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社区样本中的累积压力与自主神经调节异常

Cumulative stress and autonomic dysregulation in a community sample.

作者信息

Lampert Rachel, Tuit Keri, Hong Kwang-Ik, Donovan Theresa, Lee Forrester, Sinha Rajita

机构信息

a Department of Medicine , Yale University School of Medicine , New Haven , CT , USA ;

b Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.

出版信息

Stress. 2016 May;19(3):269-79. doi: 10.1080/10253890.2016.1174847. Epub 2016 Apr 25.

Abstract

Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers (N = 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview (CAI), a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24-h ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors and cumulative adverse life events (CALE) were all inversely associated with ultra low-frequency (ULF), very low-frequency (VLF) and low-frequency (LF) power and SDNN (all p < 0.05). In hierarchical regression analyses, total cumulative stress and chronic stress each was significantly associated with SDNN and ULF even after the highly significant contributions of age and sex, with no other covariates accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance alone but were not longer significant after adjusting for race and health behaviors. In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial.

摘要

累积压力,包括慢性压力和不良生活事件,是否与心率变异性(HRV)降低相关尚不清楚,HRV是一种预测心血管不良结局的自主神经状态的非侵入性指标。健康的社区居住志愿者(N = 157,平均年龄29岁)参加了累积压力/逆境访谈(CAI),这是一项包含140个项目的事件访谈,用于测量累积逆境,包括重大生活事件、生活创伤、近期生活事件和慢性压力源,并接受了24小时动态心电图监测。在频域中分析HRV并计算NN间期的标准差(SDNN)。初步简单回归分析显示,累积压力总分、慢性压力源和累积不良生活事件(CALE)均与超低频(ULF)、极低频(VLF)和低频(LF)功率以及SDNN呈负相关(所有p < 0.05)。在分层回归分析中,即使在年龄和性别贡献非常显著之后,累积压力总分和慢性压力各自仍与SDNN和ULF显著相关,没有其他协变量能够解释额外的可观方差。对于VLF和LF,累积压力总分和慢性压力单独对方差均有显著贡献,但在调整种族和健康行为后不再显著。总之,累积压力总分及其不良生活事件和慢性压力成分与通过HRV测量的心脏自主神经功能降低相关。研究结果提示了压力可能对健康个体死亡率产生不利影响的一种潜在机制。包括压力管理在内的一级预防策略可能被证明是有益的。

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