Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI>50 kg/m2. In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery. In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS). In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day <3.3mmol/l and 20 and 40 minutes < 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms. In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response. In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.

The spectral analysis of heart rate variability is a tool that gained more and more clinical importance in the latest years. It can be used in order to access autonomic function on the cardiovascular system through the evaluation of the different frequency bands of the HRV. So far different mathematical approaches have been used towards this aim, often with contradictory results. Therefore, the need for standardization of the methods seems more and more important. In this thesis 2 non-parametric, Fourier-based methods and two parametric based on autoregressive modeling were used in order to extract the power spectral density of patients with epilepsy. Their results were statistically compared to age matched controls. The analysis have shown that when a parametric method is used, a careful model order selection method must be used, and when this is accomplished, the power spectrum could more efficient highlight differences between controls and patients. The results between non-parametric and parametric methods were different, therefore these methods cannot be considered interchangeable. The analysis methodolgy established in this first part of the study has been used to analyse HRV signals from patients before and after deep brain stimulation. / Η φασματική ανάλυση της Μεταβλητότητας της Καρδιακής Συχνότητας (ΜΚΣ) χρησιμοποείται όλο και περισσότερο σε κλινικές μελέτες τα τελευταία χρόνια. Και αυτό γιατί μπορεί να δώσει πληροφορίες σχετικά με την λειτουργία του αυτόνομου νευρικού συστήματος πάνω στην καρδιά αναλύοντας το συχνοτικό περιεχόμενο των ΜΚΣ σημάτων σε διακριτές ζώνες συχνοτήτων. Μέχρι τώρα διαφορετικές μαθηματικές μέθοδοι έδωσαν διαφορετικά, συχνα αντικρουόμενα αποτελέσματα. Έτσι η ανάγκη λεπτομερής περιγραφής των μεθόδων φαίνεται όλο και περισσοτερο επιτακτική. Σε αυτή τη διπλωματική εργασία, δυο μη παραμετρικές μέθοδοι και δύο παραμετρικές βασισμένες σε μοντέλα αυτοπαλινδρόμησης (autoregressive modeling) εφαρμόστηκαν προκειμένου να υπολογιστεί το φάσμα ασθενών με χρόνια επιληψία. Τα αποτελέσματα συγκρίθηκαν με υγιείς εθελοντές ίδιου ηλικιακού προφίλ. Η ανάλυση έδειξε ότι όταν χρησιμοποιουνται παραμετρικές μέθοδοι, η επιλογή της τάξης του μοντέλου πρέπει να γίνεται με προσοχή και όταν αυτό γίνει, το φάσμα μπορεί να αναδείξει πιο αποτελεσματικά διαφορές μεταξύ ασθενών και υγειών εθελοντών. Τα αποτελέσματα μεταξύ παραμετρικών και μη παραμετρικών μεθόδων αποδείχθηκαν διαφορετικα, και κατά συνέπεια οι δύο αυτές κατηγορίες ανάλυσης δεν μπορούν να θεωρηθούν ίδιες. Η μεθοδολογία που αναπτύχθηκε στο πρώτο αυτό μέρος της εργασίας χρησιμοποιήθηκε για να αναλύσει σήματα ΜΚΣ από ασθενείς με Πάρκινσον πριν και μετά εν τω βάθει ερεθισμό (Deep brain simulation).

Nearly all functional magnetic resonance imaging (fMRI) studies are conducted in the supine body posture, which has been discussed as a potential confounder of such examinations. The literature suggests that cognitive functions, such as problem solving or perception, differ between supine and upright postures. However, the effect of posture on many cognitive functions is still unknown. Therefore, the aim of the present study was to investigate the effects of body posture (supine vs. sitting) on one of the most frequently used paradigms in the cognitive sciences: the N-back working memory paradigm. Twenty-two subjects were investigated in a randomized within-subject design. Subjects performed the N-back task on two consecutive days in either the supine or the upright posture. Subjective sleep quality and chronic stress were recorded as covariates. Furthermore, changes in mood dimensions and heart rate variability (HRV) were assessed during the experiment. Results indicate that the quality of sleep strongly affects reaction times when subjects performed a working memory task in a supine posture. These effects, however, could not be observed in the sitting position. The findings can be explained by HRV parameters that indicated differences in autonomic regulation in the upright vs. the supine posture. The finding is of particular relevance for fMRI group comparisons when group differences in sleep quality cannot be ruled out.

