Acute Effects of Slow-Paced Breathing on Measures of HRV in Hospitalized Patients With Bilateral COVID-19 Pneumonia: A Secondary Analysis of a Randomized Clinical Trial.

IF 2.9 3区医学 Q2 PSYCHIATRY Psychosomatic Medicine Pub Date : 2025-01-01 DOI:10.1097/PSY.0000000000001354

Elisabeth Maria Balint, Beate Grüner, Harald Gündel, Sophia Haase, Mandakini Kaw-Geppert, Julian Thayer, Katja Weimer, Marc N Jarczok

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Abstract

Objective: Slow-paced breathing (SPB) with prolonged exhalation is assumed to stimulate vagal reflexes, which is represented by increased heart rate variability (HRV) values. However, most trials were conducted in healthy participants. We sought to evaluate the feasibility of SPB in hospitalized patients with confirmed bilateral COVID-19 pneumonia with major respiratory impairment and to investigate if SPB shows acute increasing effects on HRV measures in these severely ill patients with distinctly reduced vagal tone.

Methods: This single-center randomized controlled clinical trial enrolled 23 patients in the intervention (4-second inhalation, 6-second exhalation for 20 minutes 3× daily) and 23 patients in the control group (IG/CG). The effects of SPB on HRV were calculated using post-hoc likelihood ratio tests. Baseline HRV measures between the groups over time were compared using multilevel mixed-effect linear regression models with random slope including the covariates relevant comorbidities, COVID-19 medication, and age.

Results: HRV values at baseline were significantly decreased in all patients. During SPB, HRV parameters increased significantly (ln(SDNN), ln(LF), ln(TP); all p < .001). Higher breathing rate at baseline correlated with lower LF during SPB (p < .045). IL-6 morning levels were associated with lower HRV measures (p < .001). Resting HRV measures as well as subjective health increased over hospitalization time with no differences between IG and CG (comparing random slope with random slope interaction models: all LR χ2(5) < 4.5; p > .48).

Conclusion: SPB is feasible and safe in patients with bilateral COVID-19 pneumonia and appears to be an effective self-performed intervention to acutely increase HRV measures. This observation was independent of comorbidities and comedication. Further trials should corroborate these findings and extend it to other severely ill populations.

Registration: German Clinical Trials Register under ID DRKS00023971 (https://drks.de/search/en/trial/DRKS00023971), with a Universal Trial Number (UTN) U1111-1263-8658.

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慢节奏呼吸对双侧COVID-19肺炎住院患者HRV测量的急性影响：一项随机临床试验的二次分析

目的：慢节奏呼吸（SPB）和长时间呼气被认为会刺激迷走神经反射，其表现为心率变异性（HRV）值的增加。然而，大多数试验都是在健康的参与者中进行的。我们试图评估SPB在确诊双侧COVID-19肺炎合并严重呼吸功能障碍的住院患者中的可行性，并调查SPB是否对这些迷走神经张力明显降低的重症患者的HRV测量有急性增加的影响。方法：采用单中心随机对照临床试验，23例患者为干预组（4秒吸气，6秒呼气，持续20分钟，每日3次），23例患者为对照组（IG/CG）。采用事后似然比检验计算SPB对HRV的影响。使用随机斜率的多水平混合效应线性回归模型比较各组间随时间的基线HRV测量，包括相关合并症、COVID-19药物和年龄等协变量。结果：所有患者HRV基线值均显著降低。SPB期间HRV参数显著升高(ln（SDNN）、ln（LF）、ln(TP)；p < 0.001)。基线呼吸频率较高与SPB期间低LF相关（p < 0.045）。IL-6早晨水平与较低的HRV测量值相关（p < 0.001）。静息HRV测量和主观健康随住院时间的增加而增加，IG和CG之间没有差异(比较随机斜率与随机斜率相互作用模型：所有LR χ2(5) < 4.5；P < 0.05)。结论：SPB在双侧COVID-19肺炎患者中是可行且安全的，是急性加重HRV措施的有效自我干预手段。该观察结果独立于合并症和治疗。进一步的试验应证实这些发现，并将其推广到其他重症人群。注册：德国临床试验注册，编号DRKS00023971 (https://drks.de/search/en/trial/DRKS00023971)，通用试验号（UTN） U1111-1263-8658。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychosomatic Medicine 医学-精神病学

CiteScore

5.10

自引率

0.00%

发文量

258

审稿时长

4-8 weeks

期刊介绍： Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society. The journal publishes experimental, clinical, and epidemiological studies on the role of psychological and social factors in the biological and behavioral processes relevant to health and disease. Psychosomatic Medicine is an interdisciplinary peer-reviewed journal devoted to high-quality science on biobehavioral mechanisms, brain-behavior interactions relevant to physical and mental disorders, as well as interventions in clinical and public health settings. Psychosomatic Medicine was founded in 1939 and publishes interdisciplinary research articles relevant to medicine, psychiatry, psychology, and other health-related disciplines. The print journal is published nine times a year; most articles are published online ahead of print. Supplementary issues may contain reports of conferences at which original research was presented in areas relevant to the psychosomatic and behavioral medicine.