respiratory-feedback conditions showed higher heart-rate increase and decrease than heart-rate increase and decrease of subjects in the other six conditions.
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To assess respiratory rate as an indicator of acute respiratory dysfunction, we studied 58 consecutive patients four times daily during the postoperative period. Of 825 measurements of respiratory rate, 726 (89%) were normal (24/min or less). Elevations in respiratory rate without respiratory dysfunction were found in only 4% of all measurements. Patients without lung disease had a mean respiratory rate of 18 +/- 4/min, while patients with an abnormal respiratory rate and respiratory dysfunction had a mean of 27 +/- 5/min. Our study demonstrates that respiratory rate, if carefully measured, is a sensitive and reasonably specific marker of acute respiratory dysfunction.
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PURPOSE: To investigate the effect of 6 weeks supervised pranayamic volitional breath training (PVBT) on heart rate and breathing rate response during maximal graded exercise treadmill test (GXTT) in healthy adult volunteers0. METHODS: Consecutive, consenting healthy adult volunteers of mean age 20.56 ± 2.49 years (n = 30), underwent baseline recording of resting heart rate (HR), blood pressure (BP) and respiratory rate (RR) followed by Bruce ramp protocol maximal GXTT until volitional exhaustion providing total test time (TT), derived VO2max achieved, heart rate and breathing rate response during maximal GXTT and drop in recovery HR data. After six weeks of observation, the participants underwent pre-intervention recording followed by supervised PVBT intervention for 6 weeks, 30 minutes a day for 5 days a week, and post-intervention recording. Repeated measures ANOVA with pairwise t-statistical comparison was used to analyze the data. RESULTS: The participants, after supervised PVBT, showed significant increase in TT (805.993 ± 99.04 vs. 806.00 ± 97.92 vs. 868.97 ± 97.48 seconds, p < 0.001), VO2max (53.37 ± 6.68 vs. 53.47 ± 6.75 vs. 57.77 ± 6.74 ml/kg/min, p < 0.001), and significant difference in the heart rate and breathing rate response during maximal GXTT post intervention, which is represented graphically (Figure 1 and 2). CONCLUSIONS: After supervised PVBT, the participants showed improvement in maximal GXTT performance and altered heart rate and breathing response during exercise probably due to learnt behavior to control the breathing pattern improving the breathing economy, improvement in respiratory muscle aerobic capacity, increase in stroke volume and cardiac output and attenuation of respiratory muscle metaboreflex.
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Breathing exercises
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Respiratory Rate
Vital signs
Oxygen Saturation
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Objective To understand the effect of second-hand smoke to blood pressure,heart rate and respiratory frequency of rats,and provide the basis in revealing the harm of second-hand smoke to cardiovascular system and respiratory system.Methods Before and after exposing to second-hand smoke,heart rate and blood pressure of rats were measured using noninvasive blood pressure instrument,and their respiratory frequency by naked-eye respectively.Results After inhaling second-hand smoke,No.1 and No.2 of rats had accelerated heart rate and respiratory frequency,at the same time lowered blood pressure;rat No.3 had accelerated heart rate,decreased respiratory rate and blood pressure;rat No.4 had decreased heart rate,respiratory rate and blood pressure.Conclusion When the rats inhale second-hand smoke,blood pressure can decrease,and respiratory rate speed up within 25 minutes,but slow down after 25 minutes;meanwhile,heart rate speed up within 35 minutes,but slow down after 35 minutes.
