Les personnes avec un trouble du spectre autistique (TSA) présentent une hyperactivité de la voie sympathique du système nerveux autonome (SNA) lors de l’éveil. Il est connu que le tonus sympathique est plus élevé le matin que le soir. Or, le sommeil a une influence sur l’activité du SNA. Ainsi, l’objectif de ce mémoire est de comparer l’activité du SNA d’un groupe d’adultes TSA à un groupe d’adultes neurotypiques (NT) le soir et le matin et de mettre en relation ces variables avec leurs paramètres subjectifs de sommeil.L’électrocardiogramme des participants a été réalisé avant et après une nuit de sommeil. Des comparaisons des paramètres de sommeil et des paramètres de variabilité de la fréquence cardiaque (VFC) le soir et le matin ont été réalisées entre les deux groupes, ainsi que des corrélations entre les paramètres de sommeil et les paramètres de VFC le matin.L’analyse de la VFC a montré une activité sympathique plus élevée le matin chez les adultes TSA comparativement aux adultes NT. De plus, de longs éveils nocturnes et une moins bonne efficacité de sommeil étaient corrélés avec une haute activité sympathique le matin. Ainsi, le sommeil perturbé du groupe d’adultes avec un TSA a possiblement affecté l’activité de leur SNA de manière à avoir une balance sympathovagale plus élevée le matin que le groupe NT. À notre connaissance, cette étude est la première à étudier l’activité cardiaque d’adultes TSA en lien avec leur sommeil et ainsi elle pourra améliorer notre compréhension de la physiopathologie de cette maladie. / Individuals with autistic spectrum disorder (ASD) show higher sympathetic activity of the autonomic nervous system (ANS) during wake. It is known that typically developing (TD) individuals show higher sympathetic activity in the morning compared to the evening. Studies suggest that sleep has an influence on ANS functioning. The goal of this study is to explore evening and morning ANS activity of a group of adults with ASD and a group of TD adults and to explore its relationships with subjective sleep parameters of participants. Electrocardiographic data of both groups were recorded before and after a night of sleep. Group comparisons were done on participant’s subjective sleep data and heart rate variability (HRV) in the evening and the morning. Correlations were then performed between subjective sleep measures and morning HRV parameters. Spectral analysis of the HRV showed higher sympathetic activity in the morning for the ASD group compared to the TD group. When all participants were grouped, longer nocturnal awakening and lower sleep efficiency were correlated with higher sympathetic activity in the morning. This suggest that sleep disturbances in ASD influences ANS functioning and results in higher sympathovagal balance in the morning. To our knowledge, this is the first study to investigate ANS activity of ASD adults in relation to sleep, and it may improve our understanding of the pathophysiology of this disease.

Learning of a positive diagnosis of HIV may be one of the most challenging and stressful events in life. The memory of this event is emotionally laden, and even years later evokes an emotional response. Similarly, many people living with HIV (PLH) have memories of the first time they were treated differently because of their diagnosis. While research frequently examines the subjective of stress, few studies have examined biological markers of stress in people living with HIV. Heart Rate Variability offers a non-invasive measure of stress. Beyond serving as a biological marker for stress, changes in HRV are also associated with emotional functioning. Research demonstrates decreased HRV levels in patients with Depression, Anxiety, and PTSD. We conducted a repeated measures MANOVA to examine effects of stress induction on HRV in individuals with high and low levels of HIV-related stigma. We found that the high stigma group was significantly different from the low stigma group in regard to changes in participants’ HRV, Wilks’ λ = .50, F (1, 51) = 11.63, p < .001. A hierarchical linear regression examined the relationship between HRV and other measures of stress (Heart Rate and Blood Pressure). We found that systolic blood pressure and heart rate in the stress condition were predictive of HRV (adjusted R2=.29, F (5,46) =4.07, p<.01). Results of our study support the use of HRV as a measure of stress in HIV-positive adults. Additionally, the results of our study demonstrate significant relationships between stigma, social support and stress in HIV-positive adults.

