The effects of patterned breathing and continuous positive airway pressure on cardiovascular regulation in healthy volunteers.
1. Although the increased heart rate variability in healthy subjects in association with slow patterned breathing and continuous positive airway pressure is well documented, there is no general agreement regarding the underlying mechanism. The arterial baroreceptor stimulation due to greater blood pressure variability, the stimulation of pulmonary stretch and low pressure baroreceptors can play important role in this phenomenon. 2. In order to assess the interplay between blood pressure and heart rate changes we have studied nine healthy volunteers (mean age was 22 yrs. range 19-24), by applying 6/min patterned breathing, and continuous positive airway pressure of 10 cm of water. ECG and finger blood pressure (Finapres 2300) was continuously recorded. The oscillation amplitude of R-R intervals were analysed as well as the time and frequency domain indexes of heart rate variability. The oscillation amplitude and the corresponding frequency domain components of systolic blood pressure were also calculated. 3. The forced deep breathing caused significant increase in heart rate variability as indicated by time and frequency domain analysis of R-R intervals (LF HRV ms2: spontaneous: 777.40 +/- 526.1, patterned breathing 6828.00 +/- 5468.0). The application of CPAP in the same rhythm during patterned breathing resulted in further enhancement in heart rate variability (LF HRV ms2: 9052.00 +/- 4533.0). The analysis of the same frequency domain components of systolic blood pressure showed marked elevation of the total and low frequency power during patterned breathing. (LF BPV mm Hg2: spontaneous: 8.24 +/- 6.2, patterned breathing: 16.22 +/- 9.7). Applying CPAP with the same breathing pattern elicited further significant increment in systolic blood pressure fluctuation (LF BPV mm Hg2: deep breathing + CPAP: 27.11 +/- 9.8). The baroreflex sensitivity as calculated from spontaneous HR and BP sequences was 11.66 +/- 2.9 at baseline and increased to 17.66 +/- 6.1 and changed to 15.22 +/- 3.2 with the addition of patterned breathing and CPAP, respectively. 4. Our findings indicate that the heart rate and blood pressure responses to slow patterned breathing may be interpreted as consequences of an altered baroreflex sensitivity. In contrast the active breathing with CPAP exerts mechanical effects which in turn present an augmented systemic baroreflex trigger, however, the baroreflex sensitivity remains unchanged.