Ce projet de recherche avait pour but d’évaluer les conséquences à long terme des commotions cérébrales d’origine sportive (CCOS) subies durant le développement sur la fonction cardio-autonomique. Nous avons comparé la variabilité de la fréquence cardiaque (VFC) de joueurs de hockey adolescents avec un historique d’une ou deux CCOS (commotion ; n = 39) à la VFC de joueurs de hockey adolescents n’en ayant jamais subi (contrôle ; n = 52). Les athlètes du groupe commotion ont été testés 26 mois (20) après leur dernière CCOS. L’électrocardiogramme des participants était mesuré durant, pendant et après un exercice sur ergocycle. La séance d’exercice consistait en un échauffement incrémenté de 6 minutes suivi de 20 minutes entre 60 et 70 % de la fréquence cardiaque maximale et finalement 2 minutes de retour au calme actif. Par la suite, un repos de 10 minutes était complété. Le logarithme naturel de l’écart-type des intervalles NN (lnETNN) et le logarithme naturel des basses fréquences (lnBF) étaient tous les deux plus élevés pour le groupe commotion que pour le groupe contrôle dans les trois conditions (repos, exercice et post-exercice) ( < 0,05). Cette différence était similaire pour toutes les conditions. Ces résultats suggèrent qu’une CCOS affecte la fonction cardio-autonomique différemment durant le développement qu’à l’âge adulte, renforçant la nécessité d’interventions post-commotion spécifiques durant développement. / This research project sought to evaluate long-term consequences of sport-related concussions (SRC) sustained during development on cardio-autonomic function. To do so, we compared the heart rate variability (HRV) of adolescents hockey players with a history of one or two sport-related concussion (HOC; n = 39) to the HRV of adolescents hockey players who never incurred a SRC (WHOC; n = 52). Athletes from the HOC group were 26 months (20) away from their last injury. Participants’ electrocardiogram was measured at rest, during and after an exercise session on ergocycle. The exercise session consisted of a 6 minutes incremental warm-up followed by 20 minutes between 60 and 70 % of maximal heart rate and finally a 2 minutes active cooldown. Then, a post-exercise rest of 10 minutes was completed. HRV linear and non-linear measures were calculated before, during and after the exercise session. Natural log of standard deviation of NN intervals (lnSDNN) and natural log of low frequencies (lnLF) were both higher for HOC group in the three conditions (rest, exercise, post-exercise) ( < 0.05). This difference was similar across all conditions. These results suggest that SRC might affect cardio-autonomic function differently during development than during adulthood thus reinforcing the need for specific post-concussion interventions for the developing population.