L’objectif de la présente thèse était de caractériser le sommeil d’un groupe clinique d’enfants et d’adolescents ayant un trouble d’anxiété comme diagnostic primaire et le comparer à un groupe témoin. Dans un premier temps, nous avons vérifié si le profil de la fréquence cardiaque nocturne des enfants et des adolescents pouvait être regroupé selon le diagnostic. Pour ce faire, la fréquence cardiaque nocturne de 67 adolescents anxieux et 19 sujets non anxieux a été enregistrée à l’aide d’un équipement ambulatoire. Les résultats de cette étude montrent que le profil de la fréquence cardiaque nocturne chez les enfants anxieux varie selon le diagnostic. Alors que les adolescents non anxieux montrent un profil de la fréquence cardiaque nocturne plat, on retrouve les associations suivantes chez les adolescents ayant un trouble anxieux : a) un profil croissant de la fréquence cardiaque chez les adolescents ayant un trouble d’anxiété de séparation; b) un profil décroissant de la fréquence cardiaque chez les adolescents ayant un trouble d’anxiété généralisé; c) un profil en forme de U chez les adolescents ayant un trouble d’anxiété sociale. De plus, une association significative a été observée entre le diagnostic et la présence de fatigue matinale. L’association d’un profil de la fréquence cardiaque nocturne avec un diagnostic d’anxiété suggère la présence d’une dysrégulation de la modulation chronobiologique du système nerveux autonome. Étant donné que le profil de la fréquence cardiaque nocturne s’exprime différemment selon le diagnostic, qu’en est-il de l’architecture du sommeil? Dans un deuxième temps, nous avons enregistré le sommeil en laboratoire d’un groupe clinique de 19 jeunes ayant un trouble d’anxiété comme diagnostic primaire, avec comorbidités et médication et comparé à 19 jeunes non anxieux. Les résultats de cette étude ont montré que les participants du groupe anxieux ont une latence au sommeil plus longue, une latence au sommeil paradoxal plus longue et une durée d’éveil plus longue lorsque comparé au groupe témoin. L’évaluation subjective de la qualité du sommeil chez le groupe d’adolescents anxieux montre que leur auto-évaluation reflète les valeurs enregistrées en laboratoire. Nous avons également observé chez le groupe anxieux une fréquence cardiaque moyenne plus élevée et un index plus élevé d’apnée-hypopnée, bien que non pathologique. Nous avons également observé une association positive entre l’anxiété de trait et l’indice d’apnée-hypopnée et la latence au sommeil, ainsi qu’une association positive entre l’anxiété manifeste et la latence au sommeil paradoxal. Ces résultats suggèrent que le sommeil chez cette population est altéré, que des signes d’hypervigilance physiologique sont présents et qu'une association existe entre ces deux paramètres. Finalement, dans la troisième étude de cette thèse, nous avons analysé l’activité cardiaque pendant le sommeil en utilisant les paramètres temporels et fréquentiels de la variabilité cardiaque chez un groupe clinique de dix-sept enfants et adolescents ayant un trouble d’anxiété comme diagnostic primaire avec comorbidité et médication, et comparé à un groupe non anxieux. Les résultats ont montré que les participants du groupe anxieux, lorsque comparés au groupe non anxieux, présentent des intervalles interbattements plus courts, un indice temporel de la variabilité cardiaque représentant la branche parasympathique moindre, une activité des hautes fréquences normalisées moindre et un ratio basse fréquence sur haute fréquence augmenté. Plusieurs corrélations ont été observées entre les mesures cliniques de l’anxiété et les mesures de la variabilité cardiaque. Ces résultats viennent ajouter à la littérature actuelle un volet descriptif clinique à ce jour non documenté, soit l’impact de l’anxiété pathologique chez un groupe clinique d’enfants et d’adolescents sur le processus normal du sommeil et sur la régulation de la fréquence