From the Department of Psychology, University of Jaén (Reyes del Paso, Contreras-Merino), Jaén, Spain; and Institute of Psychology, UMIT (Duschek), Tirol, Austria.
Psychosom Med. 2022 Sep 1;84(7):793-802. doi: 10.1097/PSY.0000000000001097. Epub 2022 Jun 22.
Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia.
Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression ( n = 27), in participants with fibromyalgia without depression ( n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance.
Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls ( p values < .012, d values = 0.71-1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls ( p values < .013, d values = 0.62-0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls.
The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia.
先前的研究揭示了纤维肌痛患者自主心血管调节异常，这可能与症状发生以及纤维肌痛患者心血管疾病风险增加有关。本研究探讨了共病抑郁在纤维肌痛自主心血管失调中的作用。
在休息时和冷加压试验及算术任务期间，对 53 名患有纤维肌痛且患有抑郁（n=27）、患有纤维肌痛但无抑郁（n=26）和 29 名健康对照者进行心血管记录。评估的参数包括心搏间期、血压、心率变异性、压力反射敏感性、每搏输出量、射血前期、左心室射血时间、Heather 指数和总外周阻力。
患有纤维肌痛和抑郁的患者与仅患有纤维肌痛而无抑郁的患者和对照组相比，静息时的紧张性心搏间期、压力反射敏感性和心率变异性均较低（p 值均<.012，d 值=0.71-1.06）。这些变量在仅患有纤维肌痛而无抑郁的患者与对照组之间无差异。此外，患有纤维肌痛且伴抑郁的患者与对照组相比，Heather 指数、每搏输出量和左心室射血时间均较低（p 值均<.013，d 值=0.62-0.78）。但在射血前期或总外周阻力方面，各组之间无差异。与对照组相比，无论是否存在抑郁，纤维肌痛患者的舒张压、心搏间期、左心室射血时间和心率变异性的应激反应均降低。
抑郁在纤维肌痛自主神经失调中的作用涉及变时性心脏控制，而不是肾上腺素能对收缩力和血管张力的影响。心血管反应迟钝可能归因于纤维肌痛固有的病理因素。这些结果强调了在纤维肌痛管理中诊断和治疗共病抑郁障碍的重要性。
