Department of Medicine, University of California, San Francisco, CA.
San Francisco Veterans Affairs Health Care System, San Francisco, CA.
Menopause. 2018 Dec;25(12):1470-1475. doi: 10.1097/GME.0000000000001153.
The aim of the study was to examine whether anxiety and depressive symptoms are associated with an adverse cardiac autonomic profile among midlife women with hot flashes.
Anxiety and depressive symptoms were evaluated by validated self-administered questionnaires among peri- and postmenopausal women in a randomized trial of slow-paced respiration for hot flashes. Pre-ejection period (PEP), a marker of sympathetic activation, and respiratory sinus arrhythmia (RSA), a marker of parasympathetic activation, were measured at baseline and 12 weeks using impedance cardiography and electocardiography. Multivariable repeated measures linear regression models examined associations between anxiety and depression symptoms and autonomic markers, corrected for multiple comparisons with Benjamini-Hochberg procedure, and adjusted for age and body mass index.
Among the 121 participants, greater state anxiety was associated with shorter PEP, reflecting higher sympathetic activity (β = -0.24, P = 0.02). Greater trait anxiety and cognitive anxiety were associated with lower RSA, reflecting decreased parasympathetic activity (β = -0.03, P < 0.01 for Spielberger Trait Anxiety; β = -0.06, P = 0.02 for Hospital Anxiety and Depression Scale [HADS] Anxiety Subscale). Greater depressive symptoms were associated with lower RSA (β = -0.06, P = 0.03 for HADS Depression Subscale; β = -0.03, P = 0.04 for Beck Depression Inventory).
Among peri- and postmenopausal women with hot flashes, greater self-reported anxiety and depressive symptoms were associated with lower levels of resting cardiac parasympathetic activity, and greater state anxiety was associated with higher levels of cardiac sympathetic activity. Findings suggest that midlife women with increased anxiety and depressive symptoms may have an unfavorable cardiac autonomic profile with potential implications for their overall cardiovascular risk.
本研究旨在探讨围绝经期和绝经后女性出现热潮红时，焦虑和抑郁症状是否与不良心脏自主神经特征相关。
在一项针对热潮红的缓慢呼吸随机试验中，使用经过验证的自我管理问卷评估焦虑和抑郁症状。在基线和 12 周时，使用阻抗心动图和心电图测量射前期（PEP），这是交感神经激活的标志物，以及呼吸窦性心律失常（RSA），这是副交感神经激活的标志物。使用多变量重复测量线性回归模型，在贝叶斯-霍赫贝格程序校正多重比较后，调整年龄和体重指数，探讨焦虑和抑郁症状与自主神经标志物之间的关联。
在 121 名参与者中，状态焦虑程度越高，PEP 越短，反映出更高的交感神经活动（β=-0.24，P=0.02）。特质焦虑和认知焦虑越高，RSA 越低，反映出副交感神经活动降低（Spielberger 特质焦虑β=-0.03，P<0.01；医院焦虑和抑郁量表[HADS]焦虑分量表β=-0.06，P=0.02）。抑郁症状越严重，RSA 越低（HADS 抑郁分量表β=-0.06，P=0.03；贝克抑郁量表β=-0.03，P=0.04）。
在出现热潮红的围绝经期和绝经后女性中，自我报告的焦虑和抑郁症状越严重，静息心脏副交感神经活动水平越低，状态焦虑越严重，心脏交感神经活动水平越高。研究结果表明，焦虑和抑郁症状增加的中年女性可能具有不良的心脏自主神经特征，这可能对其整体心血管风险产生影响。