<div>Vehicle automation is developing at a rapid rate worldwide. However, even lower levels of automation, such as SAE Level-1, are expected to reduce drivers’ workload by controlling either speed or lane position. At the same time, however, drivers’ engagement in secondary tasks may make up for this difference in workload displaced by automation. Previous research has investigated the effects of adaptive cruise control (ACC) on driving performance and workload, but little attention has been devoted to Lane Keeping Systems (LKS). In addition, the influence of secondary cognitive tasks on Level-1 driving performance is also not well understood.</div><div><br></div><div>The first goal of this thesis study was to examine the effects of secondary cognitive tasks and driving condition on driving performance. The second goal was to examine the effects of secondary cognitive tasks and driving condition on heart rate related measurements that reflect changes in workload. Both a novel nano-sensor and a commercial ECG sensor were used to measure heart rate. Thus, the third goal was to compare the capability of a nano-sensor in detecting changes in heart rate and heart rate variability with a commercially available ECG sensor. Twenty-five participants drove a simulated vehicle in manual, ACC and LKS driving conditions, while performing a secondary cognitive (N-back) task with varying levels of difficulty.</div><div><br></div><div>Results showed that more difficult cognitive secondary tasks were beneficial to driving performance in that a lower standard deviation of lane departure (SDLD) and a lower standard deviation of vehicle speed (SDVS) were both observed. Heart rate and NASA-TLX workload scores were significantly higher in the most difficult secondary task and in the manual driving conditions. However, heart rate variability measures (SDNN, RMSSD, pNN50, LF Power and HF Power) indicated lower variability under more difficult secondary tasks. This thesis suggests that nanotechnological devices may serve as a potential alternative to other heart rate measuring technology. Limitations in detecting minor heart rate changes between different driving conditions and in heart rate variability measuring were also acknowledged.</div>

Le nouveau-né hospitalisé est exposé de manière répétée à des procédures douloureuses ou stressantes pouvant entraîner des conséquences neurodéveloppementales à court et long terme. La prévention de la douleur procédurale est essentiellement basée sur l’utilisation de traitements non pharmacologiques parmi lesquels les solutions sucrées possèdent un niveau de preuve élevé. Cependant, leur efficacité a récemment été remise en cause et leurs mécanismes d’action restent mal compris. Enfin, la dissociation parfois retrouvée entre les réponses comportementales et corticales suggère de monitorer la douleur de manière multimodale. Les objectifs de ce travail étaient : 1) de comparer l’efficacité de l’allaitement maternel et du sucrose sur la douleur procédurale en analysant spécifiquement les réponses corticales, 2) d’étudier les effets périphériques des solutions sucrées au niveau de neurones sensoriels de ratons, 3) d’évaluer l’intérêt d’un modèle d’évaluation multimodale de la douleur chez le nouveau-né à terme et prématuré. Aucune différence entre le sucrose et l’allaitement maternel n’a pu être objectivée sur les réponses corticales(NIRS) à la douleur chez des nouveau-nés à terme à 3 jours de vie. Nous avons objectivé un effet périphérique du glucose et du sucrose sur des neurones sensoriels de ratons nouveau-nés, médié par TRPV1. L'effet du glucose était associé à une diminution de la libération de la substance P. L’évaluation multimodale de la douleur retrouvait des corrélations faibles à modérées entre le score NFCS et la conductance cutanée, le cortisol salivaire et les changements d’ [HbT] mesurés en NIRS. L’étude menée chez les nouveau-nés prématurés nous permettra de préciser l’intérêt de l’utilisation de la variabilité de la fréquence cardiaque (indice NIPE instantané) dans cette indication afin de proposer un modèle multimodal fiable pour de futurs essais randomisés contrôlés. / Hospitalized newborns are exposed to repeated painful or stressful procedures that can lead to short- and long-term neurodevelopmental sequellae.The prevention of procedural pain is essentially based on the use of nonpharmacological treatments among which the sweet solutions appear to be among the most effective. However, their effectiveness has recently been challenged and their mechanisms of action remain poorly understood. Finally, the dissociation frequently found between behavioural and cortical responses shows the importance of monitoring pain in a multimodal way. The objectives of this work were 1) to compare the efficacy of breastfeeding and sucrose on procedural pain by specifically analyzing cortical responses, 2) to study the peripheral effects of sweet solutions on sensory neurons of newborn rats and 3) to evaluate the contribution of a multimodal pain assessment model in term and preterm neonates. No difference between sucrose and breastfeeding was measured on pain-evoked cortical responses (NIRS) in term neonates at 3 days of life.We reported a peripheral effect of glucose and sucrose on afferent sensory neurons from newborns rats mediated byTRPV1. The effect for glucose was associated with a decrease of substance P release.The multidimensional assessment of pain found mild to moderate correlations between the NFCS score, skin conductance, salivary cortisol and changes in [HbT] measured in NIRS.The study conducted in preterm newborns will specify the reliability of heart rate variability (instant NIPE index) in thisindication to provide a suited multimodal pain assessment model for future randomized controlled trials.