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An automated system was developed for evaluating changes in respiratory symptoms in guinea pigs over a long period with a personal computer. The data on breathing curves obtained with a body plethysmograph were analyzed to determine respiratory rate, expiration/inspiration ratio, ventilation ratio, and other parameters. With this system, respiratory changes in guinea pigs, such as increase or decrease of respiratory rate, expiration/inspiration ratio, and ventilation ratio, and death of animals could be easily observed. Investigation of delayed respiratory response to Candida albicans in sensitized guinea pigs and of the effects of SO2 or NO2 exposures on its response was carried out using this system. Respiratory changes in delayed respiratory response were mostly increased respiration rate and succeeding expiratory prolongation being noted just before death. In the influences of SO2 or NO2 exposure on delayed respiratory response, increase of respiratory rate in NO2 and expiratory and inspiratory prolongation in SO2 were found. This system should prove useful for evaluating changes in respiratory symptoms due to toxic agents, medicines, and air pollutants in small animals.
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Heart rate, respiratory rate and body temperature of four free‐ranging American opossums, Didelphis marsupialis of both sexes (2.47 ± 0.27 kg; ± +± SE), were monitored during mild provocation and during death feigning (‘play possum’). Mild provocations, caused by the approach of either man or dog, elicited a freezing response. The behavioural response was accompanied by a 12% decrease in heart rate (218 ± 11 to 192 ± 10 beats‐min ‐1 ; ± SE) and a 31% reduction in respiratory rate (26.7 ± 1.7 to 18.4 ± 1.4 breaths‐min ‐1 ) from pre‐stimulation values. Death feigning was induced by vigorous tactile stimulation by either investigator or dog. The response was marked by immobility, prone position and stiffness of the body. Mouth was open and the animal showed no response to touch or pinching. Death feigning was always accompanied by salivation, urination, defaecation and erection of the penis (in males). Heart rate decreased 46% (222 ± 10.6 to 120 ± 17 beats‐min ‐1 ) and respiratory rate was reduced 30% (27.4 ± 1.5 to 19.2 ± 2.3 breaths‐min ‐1 ) from pre‐stimulation values. Body temperature dropped from 34.8 ± 0.2 to 34.2 ± o.3 o C. During death feigning the animal was fully conscious as was evident by heart rate reduction during the re‐approach of the dog. Atropine treatment had no obvious effect on behaviour but abolished the bradycardia when compared to pre‐stimulus condition.
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To assess respiratory rate as an indicator of acute respiratory dysfunction, we studied 58 consecutive patients four times daily during the postoperative period. Of 825 measurements of respiratory rate, 726 (89%) were normal (24/min or less). Elevations in respiratory rate without respiratory dysfunction were found in only 4% of all measurements. Patients without lung disease had a mean respiratory rate of 18±4/min, while patients with an abnormal respiratory rate and respiratory dysfunction had a mean of 27±5/min. Our study demonstrates that respiratory rate, if carefully measured, is a sensitive and reasonably specific marker of acute respiratory dysfunction. (JAMA244:1123-1125, 1980)
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Respiratory monitoring
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The relationship between increase in body temperature, heart rate, and respiratory rate has only been studied in young, healthy subjects.To show the changes in heart and respiratory rate associated with fever in acutely admitted medical patients.A prospective observational cohort study.Vital parameters from 4,493 patients were retrospectively extracted. Linear and multiple variable regression analysis was used to calculate the change in heart and temperature rate for every degree rise in temperature (i.e. ΔHR/°C and ΔRR/°C) in the entire study group and in those with low (<36.1°C), normal (36.1-38°C) and high (>38°C) body temperatures.The ΔHR/°C and ΔRR/°C was 7.2±0.4 beats per minute (bpm) and 1.4 ±0.1 (1.2 to 1.62) breaths per minute (bpm). Adjusting for age, oxygen saturation and mean blood pressure, the results were 6.4±0.4 (5.7 to 7.1) bpm and 1.2±0.1 (1.0 to 1.4) bpm. In low, normal and high body temperature the ΔHR/°C were 2.7±1.9, 6.9±1.9 and 7.4±0.9 bpm, respectively; for ΔRR/°C the values were -0.5±0.5, 1.5±0.5 and 2.3±0.3 bpm, respectively.We only found a modest association between fever and changes in heart rate and respiratory rate.
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Oxygen Saturation
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