Shaltout Hossam A, Lee Sung W, Tegeler Catherine L, Hirsch Joshua R, Simpson Sean L, Gerdes Lee, Tegeler Charles H
Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States.
University of Arizona School of Medicine, Phoenix, AZ, United States.
Front Public Health. 2018 Apr 25;6:116. doi: 10.3389/fpubh.2018.00116. eCollection 2018.
Heart rate variability (HRV) is an indicator of dynamic adaptability of the autonomic nervous system. Few interventions target upstream, cerebral cortex components of the heart-brain system for autonomic management. We report changes in HRV and baroreflex sensitivity (BRS), associated with use of a noninvasive, closed-loop, allostatic, computer-guided, acoustic stimulation neurotechnology.
Over 5 years, 220 subjects with heterogeneous neurological, cardiovascular, and psychophysiological conditions consecutively enrolled in a naturalistic, single-arm study exploring clinical effects associated with use of the neurotechnology. Of those, 202 completed the study protocol and 160 had recordings adequate to analyze HRV and BRS. Mean age was 44.0 (SD 19.4), with 130 women. Participants received a mean of 16.1 (5.2) sessions, over 24.2 days (23.3), with 9.5 (3.8) actual intervention days. Sessions included real-time analysis of brain electrical activity and software algorithm-guided translation of selected frequencies into patterns of acoustic stimulation (audible tones of variable pitch and timing), to facilitate auto-calibration of neural oscillations. Outcomes including 10-min supine, at-rest recordings of blood pressure and heart rate, and inventories for insomnia (ISI) and depression (CES-D or BDI-II), were obtained at baseline and 15.3 (16.7) days after the last session.
Compared to baseline, significant increases (all < 0.001) were observed for measures of HRV across all participants including the mean percentage change for SDNN 24.2% (SE 0.04), and RMSSD, 42.2% (0.08), and BRS [Sequence Up, 55.5% (0.09), Sequence Down, 77.6% (0.23), and Sequence All, 53.7% (0.07)]. Significant improvements were noted in SAP, MAP, and DAP, as well as natural log of HF, and total power. Self-reported ISI was reduced (ISI, -6.4 points, SD 5.6, < 0.001). The proportion reporting clinically significant depressive symptoms reduced from 48.2% at baseline to 22.1% at follow-up. Linear regression showed that rightward asymmetry predicted lower SDNN ( = 0.02). Exploratory analysis showed a trend for improved balance of temporal lobe high-frequency amplitudes over the course of initial sessions.
These findings indicate that use of a noninvasive, allostatic, closed-loop neurotechnology appears to have robust potential for public health efforts to support greater flexibility in autonomic cardiovascular regulation, through self-optimization of electrical activity at the level of the brain.
心率变异性（HRV）是自主神经系统动态适应性的一个指标。很少有干预措施针对心脏 - 脑系统上游的大脑皮层成分进行自主管理。我们报告了与使用一种非侵入性、闭环、适应性、计算机引导的声学刺激神经技术相关的HRV和压力反射敏感性（BRS）的变化。
在5年时间里，220名患有不同神经、心血管和心理生理疾病的受试者连续参加了一项自然主义的单臂研究，探索与使用该神经技术相关的临床效果。其中，202名完成了研究方案，160名有足够的记录来分析HRV和BRS。平均年龄为44.0岁（标准差19.4），女性130名。参与者平均接受了16.1（5.2）次治疗，历时24.2天（23.3），实际干预天数为9.5（3.8）天。治疗包括对脑电活动的实时分析以及软件算法引导下将选定频率转换为声学刺激模式（可变音高和时间的可听音调），以促进神经振荡的自动校准。在基线和最后一次治疗后15.3（16.7）天，获取了包括10分钟仰卧位静息时的血压和心率记录，以及失眠（ISI）和抑郁（CES - D或BDI - II）量表。
与基线相比，所有参与者的HRV指标均显著增加（均P < 0.001），包括SDNN的平均百分比变化24.2%（标准误0.04）、RMSSD的42.2%（0.08），以及BRS[序列上升，55.5%（0.09），序列下降，77.6%（0.23），序列全部，53.7%（0.07）]。收缩压、平均动脉压和舒张压以及高频功率的自然对数均有显著改善。自我报告的ISI降低（ISI，-6.4分，标准差5.6，P < 0.001）。报告有临床显著抑郁症状的比例从基线时的48.2%降至随访时的22.1%。线性回归显示右侧不对称预测较低的SDNN（P = 0.02）。探索性分析显示在初始治疗过程中颞叶高频振幅平衡有改善趋势。
这些发现表明，使用一种非侵入性、适应性、闭环神经技术似乎在公共卫生方面具有强大潜力，可通过大脑水平的电活动自我优化来支持自主心血管调节的更大灵活性。
