Servant D, Logier R, Mouster Y, Goudemand M
Service de Psychiatrie Générale, Hôpital Fontan, CHRU de Lille, rue Verhaeghe, 59037 Lille Cedex, France.
Encephale. 2009 Oct;35(5):423-8. doi: 10.1016/j.encep.2008.06.016. Epub 2008 Dec 18.
The autonomic nervous system sends messages through the sympathetic and parasympathetic nervous system. The sympathetic nervous system innervates the cardioaccelerating center of the heart, the lungs (increased ventilatory rhythm and dilatation of the bronchi) and the non-striated muscles (artery contraction). It releases adrenaline and noradrenaline. As opposed to the sympathetic nervous system, it innervates the cardiomoderator center of the heart, the lungs (slower ventilatory rhythm and contraction of the bronchi) and the non-striated muscles (artery dilatation). It uses acetylcholine (ACh) as its neurotransmitter. Sympathetic and parasympathetic divisions function antagonistically to preserve a dynamic modulation of vital functions. These systems act on the heart respectively through the stellar ganglion and the vagus nerve. The interaction of these messages towards the sinoauricular node is responsible for normal cardiac variability, which can be measured by monitoring heart rate variability (HRV). Heart rate is primarily controlled by vagal activity. Sensorial data coming from the heart are fed back to the central nervous system. HRV is an indicator of both how the central nervous system regulates the autonomic nervous system, and of how peripheral neurons feed information back to the central level. HRV measures are derived by estimating the variation among a set of temporally ordered interbeat intervals. The state of perfect symmetry, which, in medical parlance, is called respiratory sinus arrhythmia (RSA), can be described as a state of cardiac coherence. Obtaining a series of interbeat intervals requires a continuous measure of heart rate, typically electrocardiography (ECG). Commercially available software is then used to define the interbeat intervals within an ECG recording.
The autonomic nervous system is highly adaptable and allows the organism to maintain its balance when experiencing strain or stress. Conversely, a lack of flexibility and a rigid system can lead to somatic and psychological pathologies. Several studies have shown a link between reduced HRV in postmyocardial infarction patients and increased risk for adverse cardiovascular events, including ventricular arrhythmias and sudden death. Recently, studies indicate that patients with depression and anxiety disorders exhibit abnormally low HRV compared with non-psychiatric controls. Reduced HRV seems indicate decreased cardiac vagal tone and elevated sympathetic activity in anxious and depressive patients and would reflect deficit in flexibility of emotional physiological mechanisms. A few studies have also revealed that biofeedback using respiratory control, relaxation and meditation techniques can increase HRV. For now, there is insufficient data to determine if paced respiration or subjective relaxation is necessary or sufficient for the efficacy of HRV biofeedback. Although the literature is modest, this review suggests that the use of biofeedback with relaxation and meditation approaches may result in increased HRV and parasympathetic activity. Limitations of the review literature have also been considered to identify areas for future research.
自主神经系统通过交感神经系统和副交感神经系统传递信息。交感神经系统支配心脏的心脏加速中枢、肺部（增加通气节律和支气管扩张）和非横纹肌（动脉收缩）。它释放肾上腺素和去甲肾上腺素。与交感神经系统相反，副交感神经系统支配心脏的心脏抑制中枢、肺部（较慢的通气节律和支气管收缩）和非横纹肌（动脉扩张）。它使用乙酰胆碱（ACh）作为神经递质。交感神经和副交感神经分支发挥拮抗作用，以维持对重要功能的动态调节。这些系统分别通过星状神经节和迷走神经作用于心脏。这些信息与窦房结之间的相互作用负责正常的心脏变异性，这可以通过监测心率变异性（HRV）来测量。心率主要受迷走神经活动控制。来自心脏的感觉数据反馈到中枢神经系统。HRV是中枢神经系统调节自主神经系统方式以及外周神经元如何将信息反馈到中枢水平的指标。HRV测量值是通过估计一组按时间顺序排列的心跳间期之间的变化得出的。完美对称的状态，在医学术语中称为呼吸性窦性心律不齐（RSA），可以描述为心脏相干状态。获取一系列心跳间期需要连续测量心率，通常采用心电图（ECG）。然后使用市售软件定义ECG记录中的心跳间期。
自主神经系统具有高度适应性，使机体在经历压力或应激时能够保持平衡。相反，缺乏灵活性和僵化的系统会导致躯体和心理疾病。多项研究表明，心肌梗死后患者HRV降低与不良心血管事件风险增加之间存在关联，包括室性心律失常和猝死。最近，研究表明，与非精神科对照相比，抑郁症和焦虑症患者的HRV异常低。HRV降低似乎表明焦虑和抑郁患者的心脏迷走神经张力降低和交感神经活动增强，这将反映情绪生理机制灵活性的不足。一些研究还表明，使用呼吸控制、放松和冥想技术进行生物反馈可以增加HRV。目前，没有足够的数据来确定有节奏的呼吸或主观放松对于HRV生物反馈的疗效是否必要或充分。尽管相关文献较少，但本综述表明，将生物反馈与放松和冥想方法结合使用可能会增加HRV和副交感神经活动。本综述文献的局限性也已被考虑，以确定未来研究的领域。