cardiaque. En résumé, les résultats de ces trois études ont permis de documenter chez un groupe clinique d’enfants et d’adolescents ayant de l’anxiété pathologique, la présence d’une altération circadienne du profil de la fréquence cardiaque, d’une architecture altérée du sommeil ainsi qu’une dysrégulation du système nerveux contrôlant l’activité cardiaque. / The aim of this thesis was to characterize, in a clinical group of children and adolescents with anxiety disorder as a primary diagnostic, the sleep period and to compare it to a control group. Firstly, we have verified if the nocturnal sleep pattern of children and adolescents could be grouped by psychiatric disorders. Sixty-seven children and adolescents with anxiety disorders and nineteen non anxious match controls were monitored using ambulatory recording equipment. Results showed that nocturnal heart rate pattern of anxious adolescents would vary accordingly with the diagnosis. While non anxious adolescents exhibit a flat nocturnal heart rate pattern through the night, anxious participants showed the following associations: a) increased nocturnal heart rate pattern associated with separation anxiety disorder; b) decreased nocturnal heart rate pattern associated with generalized anxiety disorder; and c) U shape nocturnal heart rate pattern associated with social phobia. Moreover, a significant association was found between anxiety diagnosis and presence of morning fatigue. The association between nocturnal heart rate patterns with anxiety suggests that the circadian modulation of heart rate is dysregulated, but what about the sleep macrostructure? Secondly, we have monitored in a sleep laboratory a clinical sample of nineteen adolescents with pathological anxiety, comorbidity and medication, and compared it to nineteen non anxious match controls. Results showed that anxious participants had longer sleep latency, longer REM sleep latency and longer awake period during sleep when compared to control participants. Compared to control participants, anxious patients subjectively reported sleep disturbances, manifested objective sleep disorders and presented no adaptation to the laboratory environment. Moreover, higher nocturnal heart rate and higher apnea-hypopnea index were observed in anxious group when compared to non anxious group. Significant positive associations were observed between Trait anxiety and apnea-hypopnea index as well as for sleep latency while manifest anxiety was associated to REM sleep latency. Results suggest that sleep of children and adolescents with pathological anxiety is altered, that signs of physiological hypervigilance are observed and that both are associated. Following previous results, we have analyzed in a third study heart rate variability during nocturnal sleep using both, times and frequency domains in a clinical sample group of seventeen children and adolescents with anxiety disorder as primary diagnostic with comorbidity and medication. Results showed that anxious when compared to non anxious, had a shorter interbeat interval, and had lower rMSSD values, less high frequency in normalized units and higher low frequency/high frequency ratio. Correlations were observed between clinical anxiety scores and time and frequency domains of heart rate variability. These results add to the growing body of literature that pathological anxiety in a clinical group of children and adolescents impact on sleep process and heart rate regulation during sleep. Overall findings add to the growing body of recent clinical literature, a sleep alteration description of a clinical sample of children and adolescents. From the three studies of this thesis, results showed that circadian heart rate pattern is altered, that sleep architecture is altered, and that the time and frequency domain of nocturnal heart rate variability is altered in a clinical group of children and adolescents with pathological anxiety.

