Deep and slow breathing increases vagal modulation in pregnant women
DOI:
https://doi.org/10.15448/1980-6108.2017.4.28050Keywords:
pregnancy, respiration, cardiovascular system, heart rate, respiratory sinus arrhythmia, autonomic nervous system.Abstract
AIMS: To compare the responses of the heart rate autonomic modulation in pregnant and non-pregnant women before and after the respiratory sinus arrhythmia maneuver.
METHODS: A cross-sectional study was conducted with a sample of 24 women, divided into two groups: pregnant group (independent of gestational age) and control group (non-pregnant). The evaluation consisted of recording the RR intervals using a cardiofrequencimeter, for analysis of linear and nonlinear indices of heart rate variability. The evaluations were made at rest in left lateral decubitus, before and after the maneuver of accentuation of respiratory sinus arrhythmia, consisting of slow breaths five to six cycles per minute. The expiration/inspiration ratio and the difference between inspiration and expiration were evaluated during the maneuver. Results were compared between the two groups (pregnant and non-pregnant), as well as those obtained in each group before and after the maneuver. For the statistical analysis the level of significance considered was p <0.05.
RESULTS: Linear indices showed increased baseline sympathetic modulation (low frequency band) in pregnant women when compared to non-pregnant women (pregnant women: 68.9±28.1; non pregnant women: 49.3±11.7; p=0,002). After the respiratory maneuver, the root mean square of successive differences in the RR intervals index increased in the pregnant group (pre-maneuver: 34.5±5.7; post-maneuver: 38.9±5.8; p=0,002) indicating an increase in the parasympathetic system for this population after the maneuver. In addition, there was an increase in the complexity values after the maneuver, suggested by the Shanon entropy for both groups, being the increase higher in the pregnant women. Regarding the indices evaluated during the respiratory sinus arrhythmia maneuver, both groups presented expiration/inspiration ratio values greater than 1, which suggests integrity of the autonomic nervous system.
CONCLUSIONS: There was an improvement in the regulation of the autonomic nervous system after the respiratory maneuver for pregnant women, suggesting that the slow and deep breathing pattern may increase vagal modulation and confer a cardioprotective effect, besides causing relaxation and a sense of well-being.
Downloads
References
Tejera E, Areias JM, Rodrigues A, Nieto-Villar JM, Rebelo I. Blood pressure and heart rate variability complexity in normal pregnancy. Influence of age, familiar history and parity. Hypertens Pregnancy. 2012;31(1):91-106. https://doi.org/10.3109/10641955.2010.544801
Tejera E, Areias JM, Rodrigues A, Rebelo I, Nieto-Villar JM. Network centrality and multiscale transition asymmetry in the heart rate variability analysis of normal and preeclamptic pregnancies. Commun Nonlinear Sci Numer Simul. 2011;16(3):1589-96. https://doi.org/10.1016/j.cnsns.2010.07.009
Tejera E, Areias MJ, Rodrigues AI, Ramõa A, Nieto-Villar JM, Rebelo I. Relationship between heart rate variability indexes and common biochemical markers in normal and hypertensive third trimester pregnancy. Hypertens Pregnancy. 2012b;31(1):59-69. https://doi.org/10.3109/10641955.2010.544802
Kamath M, Watanabe M, Upton A. Heart rate variability signal analysis: clinical applications. New York: CRC Press; 2013.
Vanderlei LCM, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Braz J Cardiovasc Surg. 2009;24(2):205-17. https://doi.org/10.1590/S0102-76382009000200018
Ferreira LL, Souza NM, Bernardo AFB, Vitor ALR, Valenti VE, Vanderlei LCM. Heart rate variability as a resource in physical therapy: analysis of national journal. Fisioter Mov. 2013;26(1):25-36. https://doi.org/10.1590/S0103-51502013000100003
Hayano J, Mukai S, Sakakibara M, Okada A, Takata K, Fujinami T. Effects of respiratory interval on vagal modulation of heart rate. Am J Physiol. 1994;267(1):H33-40.
Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neurosci Biobehav Rev. 2004;28(4):395-414. https://doi.org/10.1016/j.neubiorev.2004.06.004
Almeida L, Constâncio J, Santos C, Silva T, Raposo M. Análise comparativa das PE e PI máximas entre mulheres grávidas e não-grávidas e entre grávidas de diferentes períodos gestacionais. Rev Saúde Com. 2005;1(1):9-17.
