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Effects of breathing frequency on baroreflex effectiveness index and spontaneous baroreflex sensitivity derived by sequence analysis

Wang, Yong-Ping; Kuo, Terry B.J.; Lai, Chun-Ting; Lee, Guo-She; Yang, Cheryl C.H.

doi: 10.1097/HJH.0b013e328357ff46

Aims: High-frequency paced breathing is required to avoid overestimation when measuring spectral baroreflex sensitivity (BRSLF) to predict outcomes in cardiovascular patients. We examined whether respiration should also be controlled when measuring the baroreflex effectiveness index (BEI) and baroreflex sensitivity (BRSseq), which are derived by sequence analysis.

Methods: We studied 17 healthy young adults who breathed spontaneously and controlled their breathing to rates of 0.1, 0.2, 0.3 and 0.4 Hz in the supine position. We found respiratory influences on BEI and BRSseq depended on the lag used to pair the systolic arterial pressure and R–R interval in a sequence. Therefore, the two baroreflex measures were obtained by selecting the lag with a larger number of sequences for each section.

Results: BEI decreased progressively as the breathing frequency increased. BRSseq remained unchanged at rates of 0.1, 0.2 and 0.3 Hz, but was reduced during 0.4 Hz breathing. In contrast, BRSLF was constant during 0.2, 0.3, and 0.4 Hz breathing, but was greater at 0.1 Hz. Rates of spontaneous breathing range from 0.1 to 0.32 Hz with a mean value of 0.19 Hz. Baroreflex measures obtained for spontaneous breathing were found to be between the values for 0.1 and 0.3 Hz paced breathing.

Conclusion: BEI and BRSseq do not remain constant at various breathing frequencies. Nonetheless, considering the pattern of change and the frequency range of spontaneous respiration, the authors suggest that high-frequency paced breathing is not necessary when measuring the BEI and BRSseq under the conditions used in this study.

aDepartment of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan

bSleep Research Center

cInstitute of Brain Science, National Yang-Ming University

dDepartment of Education and Research, Taipei City Hospital, Taipei

eResearch Center to Adaptive Data Analysis, National Central University, Taoyuan

fFaculty of Medicine, National Yang-Ming University, Taipei, Taiwan

Correspondence to Cheryl C.H. Yang, PhD, Sleep Research Center and Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei 11221, Taiwan. Tel: +886 2 28267058; fax: +886 2 28273123; e-mail:

Abbreviations: BEI, baroreflex effectiveness index; BRSLF, baroreflex sensitivity derived by spectral analysis; BRSseq, baroreflex sensitivity derived by sequence analysis; PHASERF, phase function between systolic arterial pressure and R–R interval at the respiratory frequency; SAP, systolic arterial pressure

Received 1 March, 2012

Revised 26 June, 2012

Accepted 11 July, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.