본문 바로가기
KERD
논문KCI 등재

Posttraumatic Stress Disorder and Alterations in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류정신과학

초록

Objective The functions of both the central and peripheral autonomic nervous system, indexed by heart rate variability (HRV), are affected by psychology and physiology. This review summarizes the results of studies comparing the evaluation of HRV parameters between individuals with posttraumatic stress disorder (PTSD) and healthy controls. Methods Eligible studies (n=499) were identified through literature searches of the EMBASE, Medline, PubMed and Web of Science databases. Nineteen studies met our inclusion criteria. A random effects model was used, and standardized mean differences for highfrequency HRV(HF-HRV), low-frequency HRV(LF-HRV) and the root mean square of successive R-R interval differences (RMSSD) were calculated. Results Significant effects were found for HF-HRV [p<0.0001, Z=4.18; Hedges’g=-1.58, 95% confidence interval (CI) (-2.32, -0.84); k=14] and RMSSD [p<0.00001, Z=4.80; Hedges’g=-1.96, 95% CI (-2.76, -1.16); k=9] relative to healthy controls. Considerable heterogeneity was revealed, but the main effects for HF-HRV and RMSSD were robust in subsequent meta-regression and subgroup analyses. Conclusion Given the relationships among low vagal state, inflammation, and alterations in brain structure and function, including executive function and emotion regulation, reduced HRV may be regarded as an endophenotype in PTSD research.

Abstract

Objective The functions of both the central and peripheral autonomic nervous system, indexed by heart rate variability (HRV), are affected by psychology and physiology. This review summarizes the results of studies comparing the evaluation of HRV parameters between individuals with posttraumatic stress disorder (PTSD) and healthy controls. Methods Eligible studies (n=499) were identified through literature searches of the EMBASE, Medline, PubMed and Web of Science databases. Nineteen studies met our inclusion criteria. A random effects model was used, and standardized mean differences for highfrequency HRV(HF-HRV), low-frequency HRV(LF-HRV) and the root mean square of successive R-R interval differences (RMSSD) were calculated. Results Significant effects were found for HF-HRV [p<0.0001, Z=4.18; Hedges’g=-1.58, 95% confidence interval (CI) (-2.32, -0.84); k=14] and RMSSD [p<0.00001, Z=4.80; Hedges’g=-1.96, 95% CI (-2.76, -1.16); k=9] relative to healthy controls. Considerable heterogeneity was revealed, but the main effects for HF-HRV and RMSSD were robust in subsequent meta-regression and subgroup analyses. Conclusion Given the relationships among low vagal state, inflammation, and alterations in brain structure and function, including executive function and emotion regulation, reduced HRV may be regarded as an endophenotype in PTSD research.

참고문헌 (73)

