Objective-To evaluate the stability of short recordings of heart rate variability (HRV) with time, and the association of HRV with age and sex. Design-Five minute Holter recordings were made twice over a two month interval (tracking study). In addition, HRV was measured in a cross sectional study. Setting-Residents of 11 Israeli kibbutzim were examined in their settlements. Subjects-32 men and 38 women (aged 31-67) participated in the tracking study and 294 (aged 35-65) were involved in the cross sectional study. Main outcome measures-Time and frequency domain analyses on Holter recordings were undertaken in two breathing conditions: spontaneous and controlled breathing (15 respirations per minute). Regression was used to assess the relations of sex, age, heart rate, and logarithmically transformed HRV indices. Results-HRV measures were highly consistent with time with correlations of 0.76-0.80 for high frequency and total power. Geometric mean total power declined with age by 45% in men and 32% in women, and was lower by 24% among women than among men (all p < 0.005). Men had a 34% higher very low and low frequency power and a higher ratio of low to high frequency power (p < 0.001). Conversely, high frequency power in women represents a greater proportion of total power than in men. Conclusion-Short recordings of HRV in a non-laboratory setting are stable over months and therefore characteristic of an individual. Strong age and sex eVects were evident. HRV derived from short recordings can be informative in population based studies. (Heart 1998;80:156-162) Keywords: heart rate variability; parasympathetic activity; reliability; sex diVerences Heart rate variability (HRV) measures can provide non-invasive information on the autonomic nervous system, including its vagal and sympathetic components. [1][2][3][4] Interest in these measures has increased recently in light of predictive associations between reduced HRV and increased mortality after an acute myocardial infarction (MI), 5-8 and between HRV and the incidence of coronary heart disease and mortality in a community based population. 9 10 These associations were independent of the eVect of conventional risk factors. 9 10 Most studies of HRV have used 24 hour Holter recorded electrocardiograms (ECGs). Such measurement is often not feasible for widescale epidemiological studies, and may be unnecessary. In men after an acute MI, HRV measures calculated from 2-15 minute segments were remarkably similar to those calculated over 24 hours, and provided predictive information similar in strength to the entire record. 8 A recently published report of a European and North American task force on measurement of HRV for clinical use indicated sparse availability of information on the reliability of short segment recordings. 11 We undertook two studies in an unselected free living population sample to determine the feasibility and potential usefulness of five minute recordings in men and women aged 35-65 years. Recordings were made under conditions of free and ...

Introduction Despite their widespread prevalence, there are no existing evidence-based psychological treatments for women with sexual desire and arousal disorder. Mindfulness, the practice of relaxed wakefulness, is an ancient eastern practice with roots in Buddhist meditation which has been found to be an effective component of psychological treatments for numerous psychiatric and medical illnesses. In recent years, mindfulness has been incorporated into sex therapy and has been found effective for genital arousal disorder among women with acquired sexual complaints secondary to gynecologic cancer. Aim The aim of this study was to adapt an existing mindfulness-based psychoeducation (PED) to a group format for women with sexual desire/interest disorder and/or sexual arousal disorders unrelated to cancer. Methods Twenty-six women participated in three 90-minute sessions, spaced 2 weeks apart, with four to six other women. Group PED was administered by one mental health trained provider and one gynecologist with post graduate training and experience in sexual medicine. Main Outcome Measures Prior to and following the group, women viewed audiovisual erotic stimuli and had both physiological (vaginal pulse amplitude) and subjective sexual arousal assessed. Additionally, they completed self-report questionnaires of sexual response, sexual distress, mood, and relationship satisfaction. Results There was a significant beneficial effect of the group PED on sexual desire and sexual distress. Also, we found a positive effect on self-assessed genital wetness despite little or no change in actual physiological arousal, and a marginally significant improvement in subjective and self-reported physical arousal during an erotic stimulus. A follow-up comparison of women with and without a sexual abuse history revealed that women with a sexual abuse history improved significantly more than those without such history on mental sexual excitement, genital tingling/throbbing, arousal, overall sexual function, sexual distress, and on negative affect while viewing the erotic film. Moreover, there was a trend for greater improvement on depression scores among those with a sexual abuse history. Conclusions These data provide preliminary support for a brief, three-session group psychoeducational intervention for women with sexual desire and arousal complaints. Specifically, women with a history of sexual abuse improved more than women without such a history. Participant feedback indicated that mindfulness was the most effective component of the treatment, in line with prior findings. However, future compartmentalization trials are necessary in order to conclude this more definitively.

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Introduction A committee of five was convened to update the chapter on women’s sexual dysfunctions from the perspective of diagnostic issues, pathophysiology, assessment, and treatment. Aim To review the literature since 2003 and provide recommendations based on evidence. Methods Research databases, conference proceedings, and articles in press were read for relevant new data on these topics for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), female orgasmic disorder (FOD), and persistent genital arousal disorder (PGAD). Main Outcome Measures Recommendations by five experts from five countries were formulated with associated grades. Results The definitions of HSDD, FSAD, and FOD in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text-Revised are imperfect and have been criticized over the last decade. Proposed new criteria that take into account empirical findings and the diversity across women are recommended. There has been a flurry of new epidemiological studies on women’s sexual dysfunction; studies also assessing distress consistenly find a much lower prevalence of dysfunction if distress is considered. Assessment of sexual difficulties is best achieved through a biopsychosocial clinical interview of the woman and her partner (if possible); though laboratory investigations, a physical examination, psychophysiological measurement, and self-report questionnaires can often supplement the interview information. There are currently no approved pharmacological treatments for women’s sexual dysfunction in North America, though a number of promising agents have been studied. Evidence for the efficacy of psychological treatments is based on limited studies. There is an urgent need for more data on the assessment, etiology, and treatment of PGAD. Conclusions Specific recommendations for the assessment and treatment of women’s desire, arousal, and orgasm disorders are forwarded; however, more research into these domains is needed.

These data suggest that haemodynamic instability is strongly associated with a decreased HRV and an impaired sympathovagal balance, suggesting disturbed autonomic control in uraemic patients with cardiac damage. Patients with ischaemic heart disease, reduced left ventricular systolic function and decreased HRV may be at the highest risk to be haemodynamically unstable during haemodialysis. The role of early detection and treatment of ischaemic heart disease in preventing symptomatic hypotensive episodes in these patients remains to be determined.