Introdução - Alterações cardíacas na anemia falciforme (AF) são frequentes e iniciam-se precocemente. Há evidências de que exista também disfunção na regulação do sistema nervoso autônomo o que pode contribuir com eventos de morbidade. Objetivos Avaliar a modulação autonômica cardíaca por meio da variabilidade da frequência cardíaca em crianças e adolescentes com anemia falciforme. Método - Estudo analítico no qual foi realizada uma comparação da variabilidade da frequência cardíaca em 45 crianças e adolescentes, menores de 20 anos, com anemia falciforme, com um grupo controle pareado um a um por idade e sexo. A frequência cardíaca foi obtida pelo frequencímetro de pulso e analisada, batimento a batimento. Estes pacientes são usuários do ambulatório de hematologia pediátrica do Sistema Único de Saúde. Esta pesquisa está em consonância com a resolução 466/2012 do Ministério da Saúde. Resultados - Observamos diferença significativa nos índices do domínio da frequência (VLF, LF, HF e LF/HF). Estas diferenças não foram observadas nos pacientes em uso de hidroxiureia. Conclusão - Existe uma disfunção autonômica na AF que ocorre desde a infância, podendo estar relacionada a uma menor modulação do simpático e uma maior modulação do parassimpático. Esta diferença não foi observada em pacientes em uso de hidroxiureia / Introduction - Cardiac changes in sickle cell disease (AF) are frequent and begin early. There is evidence that there is also dysfunction in the regulation of the autonomic nervous system, which may contribute to morbidity events. Objectives - To evaluate the autonomic cardiac modulation by heart rate variability in children and adolescents with sickle cell anemia. Method - An analytical study comparing the heart rate variability of 45 children and adolescents, younger than 20 years, with sickle cell anemia, with a control group matched one by one by age and sex. The heart rate was obtained by pulse frequency and analyzed, beat by beat. These patients are attending the pediatric hematology outpatient of the National Health System. Results - We observed a significant difference in the frequency domain indexes (VLF, LF, HF and LF / HF). The results of this study are in agreement with resolution 466/2012 of the Ministry of Health of Brazil. These differences were not observed in patients taking hydroxyurea. Conclusion - There is an autonomic dysfunction in AF that occurs from childhood, and may be related to a lower modulation of the sympathetic and greater modulation of the parasympathetic. This difference was not observed in patients taking hydroxyurea

O propósito do presente estudo foi obter evidências de validade e reprodutibilidade dos limiares de variabilidade da frequência cardíaca (VFC) durante a corrida. Dezenove sujeitos homens, saudáveis e praticantes de corrida (30,4 ± 4,1 anos; 175,9 ± 6,4 cm; 74,3 ± 8,5 kg) foram submetidos a um teste progressivo máximo em esteira rolante com velocidade inicial 5 km.h-1 e incrementos de 1 km.h-1 a cada 3 minutos (1% de inclinação constante) até exaustão voluntária. Todos os indivíduos realizaram o reteste em um intervalo de tempo entre 48 horas e uma semana. Foram realizadas as medidas das trocas gasosas, do lactato sanguíneo e da VFC (plotagem de Poincaré). Os limiares aeróbio (LAe) e anaeróbio (LAn) foram determinados pelos limares de lactato, ventilatórios e da VFC. Para a comparação entre os métodos foi uitlizada ANOVA para medidas repetidas, acompanhada de teste de post hoc de Bonferroni. A reprodutibilidade das variáveis analisadas foram verificadas pela plotagem de Bland-Altman e pelo coeficiente de correlação intraclasse (CCI). Os resultados do presente estudo demonstraram que a velocidade correspondente ao segundo e terceiro modelos utilizados para se determinar o LA pela VFC não eram significativamente diferentes (p > 0,05) do primeiro limiar de lactato e ventilatório. Em relação ao LAn, não foram observadas diferenças significativas nas velocidades correspondentes ao LAn detectado pelos diferentes métodos (p > 0,05). Os valores do CCI estavam entre 0,69 a 0,80 (p < 0,001). Conclui-se que o LAe e o LAn podem ser identificados pela análise da VFC, desde que se utilize os procedimentos empregados na presente investigação / The aim of the present study was to obtain evidences of validity and reliability of the thresholds of heart rate variability (HRV). Nineteen