Hua Ting

Electroacupuncture at Hoku elicits dual effect on autonomic nervous system in anesthetized rats

To address the effect of electroacupuncture (Ea) on the autonomic nerve activity, responses of arteriole blood pressure (BP), intragastric pressure (IGP) and parasympathetic vagal nerve activity (VNA) to Ea were investigated in alpha-chloralose anesthetized rats. The acupoint: Hoku (Li-4) was tested with two different stimulation frequencies (2 and 20 Hz). Decrease in VNA and basal IGP associated with elevation of BP were elicited during Ea at Hoku with stimulation intensity of 20 times of motor threshold. The pattern of response induced by the low frequency Ea (LFEa) was different from that by the high frequency Ea (HFEa), i.e. a tonic effect was elicited by the LFEa, while a phasic one was induced by the HFEa. All the results in this study implicated that: (1) Ea at Hoku may activate the sympathetic and simultaneously inhibit the gastric parasympathetic nerve; (2) Ea at Hoku with different stimulation frequencies may elicit distinct mechanism to induce therapeutic effect; (3) Ea at Hoku may ameliorate the hyperactive stomach in clinical therapy.

Depressor effect on blood pressure and flow elicited by electroacupuncture in normal subjects

To clarify the effect of electroacupuncture (Ea) on the activity of the cardiovascular system in normal individuals, hemodynamic parameters including arterial blood pressure (BP), finger blood flow (FBF) and heart rate (HR) as well as paravertebral temperature (PVT) were non-invasively recorded under Ea stimulation. Surface stimulation electrode was placed on the Hoku point (Li-4). Square wave pulses (0.05 ms) were applied from a stimulator with a stimulation frequency of 2 Hz (3 min). The stimulation intensity was five times of sensory threshold. BP and FBF were decreased (68.5+/-6.0%, P<0.01 and 96.8+/-1.1%, P<0.01 of control, respectively, n=7) while HR and PVT were increased significantly (115.0+/-5.1 of control, P<0.05 and 0.054+/-0.004 degree C, P<0.01, respectively, n=7) during Ea treatment. The results suggested an inhibition in sympathetic outflow, which induced vasodilatation of systemic arteriole and decrease in BP and FBF were elicited by Ea stimulation.

Post- to pre-overnight sleep systolic blood pressures are associated with sleep respiratory disturbance, pro-inflammatory state and metabolic situation in patients with sleep-disordered breathing

OBJECTIVE The aim of the current study was to investigate whether changes in post- to pre-overnight sleep systolic blood pressure (SSBP) are associated with sleep respiratory disturbance, pro-inflammatory state, and metabolic situation in patients with sleep-disordered breathing (SDB). METHODS Anthropometry, sleep polysomnography, biochemical markers, and pre- and post-overnight sleep BP were measured from 263 SDB patients. All SDB patients were further subgrouped into MORNING SURGE (% changes from post- to pre-overnight SSBP >+1SD of this cohort), MORNING DROP (% changes <-1SD), CONSTANT HIGH (% changes within+/-1SD, averaged SSBP>130mmHg) and CONSTANT LOW (% changes within+/-1SD, averaged SSBP<130mmHg). RESULTS BMI, neck circumference, waistline circumference, respiratory disturbance index, arousal index, lowest oxygen saturation, duration of SaO(2)<90%, blood glucose, hs-CRP, and metabolic syndrome score in MORNING SURGE and CONSTANT HIGH were significantly greater than those in CONSTANT LOW. Except metabolic syndrome score, all other parameters in MORNING DROP were similar to those in CONSTANT LOW. CONCLUSION Patients with SDB whose post- to pre-overnight SSBPs were elevated or maintained a constant high have more sleep respiratory disturbance, more pro-inflammatory state, and higher metabolic syndrome indices than the rest. Without subdividing into CONSTANT LOW, MORNING DROP, CONSTANT HIGH, and MORNING SURGE, the important pathophysiologic points of SDB patients will possibly be missed.

Pressor effect on blood pressure and renal nerve activity elicited by electroacupuncture in intact and acute hemorrhage rats

The neural mechanism underlying the effect of electroacupuncture (Ea) on arterial blood pressure (BP) and renal nerve activity (RNA) in the intact state and during acute hemorrhage was investigated in anesthetized rats. Two acupoints, Hoku (Li-4, at the junction of the first and the second metacarpal bone) and Tsusanli (St-36, at the lateral upper tibia bone), were tested using Ea of two different frequencies (2 and 20 Hz). In the intact state, Ea at Hoku elicited an elevation of BP in parallel with RNA, while Ea found no response with identical parameters at Tsusanli. The pattern of the pressor response caused by a low frequency Ea (2 Hz) at Hoku was different than a high frequency one (20 Hz), i.e. a tonic effect was elicited with 2 Hz, while a phasic one was induced with 20 Hz. In mild hemorrhage conditions (10% of BP decrease), similar pressor effects, as in intact rats, were also elicited by Ea. However, in severe hemorrhage conditions (20 and 30% BP decrease), Ea induced a pressor effect on RNA and an attenuated effect on BP. BP and RNA showed a significant correlation in intact and mild hemorrhage conditions, but not in severe hemorrhage conditions. All the results suggested that Ea at Hoku with appropriate stimulation parameters can increase and maintain BP in normal and hemorrhage conditions, and such a therapeutic technique has potential in clinical practice.