This work is trying to identify possible non-stimulatory effects and distant effects of muscle electrostimulation musculus quadriceps femoris based on a literature search. Furthermore evaluates the influence of High Tone Electrical Stimulation (HTEMS) muscles of lower limbs on the activity of the autonomic nervous system, expressed by heart rate variability, a spectral power in the individual frequency bands. Randomized crossover study involved 20 healthy subjects (12 men and 8 women), average age 24.6 ± 5.6 years. Heart rate variability was evaluated before application of HTEMS and immediately after. Measurements were performed with electrostimulator HiToP 191. The results did not show statistically significant increase in spectral power in the individual frequency bands. The study also deals with the reproducibility of measurements of sensitive and motor threshold for electrostimulation HTEMS method, which was confirmed. Powered by TCPDF (www.tcpdf.org)

This work is trying to identify possible non-stimulatory effects and distant effects of muscle electrostimulation musculus quadriceps femoris based on a literature search. Furthermore evaluates the influence of High Tone Electrical Stimulation (HTEMS) muscles of lower limbs on the activity of the autonomic nervous system, expressed by heart rate variability, a spectral power in the individual frequency bands. Randomized crossover study involved 15 healthy subjects (7 men and 8 women), average age 24.4 ± 2,5 years. Heart rate variability was evaluated in two situations: the situation without the application HTEMS and the situation with the aplication of HTEMS. Electrostimulation was done with HITOP 191. The results did not show statistically significant differences in all monitored components. The study also dealt with the reproducibility of measurements of perception and motor threshold for HTEMS.

Este trabalho teve por objetivo construir e avaliar ferramentas de quantificação e análise da variabilidade da freqüência cardíaca segundo o paradigma não extensivo de Tsallis na modelagem do sistema de regulação da freqüência cardíaca, e na discriminação de situação de normalidade e cardiopatias e apoio ao diagnóstico de cardiopatias. O sistema de regulação da freqüência cardíaca é reconhecidamente não linear. Este estudo explora esta característica, quantificando a complexidade através de uma família de entropias condicionais não extensivas e outras medidas de avaliação usualmente utilizadas na análise da variabilidade cardíaca. Foram utilizados dados reais de 15 indivíduos saudáveis, 23 indivíduos chagásicos e 19 indivíduos hipertensos, além de dados simulados computacionalmente para uma avaliação controlada das ferramentas estatísticas estudadas. Durante a avaliação foram gerados dados substitutos (surrogate data) para os testes de validade e intensidade da hipótese de não linearidade das séries. Os resultados mostraram que o parâmetro q introduz uma forma diferente de quantificação da complexidade do sinal. Com o auxílio dos dados substitutos, foi possível identificar, para alguns sinais, a região de valores de q onde o comportamento não linear é mais evidente. Os resultados obtidos indicam que a abordagem merece estudos mais aprofundados. / This study aimed to construct and evaluate tools for quantification and analysis of heart rate variability under Tsallis non-extensive statistical paradigm to model heart rate regulation system, and discrimination in situations of healthy conditions and support diagnosis of heart diseases. The heart rate regulation system is known to be nonlinear. This study explores this feature by quantifying the signal complexity through a family of non extensive conditional entropy and other evaluation measures commonly used in the analysis of heart rate variability. We used real data from 15 healthy subjects, 23 individuals with Chagas disease and 19 hypertensive individuals, in addition to simulated data to make a computationally controlled evaluation of the statistical tools studied. During the evaluation were generated surrogate data for tests of validity and strength of the time series non-linearity hypothesis. The results have shown that the q parameter introduces a different way of quantifying the complexity of the signal. With the support of surrogate data, it was possible to identify a range of q values that nonlinear behavior is more evident for some signals. The results indicate that the approach deserves further study.