male subjects, healthy and runners (30,4 ± 4,1 years; 175,9 ± 6,4 cm; 74,3 ± 8,5 kg) performed a progressive maximal test on a treadmill with initial velocity 5 km.h-1 e increases of 1 km.h-1 every 3 minutes (1% slope) until voluntary exhaustion. All subjects performed the retest at an interval of time between 48 hours and one week. It was measured gas exchange, blood lactate and heart rate variability (Poincaré plot). The aerobic threshold (AT) and anaerobic (AnT) were determined by lactate, ventilatory and heart rate variability. ANOVA for repeated measures and post-hoc test of Bonferroni was used to compare the methods. To analyze the reproducibility of the variables were used the Bland- Altman plots and intraclass correlation coefficient (ICC). The results of this study show that the velocity at the second and third models employed to determine the AT by HRV were not significantly different (p > 0.05) of the first lactate threshold and ventilatory. Similarly, there were no significant differences in the velocities corresponding to AnT detected by different methods (p> 0.05). The ICC values were between 0.69 to 0.80 (p < 0.001). We conclude that the AT and the AnT can be estimated by HRV analysis, since it utilizes the procedures employed in this study

A síncope neurocardiogênica (SNC) é caracterizada por perda transitória da consciência e do controle postural, devido a uma hipoperfusão cerebral global de surgimento abrupto, com recuperação rápida e espontânea do paciente ao retornar à posição horizontal. Entretanto, investigações adicionais são necessárias para melhor avaliação das respostas cardiorrespiratórias e autonômicas de pacientes com SNC submetidos ao Tilt-test. O presente estudo teve como objetivo avaliar, em pacientes com história clínica sugestiva de SNC, os efeitos da mudança postural induzidas pelo Tilt-test na pressão arterial (PA) e frequência cardíaca (FC), na variabilidade cardiocirculatória e na sensibilidade barorreflexa (SBR). Além disso, o estudo também avaliou a relação entre a idade, sexo e características antropométricas dos pacientes com as respostas ao Tilt-test, e a relação entre o tempo do início da mudança postural e o momento da síncope, com um ou mais parâmetros acima mencionados. O estudo foi dividido em 3 partes: 1 Estudo retrospectivo de 180 pacientes, com história clínica sugestiva de SNC, mas que apresentaram Tilt-test positivo (TTP) (128 indivíduos) ou negativo (TTN) (52 indivíduos) para síncope; 2 Estudo da variabilidade da frequência cardíaca (VFC), usando-se métodos lineares (Transformada Rápida de Fourier) em pacientes com história clínica sugestiva de SNC, e com respostas positiva ou negativa ao Tilt-test. Foram incluídos 62 pacientes, 31 com Tilt-test positivo e 31 negativo; 3 Estudo da variabilidade da pressão arterial sistólica (VPAS), usando-se métodos lineares (Transformada Rápida de Fourier), e da SBR (Método da Sequência) em pacientes com história clínica sugestiva de SNC, e com respostas positiva ou negativa ao Tilt-test. Foram estudados 33 indivíduos, 16 com Tilt-test positivo e 17 negativo. Estudo 1 Observou-se que a incidência de SNC foi 1,5 vezes maior em mulheres do que em homens. Além disso, os grupos TTP e TTN apresentaram idade e características antropométricas semelhantes entre si, e não houve significância estatística nas correlações entre o tempo do início da posição vertical até a síncope, a idade e as características antropométricas. Estudo 2 Comparando os 2 grupos nos domínios do tempo (SD-iRR, variância-iRR, RMSSD) e da frequência (LF (un), HF (un) e LF/HF) nas fases Pré-Tilt, Tilt e Pós-Tilt, com exceção do iRR (ms), não observou-se diferença entre os grupos. Houve, na fase Tilt, um menor valor do iRR no grupo TTP. O Pré-Tilt comparado ao Tilt, promoveu em ambos os grupos redução do iRR e aumento na razão LF/HF. Estudo 3 Comparando-se os grupos TTP e TTN no Pré-Tilt e Tilt, não houve diferença no LF da PAS e na SBR. O Tilt promoveu, em ambos os grupos, aumento no LF da PAS, redução na SBR. Somente no grupo TTP foi observado aumento no desvio padrão da PAS durante o Tilt. Em conclusão, o estudo 1 demonstrou que a SNC não foi influenciada pela idade e características antropométricas, no que diz respeito à prevalência, e ao tempo de duração entre o início da mudança postural no Tilt-test e o momento do aparecimento da síncope na posição vertical. O