  1. Kessler RC BP, "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication", Arch Gen Psychiatry, 62, pp.593~602 (2005)
  2. Britvić D AV, "Comorbidities with posttraumatic stress disorder(PTSD)among combat veterans : 15 years postwar analysis", Int J Clin Health Psychol, 15, pp.81~92 (2015)
  3. Brudey C, "Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease", Am J Physiol Regul Integr Comp Physiol, 309, pp.R315~R321 (2015)
  4. Guina J, "Which posttraumatic stress disorder symptoms, trauma types, and substances correlate with suicide attempts in trauma survivors?", Prim Care Companion CNS Disord, 19, pp.17m02177~ (2017)
  5. Schnurr PP, "Clinical. Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan", Clin Psychol Rev, 29, pp.727~735 (2009)
  6. Jakupcak M, "Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans", J Trauma Stress, 22, pp.303~306 (2009)
  7. Lewis C, "Trauma exposure and undetected posttraumatic stress disorder among adults with a mental disorder", Depress Anxiety, 35, pp.178~184 (2018)
  8. D’Andrea W, "Physical health problems after single trauma exposure : when stress takes root in the body", J Am Psychiatr Nurses Assoc, 17, pp.378~392 (2011)
  9. Ulrich-Lai YM, "Neural regulation of endocrine and autonomic stress responses", Nat Rev Neurosci, 10, pp.397~409 (2009)
  10. Sherin JE, "Post-traumatic stress disorder : the neurobiological impact of psychological trauma", Dialogues Clin Neurosci, 13, pp.263~278 (2011)
  11. Kemp AH, "The relationship between mental and physical health : insights from the study of heart rate variability", Int J Psychophysiol, 89, pp.288~296 (2013)
  12. Zygmunt A, "Methods of evaluation of autonomic nervous system function", Arch Med Sci, 6, pp.11~18 (2010)
  13. Force T, "Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology", Circulation, 93, pp.1043~1065 (1996)
  14. Pinna GD, "Heart rate variability measures: a fresh look at reliability", Clin Sci (Lond), 113, pp.131~140 (2007)
  15. Ernst G, "Heart-rate variability-more than heart beats?", Front Public Health, 5, pp.240~ (2017)
  16. Appelhans BM, "Heart rate variability as an index of regulated emotional responding", Rev Gen Psychol, 10, pp.229~240 (2006)
  17. Beauchaine TP, "Heart rate variability as a transdiagnostic biomarker of psychopathology", Int J Psychophysiol, 98, pp.338~350 (2015)
  18. Berntson GG, "Heart rate variability : origins, methods, and interpretive caveats", Psychophysiology, 34, pp.623~648 (1997)
  19. Quintana DS, "Guidelines for Reporting Articles on Psychiatry and Heart rate variability(GRAPH) : recommendations to advance research communication", Transl Psychiatry, 6, pp.e803~ (2016)
  20. Heathers JA, "Everything hertz: methodological issues in short-term frequencydomain HRV", Front Physiol, 5, pp.177~ (2014)
  21. "Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology", Circulation, 93, pp.1043~1065 (1996)
  22. Berntson GG, "Filter properties of root mean square successive difference(RMSSD)for heart rate", Psychophysiology, 42, pp.246~252 (2005)
  23. Burg MM, "Post-traumatic stress disorder and cardiovascular disease", Curr Cardiol Rep, 18, pp.94~ (2016)
  24. La Rovere MT, "Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients", Circulation, 107, pp.565~570 (2003)
  25. Jovanovic T, "How the neurocircuitry and genetics of fear inhibition may inform our understanding of PTSD", Am J Psychiatry, 167, pp.648~662 (2010)
  26. Thayer JF, "Heart rate variability, prefrontal neural function, and cognitive performance : the neurovisceral integration perspective on self-regulation, adaptation, and health", Ann Behav Med, 37, pp.141~153 (2009)
  27. Thayer JF, "A model of neurovisceral integration in emotion regulation and dysregulation", J Affect Disord, 61, pp.201~216 (2000)
  28. Thayer JF, "A metaanalysis of heart rate variability and neuroimaging studies : implications for heart rate variability as a marker of stress and health", Neurosci Biobehav Rev, 36, pp.747~756 (2012)
  29. Hauschildt M, "Heart rate variability in response to affective scenes in posttraumatic stress disorder", Biol Psychol, 88, pp.215~222 (2011)
  30. Lakusic N, "Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction", Mil Med, 172, pp.1190~1193 (2007)
  31. Agorastos A, "Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder", Stress, 16, pp.300~310 (2013)
  32. Wahbeh H, "Peak high-frequency HRV and peak alpha frequency higher in PTSD", Appl Psychophysiol Biofeedback, 38, pp.57~69 (2013)
  33. Cohen H, "Autonomic dysregulation in panic disorder and in post-traumatic stress disorder : application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks", Psychiatry Res, 96, pp.1~13 (2000)
  34. Lee SM, "Heart rate variability associated with posttraumatic stress disorder in victims’families of sewol ferry disaster", Psychiatry Res, 259, pp.277~282 (2018)
  35. Tucker P, "Emotional stress and heart rate variability measures associated with cardiovascular risk in relocated Katrina survivors", Psychosom Med, 74, pp.160~168 (2012)
  36. Hsin-An Chang, "Decreased Cardiac Vagal Control in Drug-Naïve Patients with Posttraumatic Stress Disorder", PSYCHIATRY INVESTIGATION, 10(2), pp.121~130 (2013), 대한신경정신의학회[DOI]
  37. 문은옥, "Comparative Study of Heart Rate Variability in Patients with Schizophrenia,Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder", Clinical Psychopharmacology and Neuroscience, 11(3), pp.137~143 (2013), 대한정신약물학회
