Holter monitoring of heart rate variability in patients with ... - Firstbeat

Holter monitoring of heart rate
variability in patients with burnout
syndrome
Lyskov E, Ristiniemi H, Perski A, Yermakova I,
Chaikovsky I, Sakaev E, Bortkiewicz A.
University of Gevle, Sweden
Karolinska Institutet, Sweden,
Scientific Training Centre for Information Technologies and Systems,
National Academy of Sciences, Ukraine
Nofer Institute for Occupational Health, Poland

Burn-out
• State of vital exhaustion, F 43.8A; or Z73.0 ; ICD-10
• Profound fatigue, cognitive problems, decreased work capacity,
cynism. Relation to work stress factors - workload, control,
reward, community, fairness, values
• Primarily stress related disorder (same group as: acute stress
reaction, post-traumatic stress disorder)
• Many in common with other functional disorders as: fibromyalgia,
environmental intolerance, chronic fatigue syndrome
• Unknown mechanisms, difficult to differentiate with other stress
related disorders, clinically based expertise
• Diverse treatment

[msec ]
2
Ratio LF [msec ] / HF
Fibromyalgia: Changes in HRV; Ratio
LF/HF (Martinez-Lavin et al. 1998)
2Controls
7
Patients
6
5
4
3
2
1
p

Environmental Intolerance – Changes
in HRV, Normalized HF (Sandström et al, 2003)

Gulf War Syndrom, Changes in HRV,
HF and QT intervals (Hall et al. , 2002)
• Circadian variation in parameters of
autonomic regulation measured by
24-hour Holter monitoring in 21 ill Gulf
War veterans (solid circles) and 19
matched control veterans (open
circles).
• High-frequency spectral power of
heart rate variability, measured in 5-
minute epochs every 15 minutes over
24 hours (A)
• Corrected QT interval (QTc),
measured in 5-minute epochs every
hour (B)

Ambulatory personal with stressrelated
symptoms, Changes in HRV, LF
(Aasa et al. 2006)

HRV and stress-related syndroms
• Aberration in the central regulatory mechanisms and ANS
parameters seems to be an essential element in pathogenesis of
stress related disorders
• Commonly observed phenomenon is a distortion of circadian
rhythms
• Changes in HRV have been observed in different time and
frequency-domain variables
• Holter ECG monitoring may be useful in understanding of
physiological mechanism of Burn-out syndrom, as well as in
assessment of treatment efficiency
• Complex analysis of clinical data and “HRV variables” is
important

Grounding
• “Total-body movement exercises
directed downward and designed
to induce pleasure and wellbeing”
• Reduce muscular tensions and
raise energy level, normalize
breathing pattern
• Emphasiz on psychodynamic
aspects of Afrikans dance
• Role of Music
• Effects on cardiovascular
regulation and skeleto-muscular
system
• Popular in Sweden, in complex
with other methods

Aims - to test:
• Is Burn-out syndrome
characterised by decreased
heart rate variability and
day/night contrasts?
• Somatic complaints, pain –
are they common in patients
with Burn-out syndrome?
• What is immediate and
distant effect of the
Grounding?

Materials methods
• 15 burnout patients (12 female, 42,8 +/- 6 y.o) and age and
gender matched symptom free controls
• Clinical examination
• Self ratings –Sleep Scale, Respiratory Functions, Anxiety, Pain,
Wellbeing
• 48+ hours HRV monitoring, Suunto Memory Belt (longer time of
recording is available with Body-Guard device). Firstbeat
HEALTH 3.1.1.0. Firstbeat Technologies Oy; Finland.
• HRV variables in time, frequency domains, integrative
characteristics of RR variability during day and night hours
• Physical activity, 3-axial accelerometer

Direct and Indirect Variables,
Firstbeat HEALTH, Firstbeat Technologies Oy; Finland
• Direct measure of RR
intervals - Heart rate, RMSSD,
variables in time and
frequency domain….
• Extrapolation - HR % MAX,
Respiration rate, Ventilation,
Energy Expenditure,
%VO2…..
• Summary in comprehensive
reports: Health promouting
Physical Activity, Weight
managment, Energy
Expenditure, Physical
Workload ….

Independent variables
• GROUP (2; Case, Control)
• GROUNDING (3; Introduction Session, First Session, Last
Session)
• ROUND the CLOCK (2; The First 24 hours, The Second 24
Hours)

Preliminary results of Holter monitoring.
48 Hours, Averaged data, Patients Control.
Heart Rate, BPM
RMSSD, ms

Direct effects of the Grounding
Heart rate, ms
RMSSD, ms

Direct effects of the Grounding
Respiration (per min)
VO2 (ml/kg/min)

Chaos in HRV?
• Sample Entropy is the negative natural logarithm of an estimate
of the conditional probability that subseries (epochs) of length m
that match pointwise within a tolerance r also match at the next
point.
• Chaos := ((1-SOD)+ApEn+SampEn+(1-2*|FDDA-1.5|))/4*100%

Discriminant power of different
variables
90
1_2среднее
80
70
60
50
40
1_2среднее
30
20
10
0
Хаос Энтропия ЧСС SDNN RMSSD TINN PAPR IN LF/HF derHR

Perceived Pain, VAS scala, Localization
6
5
4
3
Burnout
Control
2
1
0
Before After Treatment

Summary
• Preliminary results of the HRV Holter monitoring show distinctive
cardiovascular effects of Grounding in both groups. In controls
these effects can be even stronger at the end of training course
• No difference between groups was found in averaged (48 hours)
HRV monitoring data
• Musculoskeletal pain, (first of all in neck-shoulder and lowback
areas) is quite common symptom in persons with burn-out
• Hourly measured circadian rhythms in HRV will be analysed
• Possible difference between the first (after Grounding session)
and the second nights will be analysed
• (Cor)relations between symptoms, clinical effects of Grounding,
physical activity and HRV data will be analysed