estudo 2 demonstrou que indivíduos com suspeita clínica de SNC, e Tilt-test positivo ou negativo não apresentam anormalidades no balanço simpato-vagal cardíaco, mas, apresentaram diferenças no iRR. O estudo 3 não evidenciou diferenças no controle autonômico cardiovascular (LF-PAS e SBR) entre os grupos TTP e TTN no Pré-Tilt e Tilt. Os estudos 2 e 3 mostraram que com a metodologia utilizada na análise da VFC e VPAS não foi possível detectar anormalidades significativas da modulação autonômica cardiovascular nos grupos TTP e TTN, e desse modo, prever na posição vertical do Tilttest, se um paciente com história clínica sugestiva de SNC apresentará ou não síncope. / Neurocardiogenic syncope (NCS) is characterized by transient loss of consciousness and postural control, due to abrupt global cerebral hypoperfusion, with rapid and spontaneous recovery after changing the patient to horizontal position. However, further investigations are necessary to better understand the cardiorespiratory and autonomic responses to the Tilt-test in NCS patients. The present study aimed to evaluate, in patients with a history suspicion of NCS, the effects of postural change (Tilt-test) on blood pressure (BP) and heart rate (HR), on the cardiovascular variability and baroreflex sensitivity (BRS). Furthermore, the study also assessed the relationship between age, sex and anthropometric characteristics with the Tilt-test responses, and the relationship between the time period taken to experience syncope following postural change and the above cited parameters. The study was divided into three parts: 1 A retrospective study with 180 patients with a history suspicion of NCS, that experienced (TTP; 128 individuals) or not (TTN; 52 individuals) syncope following Tilt-test; 2 A study of the heart rate variability (HRV), assessed by linear methods (Fast Fourier Transform), in patients with a history suspicion of NCS and that experienced, or not, syncope following Tilt-test. The study included 62 patients (31 in TTP group and 31 in TTN group); 3 A study of the systolic blood pressure variability (SAPV), using linear methods (Fast Fourier Transform), and of the BRS (Sequence Method) in patients with a history compatible with NCS and that experienced, or not, syncope following Tilt-test. The study included 33 patients (16 in TTP group and 17 in TTN group). Study 1 it was observed that the incidence of NCS was 1.5 times greater in women than in men. Furthermore, groups TTP and TTN showed age and anthropometric characteristics similar to each other and no statistical significance was observed in the correlations among the time period taken to experience syncope following postural change and age and anthropometric characteristics. Study 2 The analysis of the cardiovascular variability, by means of time (SD-iRR, variance-iRR, RMSSD) and frequency (LF (nu), HF (nu) and LF/HF) domain methods, revealed no differences between groups in the Pre-Tilt, Tilt and Post-Tilt phases. However, iRR (ms) was found different between groups. During the Tilt phase, TTP group has shown lower iRR as compared to TTN. Also, TTP and TTN groups exhibited lower iRR and higher LF/HF ratio during Tilt-test as compared to Pre-Tilt phase. Study 3 Comparing the TTP and TTN groups, no statistical differences were found in the LF power of SAP and BRS in both Pre-Tilt and Tilt phases. Following Tilt-test it was observed an increase in LF power of SAP and a reduction in BRS. TTP group showed higher SAP standard deviation during the Tilt phase. In conclusion, study 1 demonstrated that NCS incidence and the time period taken to experience syncope following postural change were not influenced by age and anthropometric characteristics. Study 2 has shown that patients with a history suspicion of NCS, that experienced or not syncope following Tilt-test do not show abnormalities in the sympatovagal balance, but exhibited changes in the iRR. Study 3 showed that the cardiovascular autonomic control (LF-SAP and BRS) is not different between the TTP and TTN groups, in the Pre-Tilt and Tilt phases. Studies 2 and 3 have shown that the methods employed in the analysis of HRV and SAPV were unable to reveal abnormalities in the cardiovascular autonomic modulation in TTP and TTN groups, and thus, can not predict if a patient with a history suspicion of NCS will experience or not syncope during Tilt-test.