A análise de sinais biomédicos é uma área de pesquisa importante pois diversos processos fisiológicos que ocorrem no corpo humano podem ter suas atividades registradas como sinais. Neste trabalho, investigou-se a q-transformada de Fourier (q-FT), uma generalização não linear da transformada de Fourier baseada no formalismo não extensivo de Tsallis, que é caracterizado pela presença do parâmetro q. Foram realizados estudos analíticos e experimentos computacionais com sinais reais e simulados. A partir da dfinição da q-FT, um método de análise espectral generalizado para aplicação em sinais biomédicos foi desenvolvido. Este método foi avaliado através de experimentos com séries de intervalos RR cardíacos, usadas em estudos de variabilidade da frequência cardíaca. Os resultados ajudam a esclarecer algumas propriedades desta q-transformada, porém não indicam que o método desenvolvido seja efetivo para a análise espectral de séries RR. Entretanto, estudos posteriores de novos métodos de análise espectral baseados no formalismo de Tsallis podem ser desenvolvidos para a investigação de sinais biomédicos. / Biomedical signals analysis is an important research eld because many physiological processes occurring in human body can have their activities recorded as signals.This study investigated the q-Fourier transform (q-FT), a nonlinear generalization of Fourier transform based on the Tsallis nonextensive formalism, which is characterized by q parameter. Analytical studies and computational experiments with simulated and real signals were conducted. From the denition of q-FT, a generalized spectral analysis method for application in biomedical signals has been developed. This method was assessed through experiments with cardiac RR interval time series, which are used in studies of heart rate variability. The results help to clarify some properties of the q-Fourier transform, but do not indicate that the developed method is efective for the spectral analysis of RR series. However, further studies on new spectral analysis methods based on Tsallis formalism can be developed for biomedical signals investigation.

É plausível que a poluição urbana das grandes metrópoles possa favorecer o desenvolvimento ou mesmo agravar o quadro de hipertensão arterial. A possibilidade de estudar o efeito direto do DE em roedores é extremamente importante e eficaz através do modelo de exposição com o gerador de combustíveis instalado no campus da Faculdade de Medicina da USP. A nossa proposta principal foi avaliar os efeitos hemodinâmicos, aspectos de remodelamento das fibras da matriz extracelular cardíaca e perfil inflamatório pulmonar, visando obter uma conexão entre a exposição ao DE e seus efeitos sistêmicos em 60 ratos hipertensos: SHR (Spontaneously Hypertensive Rats) e 60 normotensos: WKY (Wistar Kyoto). Esses animais foram divididos em 2 grupos: expostos ao ar filtrado e expostos ao diesel e também em 3 tempos de exposição: 15, 30 e 45 dias. Para tanto, foi proposto neste estudo a avaliação dos seguintes parâmetros: Frequência cardíaca, variabilidade da frequência cardíaca, pressão arterial, lavado broncoalveolar, hemograma completo e fatores de coagulação; expressão de marcadores de estresse oxidativo através das análises de citocinas (IL1alfa, IL6, CINC e TNF-alfa) e da enzima superóxido dismutase (SOD) e avaliação qualitativa e quantitativa do tamanho e número de cardiomiócitos e volume de ventrículo esquerdo, através de técnicas estereológicas, e o remodelamento dos elementos fibrilares da matriz extracelular do ventrículo esquerdo dos ratos. Resultados: A exposição DE causou uma diminuição da VFC: SDNN: (p=0,017), RMSSD (p=0,045) nos SHR comparados com WKY todos os tempos de exposição, também foi observado um aumento do tempo de tromboplastina parcial ativada no grupo de 45 dias (p= 0,000), do tempo de protombina nos grupos 30 (p=0,004) e 45 (p=0,000) e uma diminuição da concentração de fibrinogêni no grupo 15 dias (p=0,020). Houve um aumento da concentração de plaquetas nos