Deep Breathing Increases Heart Rate Variability in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus

Abstract

Background/ObjectiveAutoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been associated with an impaired function of the autonomic nervous system and reduced vagus nerve (VN) tone measured through lower heart rate variability (HRV). Targeting the VN through electrical stimulation has been proposed as a treatment strategy with promising results in patients with RA. Moreover, it has been suggested that the VN can be stimulated physiologically through deep breathing. In this study, the aim was to investigate if the VN can be stimulated through deep breathing in patients with RA and SLE, as measured by HRV.MethodsFifty-seven patients with RA and SLE performed deep breathing exercises for 30 minutes in this explorative study. Before the breathing exercise, 2 electrocardiogram recordings were obtained to determine the patient's baseline HRV during rest. After the 30-minute breathing exercise, 5 minutes of electrocardiogram recordings were obtained to determine postintervention HRV and used as a measure of vagal activity.ResultsNo change was observed in the HRV between the 2 recordings prior the exercise, but the heart rate and HRV significantly decreased and increased, respectively, after the deep breathing exercise.ConclusionsHRV can be modulated in patients with RA and SLE; this may have implications for future treatment with medications in conjunction with deep breathing. However, the biological and clinical effect of deep breathing must be investigated in future studies.

The role of the cholinergic anti‐inflammatory pathway in autoimmune rheumatic diseases

“…Systemic lupus erythematosus is a multi-systemic autoimmune disease, involving the musculoskeletal system, cardiovascular system, urinary system, immune system, etc; and the main clinical manifestations are as follows: changes of skin and mucous membranes, especially the erythematous facial rash with a butterfly distribution across the malar and nasal prominences; arthralgias and non-erosive arthritis of joints on the hands; glomerular inflammation, necrosis; pericarditis and valve nodules. 90 Vagus nerve tone is reduced and autonomic nervous system function is damaged in SLE, 91 and a double-blind study on 18 patients with SLE suggests that transcutaneous auricular VNS reduced pain, fatigue and joint score obviously compared to sham stimulation, 92 but how does VNS produce this effect is unclear; besides the decreased vagus nerve activity, expression of α7nAChR is also reduced, which aggravate the inflammatory response. 93 A current study found agents aimed at α7nAChR have little effect on mice with late-stage SLE 94 ; this suggests that long-term receptor dysfunction may be irreversible and treatment should be carried out as soon as possible in the early stage of the disease.…”

“…Vagus nerve tone is reduced and autonomic nervous system function is damaged in SLE, 91 and a double‐blind study on 18 patients with SLE suggests that transcutaneous auricular VNS reduced pain, fatigue and joint score obviously compared to sham stimulation, 92 but how does VNS produce this effect is unclear; besides the decreased vagus nerve activity, expression of α7nAChR is also reduced, which aggravate the inflammatory response 93 . A current study found agents aimed at α7nAChR have little effect on mice with late‐stage SLE 94 ; this suggests that long‐term receptor dysfunction may be irreversible and treatment should be carried out as soon as possible in the early stage of the disease.…”

Heart rate variability analysis in rheumatology: past, present… and future?

“…M. Martinez-Lavin (15). HRV has generally been used to assess the deleterious impact of an autoimmune disease on ANS function.…”

Modulating Heart Rate Variability through Deep Breathing Exercises and Transcutaneous Auricular Vagus Nerve Stimulation: A Study in Healthy Participants and in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus

“…Another way to stimulate the VN is through deep breathing (DB) exercises [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The mechanisms through which DB stimulates the VN are not well established, but are believed to include peripheral factors, such as the baroreflex, the peripheral chemoreflex, the Bainbridge reflex, and the Heuring–Breuer reflex, as well as such central elements as the respiratory and cardiovascular centers in the brainstem [ 38 ].…”

“…Most of the studies that have investigated DB tested the effect on HRV, and even though the methods of DB exercises used in these studies vary distinctively, a general increase in HRV parameters was found. Only two studies investigated the effect of DB in patients with RA and SLE, where DB increased the HRV parameters [ 36 , 37 ]. Furthermore, Twal et al found that yogic DB can decrease cytokine levels in saliva in healthy participants [ 32 ].…”