In dieser Dissertation untersuche ich das Zusammenspiel mentaler und körperlicher Prozesse, insbesondere den Einfluss von kontemplativem Mentaltraining (KMT) auf Interozeption (innerliches Spüren des Körpers) und physiologische Regulation. In einer großangelegten Trainingsstudie (n = 332, Trainingsdauer 3-9 Monate), der ReSource-Studie, zeige ich, dass KMT die interozeptive Genauigkeit in den Trainingskohorten erhöht, nicht jedoch in einer Retest-Kontrollgruppe. Die Steigerungen in interozeptiver Genauigkeit gehen mit Veränderungen im emotionalen Gewahrsein einher und sagen diese voraus. Im Einklang mit diesen Befunden berichten die Studienteilnehmenden von positiven Veränderungen in verschiedenen Dimensionen des Körpergewahrseins. Diese betreffen vor allem die Fähigkeit, Aufmerksamkeit auf Körperempfindungen aufrechtzuerhalten sowie deren Gebrauch zur Emotionserkennung und -regulation. Ich beschreibe eine neuentwickelte Biofeedback-Aufgabe, welche die Fähigkeit misst, willentlich die hochfrequente Herzratenvariabilität (HF-HRV) hochzuregulieren, wodurch die willentliche parasympathische Kontrollfähigkeit (WPK) indiziert wird. Ich zeige, dass individuelle Unterschiede in WPK mit dem Oxytocin-Rezeptorgen-Polymorphismus rs53576 zusammenhängen und mit individuellen Unterschieden im altruistisch motivierten Verhalten korrelieren. WPK wird durch KMT verbessert, wobei diese Verbesserungen durch den rs53576 Genotyp moduliert werden. In einer weiteren Untersuchung zeige ich, dass retrospektive, subjektive Berichte über eine emotional erregende Erfahrung teilweise die objektiv gemessene körperliche Erregung widerspiegeln. Das Ausmaß dieser körperlich-mentalen Kohärenz ist abhängig von der interozeptiven Genauigkeit. Zusammengenommen vertiefen diese Studien unser Verständnis des Zusammenspiels von physiologischen und mentalen Prozessen und zeigen wie KMT das innerliche Spüren des Körpers und die willentliche physiologische Regulation verbessert. / In this dissertation, I investigate interactions between mental and bodily processes, specifically by studying the influence of contemplative mental training (CMT) on interoception (inner body sensing) and physiological regulation. In a large-scale mental training study (n = 332, training durations 3–9 months), the ReSource Project, I find that CMT increases interoceptive accuracy in the training cohorts, but not in a retest control cohort. These increases in interoceptive accuracy co-occur with and predict improvements in emotional awareness. In line with these objective data on interoception, participants self-report training-related benefits on multiple dimensions of body awareness. The strongest changes occur in the ability to sustain attention to body sensations and the use of this ability to identify and regulate emotions. I also introduce a novel biofeedback task that measures the ability to voluntarily upregulate high frequency heart rate variability (HF-HRV), indicative of voluntary parasympathetic control. Cross-sectional data of the ReSource Project show that individual differences in voluntary parasympathetic control are related to the oxytocin receptor gene rs53576 polymorphism and correlate to individual differences in altruistically motivated behavior. Furthermore, CMT improves various aspects of voluntary HF-HRV regulation, with modulation of these improvements by rs53576 genotype. An additional investigation in cross-sectional data shows that subjective retrospective reports of an emotionally arousing experience partially mirror the objectively measured bodily arousal during the actual experience. Individual differences in this mind–body coherence are related to individual differences in interoceptive accuracy. Together, these studies highlight the tight interplay between physiological and mental processes and show how CMT improves inner body sensing and voluntary physiological regulation.