Licht Carmilla M M, de Geus Eco J C, van Dyck Richard, Penninx Brenda W J H
Department of Psychiatry, EMGO Institute, VU University Medical Center, AJ Ernststraat 887, 1081 HL, Amsterdam, The Netherlands.
Psychosom Med. 2009 Jun;71(5):508-18. doi: 10.1097/PSY.0b013e3181a292a6. Epub 2009 May 4.
To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants.
The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059).
Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20-0.80 for SDNN and 0.42-0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA.
This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants.
在一个有足够样本量以检验生活方式和抗抑郁药混杂效应的样本中，确定不同类型焦虑症（惊恐障碍、社交恐惧症、广泛性焦虑症）患者与健康对照相比是否具有更高的心率和更低的心率变异性。
在参与荷兰抑郁与焦虑研究（NESDA）的2059名受试者（平均年龄 = 41.7岁，66.8%为女性）中测量正常到正常间期的标准差（SDNN）、心率（HR）和呼吸性窦性心律不齐（RSA）。根据《精神疾病诊断与统计手册》第4版（DSM-IV）和复合国际诊断访谈（CIDI），NESDA参与者被分为健康对照（n = 616）、早年有焦虑诊断的受试者（n = 420）和当前有焦虑诊断的受试者（n = 1059）。
当前焦虑的受试者与对照相比，SDNN和RSA显著更低。缓解期焦虑的受试者与对照相比，RSA也显著更低。这三种不同类型焦虑症的这些关联相似。对生活方式进行调整影响不大。然而，对抗抑郁药使用进行额外调整后，焦虑与心率变异性之间的所有显著关联均变为不显著。使用三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂或其他抗抑郁药的焦虑受试者与对照相比，平均SDNN和RSA显著更低（SDNN的效应量 = 0.20 - 0.80，RSA的效应量 = 0.42 - 0.79）。未用药的焦虑受试者在平均SDNN和RSA方面与对照无差异。
本研究表明，焦虑症与显著更低的心率变异性相关，但这种关联似乎是由抗抑郁药的作用驱动的。