grupos 30 (p=0,000) e 45 dias (p=0,004) e hipertrofia ventricular esquerda, no grupo 45 dias (p=0,000) para os animais SHR quando comparado aos animais WKY expostos ao DE. Notamos um aumento das fibras colagênicas no grupo 45 dias (p= 0,000) e aumento de volume de cardiomiócitos nos grupos 15 (p= 0,000) 30 (p= 0,000) e 45 dias (p=0,023) em ratos SHR expostos ao DE comparados aos WKY. Também ocorreu um aumento da produção das citocinas IL1beta nos grupos 30 (p=0,002) e 45 dias (p=0,000) e TNF-alfa nos grupos 30 (p=0,012) e 45 dias (p=0,003) e CINC no grupo 45 dias (p= 0,021) em ratos SHR expostos ao DE. Comparando as linhagens, os ratos SHR expostos ao DE apresentaram maiores valores de IL1? no grupo 45 dias (p=0,043). Os valores de SOD foram menores em ratos SHR no grupo 30 dias (p= 0,016) de exposição ao DE. Nos ratos SHR, expostos ao DE, nos grupos 30 (p= 0,008) e 45 dias (p= 0,002), notou-se um aumento de macrófagos no lavado broncoalveolar. Conclusões: De acordo com esses achados, notamos que a exposição ao diesel promove inflamação pulmonar e sistêmica, desbalanço do sistema nervoso autônomo e remodelamento do miocárdio em animais hipertensos. Estes fatores poderão promover ou agravar os quadros de hipertensão arterial sistêmica em indivíduos suscetíveis e expostos a poluição urbana / The expousure to DEP (Diesel Exhaust Particles) it is related to oxidative stress, it is possible that air pollution of the cities may aggravate hypertension. The possibility of studying the direct effects of DEP in rats it is important and effective through intoxication model with the fuel generator installed in Medicine University of USP. The fuel generator system possible to evaluate the toxicological risks to the use of diesel. The study allowed hemodynamics effects, remodeling of left ventricle, pulmonary inflammation, having the connection between exposure to DEP and your systemic effects. It was evaluated: heart rate, heart rate variability, blood pressure, bronchoalveolar lavage, complete blood count and coagulation factors, citokines evaluation (IL1beta, 1L6, CINC and TNF-alpha) and SOD, vascular endothelium peribronchial vessels in bronchoalveolar lavage through immunoassay and qualitative and quantitative remodeling of extracellular matrix elements in left ventricle of 60 rats hypertensive: SHR (Spontaneosly Hypertensive Rtas) and 60 normotensive WKY (Wistar Kyoto). This animals were divided in 2 groups: exposed to filtred air and exposed to diesel and to 3 times exposures groups: 15, 30 and 45 days. Results: The DE exposure caused decreased in HRV: SDNN: (p=0,017), RMSSD (p=0,045) in SHR in all times of exposure, increased in the values of coagulation factors in SHR exposed to DE after 30 (p=0,001) and 45 days (p=0,000), an aggregation of platelets after 30 (p=0,000) and 45 days (p=0,004), and left ventricular hypertrophy after 45 days (p=0,000) in SHR exposed to DE. We noticed an increase in colagenous fibers after 45 days (p= 0,000) in SHR rats exposed to DE and increased volume of cardiomyocytes after 15 (p= 0,000), 30 (p= 0,000) and 45 days (p=0,023). A increased in citokines production IL1beta after 30 (p=0,002) and 45 days (p=0,000) e TNF-alpha after 30 (p=0,012) and 45 days (p=0,003) and CINC after 45 days (p= 0,021) in SHR exposed to DE. Comparing the lineages, the SHR exposed to DE presented increased in values of IL1beta after 45 days (p=0,043). The SOD values increased in SHR after 30 days (p= 0,016) of exposure to DE. In SHR exposed to DE presented increased after de 30 (p= 0,008) and 45 days (p= 0,002), in values of macrophages. Conclutions: According to these findings, we noticed that exposure to diesel can promote pulmonary and systemic inflammation, imbalance the autonomic nervous system and remodeling the myocardium. These factors may promote or worsen hypertension in susceptible individuals exposed to urban pollution

