Stress and the “extended” autonomic system

Goldstein, David S.

doi:10.1016/j.autneu.2021.102889

Cited by 24 publications

(20 citation statements)

References 179 publications

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“…During the first minutes and hours after stroke onset, patients experience various stressors when they realize their neurological dysfunction and the emergency hospital admission and treatment [30, 31]. Such stressors activate the “central stress system” [29], a part of the central autonomic network that triggers the “stress syndrome,” which comprises decreased parasympathetic outflow and increased norepinephrine and epinephrine levels [29], changes that manifest as reduced overall, particularly parasympathetic, cardiovascular autonomic modulation and BRS and cause increased heart rate, BP, and respiration [32–35]. Thus, the acute mental stress causes autonomic changes similar to those recorded in our patients during the first 24 h after stroke onset (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Psychological stress experienced by patients suffering an acute stroke contributes to CAD [29–31]. During the first minutes and hours after stroke onset, patients experience various stressors when they realize their neurological dysfunction and the emergency hospital admission and treatment [30, 31].…”

Section: Discussionmentioning

confidence: 99%

“…Some of the drugs may also have contributed to buffering autonomic effects of the initial stress experience; particularly beta‐blockers and centrally acting antihypertensive drugs, for example, moxonidine and clonidine, mitigate sympathetic hyperactivity and have fear‐reducing effects [41, 45–47] that help attenuate autonomic alterations resulting from the acute stress syndrome [29].…”

Section: Discussionmentioning

confidence: 99%

“…We assume that the swift autonomic improvement was related to a minor central autonomic network dysfunction upon stroke, and that psychological stress upon stroke onset caused an acute “stress syndrome” adding to the CAD recorded during our first measurement [29]. Quite likely, the mindful care and continuous monitoring on the stroke unit reduced stressors and supported the rapid CAD recovery [36].…”

Section: Conclusion and Clinical Relevancementioning

confidence: 99%

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Rapid recovery of poststroke cardiac autonomic dysfunction: Causes to be considered

Wang

Moeller

Akhundova

et al. 2023

Euro J of Neurology

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Background and purpose Acute stroke frequently causes cardiovascular–autonomic dysfunction (CAD). Studies of CAD recovery are inconclusive, whereas poststroke arrhythmias may wane within 72 h. We evaluated whether poststroke CAD recovers within 72 h upon stroke onset in association with neurological improvement or increased use of cardiovascular medication. Methods In 50 ischemic stroke patients (68 ± 13 years old) who—prior to hospital‐admission—had no known diseases nor took medication affecting autonomic modulation, we assessed National Institutes of Health Stroke Scale (NIHSS) scores, RR intervals (RRIs), systolic and diastolic blood pressure (BP), respiration rate, parameters reflecting total autonomic modulation (RRI SD, RRI total powers), sympathetic modulation (RRI low‐frequency powers, systolic BP low‐frequency powers), and parasympathetic modulation (square root of mean squared differences of successive RRIs [RMSSD], RRI high‐frequency powers), and baroreflex sensitivity within 24 h (Assessment 1) and 72 h after stroke onset (Assessment 2) and compared data to those of 31 healthy controls (64 ± 10 years). We correlated delta NIHSS values (Assessment 1 – Assessment 2) with delta values of autonomic parameters (Spearman rank correlation tests; significance: p < 0.05). Results At Assessment 1, patients were not yet on vasoactive medication and had higher systolic BP, respiration rate, and heart rate, that is, lower RRIs, but lower RRI SD, RRI coefficient of variance, RRI low‐frequency powers, RRI high‐frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity. At Assessment 2, patients were on antihypertensives, had higher RRI SD, RRI coefficient of variance, RRI low‐frequency powers, RRI high‐frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity but lower systolic blood pressure and NIHSS values than at Assessment 1; values no longer differed between patients and controls except for lower RRIs and higher respiration rate in patients. Delta NIHSS scores correlated inversely with delta values of RRI SD, RRI coefficient of variance, RMSSDs, RRI low‐frequency powers, RRI high‐frequency powers, RRI total powers, and baroreflex sensitivity. Conclusions In our patients, CAD recovery was almost complete within 72 h after stroke onset and correlated with neurological improvement. Most likely, early initiation of cardiovascular medication and probably attenuating stress supported rapid CAD recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Conclusion and Clinical Relevancementioning

confidence: 99%

See 2 more Smart Citations

Rapid recovery of poststroke cardiac autonomic dysfunction: Causes to be considered

Wang

Moeller

Akhundova

et al. 2023

Euro J of Neurology

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“…An estimated 2.5% of post-COVID patients have persistent symptoms of orthostatic intolerance ( 19 ). Further research is needed to elucidate the mechanisms of long-COVID fatigue and orthostatic intolerance, which may include direct tissue damage, cytokine storm, immune dysregulation, hormonal imbalance, or persistent low-grade infection ( 20 ), and to identify effective treatments.…”

Section: Looking Forwardmentioning

confidence: 99%

The grand challenge of autonomic disorders

Cheshire

2022

Front. Neurol.

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Infant emotion regulation in the context of stress: Effects of heart rate variability and temperament

Weiss,

Keeton,

Leung

et al. 2024

Stress and Health

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Stressful events are inherently emotional. As a result, the ability to regulate emotions is critical in responding effectively to stressors. Differential abilities in the management of stress appear very early in life, compelling a need to better understand factors that may shape the capacity for emotion regulation (ER). Variations in both biologic and behavioural characteristics are thought to influence individual differences in ER development. We sought to determine the differential contributions of temperament and heart rate variability (HRV; an indicator of autonomic nervous system function) to infant resting state emotionality and emotional reactivity in response to a stressor at 6 months of age. Participants included 108 mother‐infant dyads. Mothers completed a measure of infant temperament at 6 months postnatal. Mother and infant also participated in a standardized stressor (the Repeated Still Face Paradigm) at that time. Electrocardiographic data were acquired from the infant during a baseline resting state and throughout the stressor. Fast Fourier Transformation was used to analyse the high frequency (HF) domain of HRV, a measure of parasympathetic nervous system activity. Infant ER was measured via standardized coding of emotional distress behaviours from video‐records at baseline and throughout the stressor. Severity of mothers' depressive symptoms was included as a covariate in analyses. Results of linear regression indicate that neither temperament nor HRV were associated significantly with an infant's emotional resting state, although a small effect size was found for the relationship between infant negative affectivity and greater emotional distress (β = 0.23, p = 0.08) prior to the stressor. Higher HF‐HRV (suggesting parasympathetic dominance) was related to greater emotional distress in response to the stressor (β = 0.34, p = 0.009). This greater emotional reactivity may reflect a more robust capacity to mount an emotional response to the stressor when infants encounter it from a bedrock of parasympathetic activation. Findings may inform eventual markers for assessment of ER in infancy and areas for intervention to enhance infant management of emotions, especially during stressful events.

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Stress and the “extended” autonomic system

Cited by 24 publications

References 179 publications

Rapid recovery of poststroke cardiac autonomic dysfunction: Causes to be considered

Rapid recovery of poststroke cardiac autonomic dysfunction: Causes to be considered

The grand challenge of autonomic disorders

Infant emotion regulation in the context of stress: Effects of heart rate variability and temperament

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