  38. Friedman BH, "An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone", Biol Psychol, 74, pp.185~199 (2007)
  39. Chalmers JA, "Anxiety disorders are associated with reduced heart rate variability : a meta-analysis", Front Psychiatry, 5, pp.80~ (2014)
  40. Schmitt L, "Fatigue shifts and scatters heart rate variability in elite endurance athletes", PLoS One, 8, pp.e71588~ (2013)
  41. Ciccone AB, "Reminder : RMSSD and SD1 are identical heart rate variability metrics", Muscle Nerve, 56, pp.674~678 (2017)
  42. Tak LM, "As good as it gets? A meta-analysis and systematic review of methodological quality of heart rate variability studies in functional somatic disorders", Biol Psychol, 82, pp.101~110 (2009)
  43. al Arab AS, "Temporal analysis of heart rate variability as a predictor of post traumatic stress disorder in road traffic accidents survivors", J Psychiatr Res, 46, pp.790~796 (2012)
  44. Higgins JP, "Quantifying heterogeneity in a meta-analysis", Stat Med, 21, pp.1539~1558 (2002)
  45. Ray JM, "Alcohol use disorder moderates the effect of age on heart rate variability in veterans with posttraumatic stress disorder", J Nerv Ment Dis, 205, pp.793~800 (2017)
  46. Shaikh al arab A, "Temporal analysis of heart rate variability as a predictor of post traumatic stress disorder in road traffic accidents survivors", J Psychiatr Res, 46, pp.790~796 (2012)
  47. Lee EA, "Lower heart rate variability associated with military sexual trauma rape and posttraumatic stress disorder", Biol Res Nurs, 14, pp.412~418 (2012)
  48. Evrengül H, "Time and frequency domain analyses of heart rate variability in patients with epilepsy", Epilepsy Res, 63, pp.131~139 (2005)
  49. Draghici AE, "The physiological basis and measurement of heart rate variability in humans", J Physiol Anthropol, 35, pp.22~ (2016)
  50. Souza GG, "Resilience and vagal tone predict cardiac recovery from acute social stress", Stress, 10, pp.368~374 (2007)
  51. Williams LM, "Dysregulation of arousal and amygdala-prefrontal systems in paranoid schizophrenia", Am J Psychiatry, 161, pp.480~489 (2004)
  52. Thayer JF HA, "Heart rate variability, prefrontal neural function, and cognitive performance : the neurovisceral integration perspective on self-regulation, adaptation, and health", Ann Behav Med Care, 37, pp.141~153 (2009)
  53. Tracey KJ, "Reflex control of immunity", Nat Rev Immunol, 9, pp.418~428 (2009)
  54. Saeed RW, "Cholinergic stimulation blocks endothelial cell activation and leukocyte recruitment during inflammation", J Exp Med, 201, pp.1113~1123 (2005)
  55. Passos IC, "Inflammatory markers in post-traumatic stress disorder : a systematic review, meta-analysis, and meta-regression", Lancet Psychiatry, 2, pp.1002~1012 (2015)
  56. Muscatell KA, "Greater amygdala activity and dorsomedial prefrontal-amygdala coupling are associated with enhanced inflammatory responses to stress", Brain Behav Immun, 43, pp.46~53 (2015)
  57. Cohen H, "Normalization of heart rate variability in post-traumatic stress disorder patients following fluoxetine treatment : preliminary results", Isr Med Assoc J, 2, pp.296~301 (2000)
  58. Kemp AH, "Impact of depression and antidepressant treatment on heart rate variability : a review and meta-analysis", Biol Psychiatry, 67, pp.1067~1074 (2010)
  59. Stein DJ, "Pharmacotherapy of posttraumatic stress disorder : a review of meta-analyses and treatment guidelines", CNS Spectr, 14, pp.25~31 (2009)
  60. Minassian A, "Association of predeployment heart rate variability with risk of postdeployment posttraumatic stress disorder in activeduty marines", JAMA Psychiatry, 72, pp.979~986 (2015)
  61. Lewis GF, "Relaxation training assisted by heart rate variability biofeedback : Implication for a military predeployment stress inoculation protocol", Psychophysiology, 52, pp.1167~1174 (2015)
  62. Wahbeh H, "Mechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress disorder", J Clin Psychol, 72, pp.365~383 (2016)
  63. Cohen H, "Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder", Biol Psychiatry, 44, pp.1054~1059 (1998)
  64. Carnevali L, "Autonomic and brain morphological predictors of stress resilience", Front Neurosci, 12, pp.228~ (2018)
  65. Blechert J, "Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder", Psychosom Med, 69, pp.935~943 (2007)
  66. Keary TA, "Women with posttraumatic stress disorder have larger decreases in heart rate variability during stress tasks", Int J Psychophysiol, 73, pp.257~264 (2009)
  67. Tan G, "Heart rate variability(HRV)and posttraumatic stress disorder(PTSD) : a pilot study", Appl Psychophysiol Biofeedback, 36, pp.27~35 (2011)
  68. Slewa-Younan S, "Measures of psychophysiological arousal among resettled traumatized Iraqi refugees seeking psychological treatment", J Trauma Stress, 25, pp.348~352 (2012)
  69. Thome J, "Desynchronization of autonomic response and central autonomic network connectivity in posttraumatic stress disorder", Human Brain Mapp, 38, pp.27~40 (2017)
  70. Park JE, "Heart rate variability of chronic posttraumatic stress disorder in the Korean veterans", Psychiatry Res, 255, pp.72~77 (2017)
  71. Shah AJ, "Posttraumatic stress disorder and impaired autonomic modulation in male twins", Biol Psychiatry, 73, pp.1103~1110 (2013)
  72. Meyer PW, "Heart rate variability in patients with post-traumatic stress disorder or borderline personality disorder: relationship to early life maltreatment", J Neural Transm(Vienna), 123, pp.1107~1118 (2016)