Importância. O uso de anticoncepcional hormonal combinado oral é associado ao aumento do risco de eventos cardiovasculares adversos desde a sua introdução na prática clínica. O mecanismo exato pelo qual podem alterar o risco ainda não foi esclarecido, sendo escassa a literatura que avalia a ação dessa classe de medicação no sistema nervoso autonômico. Objetivo. O objetivo deste estudo foi avaliar o efeito de contraceptivo contendo 20 mcg de etinilestradiol e 3 mg de drospirenona sobre a variabilidade da frequência cardíaca, da sensibilidade do barorreflexo e sobre a pressão arterial de mulheres saudáveis. Métodos. Trata-se de estudo prospectivo controlado com 69 mulheres saudáveis, divididas em dois grupos: 36 voluntárias que fizeram uso de anticoncepcional hormonal combinado oral, e 33 voluntárias que utilizaram métodos contraceptivos não-hormonais. As mulheres foram avaliadas em dois momentos, antes da introdução do método contraceptivo e seis meses após seu uso. Para a aquisição dos dados, utilizou-se o Finomoter® (FMS, Finapres Medical System, Anhem, The Netherlands), obtendo-se de forma não invasiva registros contínuos da curva da pressão arterial batimento a batimento. A análise estatística foi realizada para determinar diferenças entre os grupos e entre os momentos, sendo p < 0,05 considerado estatisticamente significativo. Resultados. No momento basal, não houve diferenças nos parâmetros demográficos, hemodinâmicos e autonômicos entre os grupos. Além disso, a comparação dos diversos parâmetros hemodinâmicos e autonômicos ao final de seis meses do método contraceptivo não evidenciou diferença tanto entre os grupos como no decorrer do tempo. Conclusão. O uso de contraceptivo contendo 20 mcg de etinilestradiol e 3 mg de drospirenona não causou alterações significativas nos parâmetros hemodinâmicos e autonômicos de mulheres saudáveis / Background. The use of combined oral contraceptives has been associated with an increased risk of adverse cardiovascular events. Whether these drugs alter cardiac autonomic nervous system control is not completely determined. Objective. The objective of this study was to evaluate the effect of a contraceptive containing 20 mcg of ethinyl estradiol and 3 mg of drospirenone on the heart rate variability, baroreflex sensitivity and blood pressure of healthy women. Methods. This is a prospective controlled trial with 69 healthy women allocated in two groups: 36 volunteers under oral combined contraceptive use and 33 volunteers under use of non-hormonal contraceptives methods. Subjects were tested before the introduction of the contraceptive method and 6 months after its use. The Finometer® (FMS, Finapres Medical System, Anhem, The Netherlands) was used for data acquisition, obtaining noninvasively continuous records of the blood pressure curve beat to beat. Statistical analysis was performed to determine differences between groups and times, with p < 0.05 considered statistically significant. Results. At baseline, there were no differences in demographic, hemodynamic and autonomic parameters between groups. A comparison of various hemodynamic and autonomic parameters after 6 months of birth control methods showed no difference between both groups as over time. Conclusion. A contraceptive containing 20 mcg of ethinyl estradiol and 3 mg of drospirenone causes no significant changes in hemodynamic and autonomic parameters of healthy women

Barorezeptorsensitivität, Herzfrequenzvariabilität und Blutdruckvariabilität bei Patienten mit einem mild-moderaten Schlafapnoe Syndrom und bei gesunden Probanden Die Behandlung von Patienten mit einem mild-moderaten obstruktiven Schlafapnoe Syndrom (OSAS) wird von der klinischen Symptomatik und dem Herzkreislaufrisiko bestimmt. Wir konnten nachweisen, dass bei einem mild-moderaten OSAS unter der Beatmungstherapie neben der Beseitigung der nächtlichen Atmungsstörung auch eine Änderung der Mikrostruktur des Schlafes (Arousal) und der Müdigkeit am Tage zu verzeichnen ist. Das Herzkreislaufrisiko untersuchten wir anhand noninvasiver Parameter der sympathovagalen Balance. Dazu wurden die Herzfrequenzvariabilität (HRV), die