Relationship between linear and nonlinear dynamics of heart rate and impairment of lung function in COPD patients.

International journal of chronic obstructive pulmonary disease

PubMedID: 26316739

Mazzuco A, Medeiros WM, Sperling MP, de Souza AS, Alencar MC, Arbex FF, Neder JA, Arena R, Borghi-Silva A. Relationship between linear and nonlinear dynamics of heart rate and impairment of lung function in COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;101651-61.
BACKGROUND
In chronic obstructive pulmonary disease (COPD), functional and structural impairment of lung function can negatively impact heart rate variability (HRV); however, it is unknown if static lung volumes and lung diffusion capacity negatively impacts HRV responses. We investigated whether impairment of static lung volumes and lung diffusion capacity could be related to HRV indices in patients with moderate to severe COPD.

METHODS
Sixteen sedentary males with COPD were enrolled in this study. Resting blood gases, static lung volumes, and lung diffusion capacity for carbon monoxide (DLCO) were measured. The RR interval (RRi) was registered in the supine, standing, and seated positions (10 minutes each) and during 4 minutes of a respiratory sinus arrhythmia maneuver (M-RSA). Delta changes (?supine-standing and ?supine-M-RSA) of the standard deviation of normal RRi, low frequency (LF, normalized units [nu]) and high frequency (HF [nu]), SD1, SD2, alpha1, alpha2, and approximate entropy (ApEn) indices were calculated.

RESULTS
HF, LF, SD1, SD2, and alpha1 deltas significantly correlated with forced expiratory volume in 1 second, DLCO, airway resistance, residual volume, inspiratory capacity/total lung capacity ratio, and residual volume/total lung capacity ratio. Significant and moderate associations were also observed between LF/HF ratio versus total gas volume (%), r=0.53; LF/HF ratio versus residual volume, %, r=0.52; and HF versus total gas volume (%), r=-0.53 (P<0.05). Linear regression analysis revealed that ?RRi supine-M-RSA was independently related to DLCO (r=-0.77, r (2)=0.43, P<0.05).

CONCLUSION
Responses of HRV indices were more prominent during M-RSA in moderate to severe COPD. Moreover, greater lung function impairment was related to poorer heart rate dynamics. Finally, impaired lung diffusion capacity was related to an altered parasympathetic response in these patients.