Slow Breathing Increases Arterial Baroreflex Sensitivity in Patients With Chronic Heart Failure

Bernardi, Luciano; Porta, Cesare; Spicuzza, Lucia; Bellwon, Jerzy; Spadacini, Giammario; Frey, Axel W.; Yeung, Ling-Fung; Sanderson, John E.; Pedretti, Roberto F.E.; Tramarin, Roberto

doi:10.1161/hc0202.103311

Cited by 243 publications

(210 citation statements)

References 17 publications

(20 reference statements)

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“…It is believed that the lung inflation exerts a modulatory influence on central sympathetic neural outflow under resting conditions. 13,14 Some investigators also found that slow-breathing increases the baroreflex sensibility in hypertensives, normotensives 15 and also in patients with chronic heart failure, 16 what explains good results after 8 weeks of practice at home. Grossman et al 1 speculated that the repeated response to acute slow-and regular-breathing reverses the vascular pathology associated with hypertension, which is partially determined by the vascular tone, which is controlled by the sympathetic activity, and in this study, we observed that at least the peripheral sympathetic activity is reduced during slow-breathing exercises.…”

Section: Discussionmentioning

confidence: 98%

“…It is believed that the autonomic nervous system, through stimulation of arterial baroreceptor, pulmonary stretch receptors and low pressure baroreceptors, may have important roles in changes of BP. 15,18 Bernardi et al 16 reported that BP decrease in slower or deeper breathing is due to relative increase in vagal activity, decreased sympathetic activity and reduced afterload.…”

Section: Discussionmentioning

confidence: 99%

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Sympathetic nerve activity is decreased during device-guided slow breathing

et al. 2010

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It is known that slow breathing (o10 breaths min -1 ) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n¼14) or while subjects listened to calm music (n¼13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16 ± 3 beats per minute (b.p.m) to 5.5 ± 1.8 b.p.m (Po0.05), calm music did not affect this variable. Both interventions reduced systolic (À6 and À4 mm Hg for both) and diastolic BPs (À4 mm Hg and À3 mm Hg, respectively) and did not affect the HR (À1 and À2 b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (À8 bursts min -1 ). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Sympathetic nerve activity is decreased during device-guided slow breathing

et al. 2010

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“…These include inhibition of sympathetic outflow during exhalation and arteriolar vasodilatation, [33][34][35][36] which may be of benefit to patients with hypertension and congestive heart failure. 37,38 This may not be the case in diabetic patients due to autonomic dysfunction. 39 Neuropathy, a common complication in diabetes, is caused by damage to the blood vessels that supply the nerve fibres and might be expected to reduce the benefit provided by the device.…”

Section: Discussionmentioning

confidence: 99%

Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

et al. 2008

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The objective of the study was to evaluate the efficacy of device-guided breathing to lower blood pressure (BP) in hypertensive type II diabetic patients. A randomized controlled trial was carried out in four urban family practice clinics in Israel. Non-insulin-dependent diabetic, hypertensive patients with uncontrolled BP, receiving antihypertensive therapy or those non-medicated were enrolled. Baseline characteristics of the 66 patients who completed the study (33 intervention and 33 control) were: 62% men, age 62±8 years (mean±s.d.); body mass index 29±5 kg/m 2 ; systolic BP 148±11 mm Hg and diastolic BP 81 ± 9 mm Hg. The intervention group used a device (RESPeRATE), which interactively guides the user towards slow and regular breathing by synchronizing respiration voluntarily to musical tones for 15 min daily for an 8-week period. The control group continued with their regular treatment. BP was measured in the clinic at baseline, after 4 weeks and at 8 weeks.Medication was unchanged for 4 weeks prior to and during the study period. The main outcome measure was the office BP change from baseline to the end of the 8-week period. BP was reduced in the treatment group (mean ± s.e.) systolic À10.0 ± 1.8 mm Hg and diastolic À3.6 ± 1.3 mm Hg (Po0.0001 and Po0.01), but not in the controls þ 1.6±2.1 and À1.0±1.4 mm Hg P40.4 and P40.4, respectively. Test for between group difference Po0.0001 and P ¼ 0.08. The subjects were highly compliant with the treatment, performing 75% of the requested exercise sessions. Greater BP reduction was observed with increased compliance with device usage (P ¼ 0.01 and P ¼ 0.001). It is concluded that self-treatment with device-guided breathing at home for 8 weeks by non-insulin-dependent diabetic patients was associated with a substantial reduction in office systolic BP.

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“…Slow breathing training has been shown to be beneficial in cardiovascular disease (Bernardi, Spadacini, Bellwon, et al, 1998;Schein, Gavish, Herz, et al, 2001), probably due to its potential to increase baroreflex PCO2 Biofeedback in Asthma 19 sensitivity (Bernardi, Porta, Spicuzza, et al, 2002;Joseph, Porta, Casucci, et al, 2005).…”

Section: Pco2 Biofeedback In Asthma 18mentioning

confidence: 99%

Targeting pCO2 in Asthma: Pilot Evaluation of a Capnometry-Assisted Breathing Training

Meuret

Ritz

Wilhelm

et al. 2007

Appl Psychophysiol Biofeedback

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Objectives: This pilot study aimed to evaluate the feasibility and potential benefits of a novel biofeedback breathing training for achieving sustained increases in pCO2 levels.Methods: Twelve asthma patients were randomly assigned to an immediate 4-week treatment group or waiting list control. Patients were instructed to modify their respiration in order to change levels of end-tidal pCO2 using a hand-held capnometer. Treatment outcome was assessed in frequency and distress of symptoms, asthma control, lung function, and variability of peak expiratory flow (PEF).Results: We found stable increases in pCO2 and reductions in respiration rate during treatment and 2-month follow-up. Mean pCO2 levels rose from a hypocapnic to a normocapnic range at follow-up. Frequency and distress of symptoms was reduced and reported asthma control increased. In addition, mean PEF variability decreased significantly in the treatment group.Conclusions: Our pilot intervention provided evidence for the feasibility of pCO2-biofeedback training in asthma patients.Response to Reviewers: Dear Dr. Gevirtz, Thank you for the latest comments on our manuscript "Targeting PCO2 in asthma: Pilot-evaluation of a capnometry-assisted breathing training" (APBI55). We have now amended the manuscript by following the reviewrs suggestions in the remaining details. The amended passages are marked in yellow.Thank you for the opportunity to have our work reviewed for your journal. We are excited that it has generated sufficient interest among our reviewers and look forward to seeing it in press. Please let us know if you need more information or materials.

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Slow Breathing Increases Arterial Baroreflex Sensitivity in Patients With Chronic Heart Failure

Cited by 243 publications

References 17 publications

Sympathetic nerve activity is decreased during device-guided slow breathing

Sympathetic nerve activity is decreased during device-guided slow breathing

Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

Targeting pCO2 in Asthma: Pilot Evaluation of a Capnometry-Assisted Breathing Training

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