관련 논문AI추천

Functioning Level as a Buffer: Longitudinal Associations Between Heart Rate Variability and Post-Traumatic Stress Disorder Risk Over 2 YearsHee-Ju Kang, Hyunseok Jang, Il-Seon Shin, Jae-Min Kim, Jung-Chul Kim, Ju-Wan Kim, Ju-Yeon Lee, Sung-Wan Kim대한신경정신의학회 · PSYCHIATRY INVESTIGATION2025 · 제22권 제10호Comparative Study of Heart Rate Variability in Patients with Schizophrenia,Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder김도형, 문은옥, 이승환, 황보람대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2013 · 제11권 제3호Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature구본훈, 김혜금, Dai Seg Bai, Eun-Jin Cheon, YoungHwanLee대한신경정신의학회 · PSYCHIATRY INVESTIGATION2018 · 제15권 제3호Educational Level Modifies the Relationship between Standard Deviation of NN Intervals and Post-traumatic Stress Disorder Development over Two-yearsHee-Ju Kang, Hyun Seok Jang, Il-Seon Shin, Jae-Min Kim, Ji-Min Yoo, Jung Chul Kim, Ju-Wan Kim, Ju-Yeon Lee, Sung-Wan Kim대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2025 · 제23권 제1호만성 외상 후 스트레스 장애 환자에서 심박변이도와 증상과의 상관관계 : 외상증상과 심박변이도 관계강석훈, 김기원, 박주언, 박진수, 소형석, 최진희, 최하연대한불안의학회 · 대한불안의학회지2020 · 제16권 제2호우울장애와 외상 및 스트레스 관련 장애의 심박변이지표 차이 및 변화 비교김민채, 박수빈, 이정현대한생물치료정신의학회 · 생물치료정신의학2021 · 제27권 제3호

이 간행물의 다른 논문 (10건)