War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Discipline of Psychology, Murdoch University, Murdoch, WA 6150, Australia.
War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America.
Life Sci. 2021 Jul 15;277:119604. doi: 10.1016/j.lfs.2021.119604. Epub 2021 May 11.
Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up.
We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75).
Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT.
To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.
越来越多的证据表明，海湾战争病（GWI）的特征是自主神经系统功能障碍（心率升高[HR]，心率变异性[HRV]降低）。瑜伽——一种将正念、呼吸法和身体姿势相结合的古老身心练习——被认为可以改善自主功能障碍，但这在 GWI 中尚未得到验证。我们旨在确定：（i）接受瑜伽或认知行为疗法（CBT）治疗疼痛的 GWI 退伍军人的 HR 和 HRV 是否有所改善；以及（ii）基线自主功能是否预测整个随访过程中与治疗相关的疼痛结果。
我们对 GWI 退伍军人接受瑜伽或 CBT 治疗疼痛的随机对照试验（ClinicalTrials.govNCT02378025；N=75）的 24 小时动态心脏数据（平均 HR、连续 R-R 间期均方根差的平方根[RMSSD]、高频功率[HF-HFV]和低频与高频比值[LF/HF]，从睡眠第一小时的 5 分钟窗口中提取）进行了二次分析。
接受 CBT 的退伍军人在治疗结束时的平均 HR 呈上升趋势。基线时更好的自主功能（更低的平均 HR，更高的 RMSSD/HF-HRV）预测了整个随访过程中疼痛的更大减轻，无论治疗组如何。更好的基线自主功能（RMSSD/HF-HRV 的中等到较高范围）也预示着瑜伽治疗的疼痛减轻更大，而较差的基线自主功能（较高的平均 HR，较低的 RMSSD/HF-HRV）则预示着 CBT 治疗的疼痛减轻更大。
据我们所知，这是第一项表明在 GWI 退伍军人中，HR 可能随 CBT 而增加，但随瑜伽而保持稳定的研究。此外，HR 和 HRV 调节了瑜伽和 CBT 的整个随访过程中的疼痛结果。