Duarte G. Modificações e adaptações do organismo materno decorrentes da gravidez. In: Ferreira CHJ, Carvalho CRF, Tanaka C. Fisioterapia na saúde da mulher. Rio de Janeiro: Guanabara Koogan; 2011.
Heiskanen N, Saarelaine H, Valtonen P, Laitinen T, Vanninen E, Heinonen S. Blood pressure and heart rate variability analysis of orthostatic challenge in normal human pregnancies. Clinic Physiol Function Imaging. 2008;28(6):384-90. https://doi.org/10.1111/j.1475-097X.2008.00818.x
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996;93(5):1043-65. https://doi.org/10.1161/01.CIR.93.5.1043
Logier R, De Jonckheere J, Dassonneville A. An efficient algorithm for R-R intervals series filtering. Conf Proc IEEE Eng Med Biol Soc. 2004;6:3937-40. https://doi.org/10.1109/IEMBS.2004.1404100
Porta A, Faes L, Masé M, D'Aggio G, Pinna GD, Maestri R, Montano N, Furlan R, Guzzetti S, Nollo G, Malliani A. An integrated approach based on uniform quantization for the evaluation of complexity of short-term heart period variability: Application to 24 h Holter recordings in healthy and heart failure humans. Chaos. 2007;17(1):015117. https://doi.org/10.1063/1.2404630
Mizuno T, Tamakoshi K, Tanabe K. Anxiety during pregnancy and autonomic nervous system activity: A longitudinal observational and cross-sectional study. J Psychosom Res. 2017;99:105-111. https://doi.org/10.1016/j.jpsychores.2017.06.006
May LE, Knowlton J, Hanson J, Suminski R, Paynter C, Fang X, Gustafson KM. Effects of Exercise During Pregnancy on Maternal Heart Rate and Heart Rate Variability. PMR. 2016;8(7):611-7. https://doi.org/10.1016/j.pmrj.2015.11.006
Nakagaki A, Inami T, Minoura T, Baba R, Iwase S, Sato M. Differences in autonomic neural activity during exercise between the second and third trimesters of pregnancy. J Obstet Gynaecol Res. 201;42(8):951-9.
Carpenter RE, Emery SJ, Uzun O, Rassi D, Lewis MJ. Influence of antenatal physical exercise on heart rate variability and QT variability. J Matern Fetal Neonatal Med. 2017;30(1):79-84. https://doi.org/10.3109/14767058.2016.1163541
Miyazato K, Matsukawa K. Decreased cardiac parasympathetic nerve activity of pregnant women during foot baths. Jpn J Nurs Sci. 2010;7(1):65-75. https://doi.org/10.1111/j.1742-7924.2010.00136.x
Arsenault M, Ladouceur A, Lehmann A, Rainville P, Piche M. Pain modulation induced by respiration: phase and frequency effects. Neuroscience. 2013;252:501-11. https://doi.org/10.1016/j.neuroscience.2013.07.048
Yasuma F, Hayano J. Respiratory Sinus Arrhytmia: why does the heartbeat synchronize with respiratory rhythm? Chest. 2004;125(2):683-90. https://doi.org/10.1378/chest.125.2.683
DiPietro JA, Costigan KA, Nelson P, Gurewitsch ED, Laudenslager ML. Fetal responses to induced maternal relaxation during pregnancy. Biol Psychol. 2008;77(1):11-9. https://doi.org/10.1016/j.biopsycho.2007.08.008
Moertl MG, Lackner HK, Papousek I, Roessler A, Hinghofer-Szalkay H, Lang U, Kolovetsiou-Kreiner V, Schlembach D. Phase synchronization of hemodynamic variables at rest and after deep breathing measured during the course of pregnancy. PLoS One. 2013;8(4):e60675.
https://doi.org/10.1371/journal.pone.0060675
Goldberger AL. Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet. 1996;347(9011):1312-4. https://doi.org/10.1016/S0140-6736(96)90948-4
Souza AI, Filho MB, Ferreira LOC. Alterações hematológicas e gravidez. Revista Brasileira de Hematologia e Hemoterapia. 2002;24(1):29-36. https://doi.org/10.1590/S1516-84842002000100006
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.