Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure

Miyamoto, Shoichi; Fujita, Masatoshi; Sekiguchi, Hiroyuki; Okano, Yoshiaki; Nagaya, Noritoshi; Ueda, Kinzo; Tamaki, Shunichi; Nohara, Ryuji; Eiho, Shigeru; Sasayama, Shígetake

doi:10.1016/s0735-1097(01)01249-9

Cited by 46 publications

(42 citation statements)

References 18 publications

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“…10 Moreover, patients with chronic heart failure because of CAD prefer the right lateral decubitus position for significantly longer periods of time than either the left lateral decubitus or supine position, because the sympathetic nervous modulation is most attenuated in this position. 11,12 Modern medical research has found that the prone position can improve the arterial oxygen tension in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), [13][14][15][16][17][18] and is one of the suitable positions used during general or spinal anesthesia. 19,20 ALI and ARDS are severe clinical conditions that are associated with severe oxygenation failure and very high mortality rate.…”

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confidence: 99%

Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

Yang

Chen

Kuo

2008

Circ J

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BackgroundThis study compared the effect of 5 recumbent positions on cardiac autonomic nervous modulation in patients with coronary artery disease (CAD). Methods and ResultsSpectral heart rate variability analysis was performed on 33 CAD patients and 17 patients with patent coronary arteries in random order in 5 positions; namely, supine, right lateral decubitus, left lateral decubitus, left prone and right prone positions. In the right lateral decubitus position, the vagal modulation was the highest and the sympathetic modulation was the lowest among the 5 recumbent positions in the control group. In the CAD patients, the vagal modulation in the supine position was significantly lower than that in the other 4 positions. The lower the normalized high-frequency power (nHFP) in the supine position, the larger the percent age increase in nHFP when the position was changed from supine to another recumbent position in both CAD patients and controls. There was no significant change in the respiratory rate when the position was changed from supine to any of the other 4 positions. Conclusions Right lateral decubitus position leads to the highest vagal modulation in the controls, whereas the supine position leads to the lowest vagal modulation in the CAD patients. In addition to the right lateral decubitus position, both the right and left prone positions can be used as a vagal enhancer in patients with CAD as compared with supine, especially for those patients who have severely reduced cardiac vagal modulation while supine. (Circ J 2008; 72: 902 -908)

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Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

Yang

Chen

Kuo

2008

Circ J

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“…18,19 We consider it possible that the reason they failed to detect changes in power spectral density reflecting sympathetic or sympathovagal alterations may have been related to their failure to consider the patients' posture. Because LF/HF values in patients with CHF were shown to differ markedly among the three recumbent positions in our previous studies, 8,9 consideration of the patients' posture appears to be of great importance for analyzing HRV based on 24-h ambulatory ECG monitoring.…”

Section: Discussionmentioning

confidence: 89%

“…We previously showed that time spent in the right lateral decubitus position is significantly longer than that spent in the other recumbent positions in patients with CHF. 8,9 Therefore, the decrease in time spent in the right lateral decubitus position in these patients may itself be interpreted as a sign of improvement of CANA even without any subjective symptomatic relief.…”

Section: Discussionmentioning

confidence: 96%

“…One possible explanation for this finding may be that nLF, nHF, and LF/HF in the right lateral decubitus position had already been normalized by the self-protecting mechanism of this posture before the treatment. 8,9 The favorable effects of the right lateral decubitus position may counteract the exacerbation in CANA usually observed in patients with CHF. Values are means ± standard deviation.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Accordingly, when assessing any effects on CANA, we have to take the patients' posture into account.…”

Section: Introductionmentioning

confidence: 99%

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Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: Simultaneous recording of ambulatory electrocardiogram and posture

Tambara¹,

Fujita²,

Sumita³

et al. 2004

Clinical Cardiology

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Background: Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self‐protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA). Hypothesis: Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF. Methods: We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24‐h ambulatory electrocardiogram monitoring before and after an 8‐week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high‐frequency (0.15 to 0.40 Hz) power (nHF) and the low‐frequency (0.04 to 0.15 Hz)/high‐frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively. Results: When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 ± 20 vs. 52 ± 19 nu, p = 0.87; LF/HF, 1.39 ± 1.11 vs. 1.32 ± 1.32, p = 0.93; L, nHF, 28 ± 13 vs. 47 ± 19 nu, p = 0.019; LF/HF, 3.34 ± 2.48 vs. 1.56 ± 1.39, p = 0.029; S, nHF, 38 ± 17 vs. 53 ±16 nu, p = 0.0023; LF/HF, 2.43 ± 2.21 vs. 1.03 ± 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 ± 30 vs. 18 ± 24%, p = 0.0018; L, 11 ± 20vs. 27 ± 26%, p = 0.025). Conclusions: In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears afterthe treatment.

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Positional Central Sleep Apnea

Janssen

Verbraecken

Pevernagie

et al. 2014

Positional Therapy in Obstructive Sleep Apnea

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Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure

Abstract: The right lateral decubitus position in patients with CHF may be a self-protecting mechanism of attenuating the imbalance of cardiac autonomic nervous activity.

Cited by 46 publications

References 18 publications

Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: Simultaneous recording of ambulatory electrocardiogram and posture

Positional Central Sleep Apnea

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