Blutdruckvariabilität (BDV) und die Barorezeptorsensitivität (BRS) im Zeit- und Frequenzbereich bestimmt und diese Größen bei Patienten mit einem mild-moderaten OSAS im Vergleich zu gesunden Probanden als auch der Effekt einer CPAP-Therapie - im Schlaf als auch am Tage - analysiert. Bei gesunden Probanden fanden wir eine HRV- und BRS-Abnahme sowie eine BDV-Zunahme im REM- gegenüber dem NREM-Schlaf. OSAS Patienten haben im Vergleich zu Gesunden eine niedrigere BRS im NREM und eine erhöhte BDV sowohl im REM- als auch NREM-Schlaf. CPAP führt beim OSAS zu einer Abnahme der Herzfrequenz und Zunahme der BRS, vornehmlich im NREM Schlaf und bei zusätzlich bekannter Hypertonie. Die HRV nimmt ab und die BDV zu, jeweils unabhängig vom Schlafstadium bzw. einer bestehenden Hypertonie. Am Tage zeigt sich nur ein Kurzzeiteffekt hinsichtlich Zunahme der BRS und HRV. Dieser Effekt ist vom Ausmaß des OSAS und dem Vorhandensein einer Hypertonie abhängig und nach 4 Wochen Therapie nicht mehr nachweisbar. Untersucht man den Effekt der Beatmungstherapie auf HRV, BDV und BRS bei gesunden Probanden im Akutversuch, dann findet man eine Erhöhung des Blutdruckes bei Abnahme der Herzfrequenz und Zunahme der BRS. HRV, BDV und BRS als Parameter für das kardiovaskuläre Risiko zeigen nachweisbare Veränderungen bei Schlafapnoe Patienten, auch wenn nur ein mild-moderates OSAS vorliegt. Ein Therapieeffekt lässt sich anhand dieser Parameter auch nachweisen, wobei ein vorhandener Akuteffekt von Überdruckbeatmung auf HRV, BDV und BRS unabhängig von einem OSAS zu berücksichtigen ist. / Baroreceptor sensitivity, heart-rate variability, and blood-pressure variability in patients with mild to moderate sleep apnoea syndrome, and in healthy controls The treatment of patients with mild to moderate obstructive sleep apnoea syndrome, OSAS, is determined by the clinical symptom complex and by the cardiovascular risk. In patients with mild to moderate OSAS who received therapy in the form of assisted ventilation, we succeeded in evidencing that it is possible to influence the microstructure of sleep (i.e., of arousal) as well as fatigue experienced during the day, in addition to eliminating nocturnal respiratory disturbance. We investigated the cardiovascular risk by examining non-invasive parameters for sympathovagal balance. Therefore we analyzed heart-rate variability (HRV), blood-pressure variability (BPV), and baroreceptor sensitivity (BRS) over time and frequency ranges in patients with mild to moderate OSAS, in comparison to healthy controls. We likewise assessed the effects of CPAP therapy on these parameters, both during sleeping as well as non-sleeping hours. Among healthy test subjects, we determined decreases in HRV and BRS, as well as increase in BPV, during REM sleep, in comparison to NREM sleep. In comparison to healthy controls, OSAS patients have lower BRS during NREM and increased BPV in both REM and NREM sleep. In OSAS patients, CPAP leads to a decrease in heart rate and increase in BRS, especially in NREM sleep and in patients for whom hypertension is also known. HRV diminishes and BPV increases, in both cases regardless of the sleep stage or presence or absence of hypertension. During the day, only a short-term effect becomes apparent with respect to increases in BRS and HRV. This effect depends on the extent of OSAS and on the existence of hypertension; after four weeks of therapy, the effect is no longer in evidence. Acute testing of the effect of assisted ventilation on HRV, BPV, and BRS among healthy controls discloses increase in blood pressure, accompanied by decrease in heart rate and increase in BRS. HRV, BPV, and BRS as parameters for cardiovascular risk reveal evidence of alterations in sleep-apnoea patients, even for those suffering only from mild to moderate OSAS. Therapeutic effects are also in evidence on the basis of these parameters, whereby an existing acute effect of positive-pressure ventilation on HRV, BPV, and BRS regardless of OSAS must also be taken into account.