Electroacupuncture-induced pressor and chronotropic effects in anesthetized rats

The effects of electroacupuncture (Ea) on circulatory dynamics were investigated in anesthetized rats. The arterial blood pressure (BP) and the heart rate (HR) in response to Ea stimulations at the Tsusanli point (St-36) and the Hoku point (Li-4) were tested by a low frequency Ea (2 Hz; LFEa) and a high frequency Ea (20 Hz; HFEa) with stimulation intensities 20 times the motor threshold. Neither the HR nor the BP was affected when the Tsusanli point was stimulated. Whereas, Ea stimulations at the Hoku point elicit chronotropic and pressor effects. The patterns of pressor responses caused by the LFEa were different from that of an HFEa, i.e., the LFEa elicited a tonic effect, while an HFEa had a phasic one. The HFEa-induced pressor and chronotropic effects were attenuated, while the LFEa induced effects were completely blocked by an intravenous infusion of an alpha-adrenergic blocker (moxisylyte 0.2 mg/min/kg, i.v., for 20 min). A co-infusion with alpha-and beta-adrenergic blockers (propanolol 0.2 mg/min/kg, i.v., for 20 min) completely blocked the HFEa-induced pressor and chronotropic effects. We concluded that Ea stimulations, at the Hoku acupoint, with appropriate stimulation parameters can increase and maintain BP. Furthermore, the LFEa stimulation activates sympathetic vasomotor tone, whereas the HFEa stimulation causes an additional potentiation on the sympathetic drive to the heart.

Poor sleep quality measured by polysomnography in non-obese asthmatic children with or without moderate to severe obstructive sleep apnea

BACKGROUND The co-effect of asthma and obstructive sleep apnea (OSA) on sleep quality among children remained unclear. OBJECTIVE To compare sleep quality and emotional/behavioral problems among asthmatic and non-asthmatic children with or without moderate to severe obstructive sleep apnea. METHOD An AHI-range-matched BMI-range-matched cross-sectional design was used to examine polysomnographic evaluation and emotional/behavioral problems in 102 non-obese children aged between 6 and 12 years old, categorized as with or without asthma and sleep disordered breathing. RESULTS Asthmatic children in AHI ≤ 5/h group revealed a significantly longer sleep latency, a greater leg movement index (LMI), and a lower ratio of slow wave sleep compared with non-asthmatic AHI ≤ 5/h group. Compared with non-asthmatic AHI > 5/h group, asthmatic children displayed a higher ratio of REM sleep, sleep stage 1 and 2, a lower ratio of slow wave sleep, as well as a greater respiratory arousal index and LMI. There was no significant difference in emotional/behavior problems among groups. CONCLUSION Sleep disturbance exists in asthmatic children with or without moderate to severe obstructive sleep apnea. Non-obese asthmatic children had less slow wave sleep compared with non-asthmatic children. We might recommend that sleep quality could be noticed and evaluated in children with asthma.

Evaluation of candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers

Background: Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. Results: 63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1) Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87∼0.92); (2) Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61∼0.89); and (3) ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70∼0.70), based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1) 94.5%∼96.6%, (2) 93.8%∼97.2%, (3) 91.1%∼91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers.

Vanished Gender Differences of Cardiometabolic Risk Factors After Matching the Apnea Hypopnea Index at Postmenopausal Age

BACKGROUND Sleep-disordered breathing (SDB) and cardiometabolic risk factors are male prevalent. OBJECTIVE This study investigated whether gender differences remained prominent after matching for the apnea hypopnea index (AHI) and postmenopause. METHODS In a retrospective analysis of 350 eligible SDB patients, female patients were matched with male patients of the same age and body mass index (BMI) (age-BMI-matched [nAHImt]; n = 102 pairs) or were matched with male patients of the same age, BMI, and AHI (age-BMI-AHI-matched [AHImt]; n = 66 pairs). The nAHImt or AHImt patients were further separated into junior and senior subgroups. RESULTS In the nAHImt/junior group, women had shorter neck circumferences, better sleep architecture, and lower AHI, Epworth Sleepiness Scale (ESS) score, blood pressure (BP), total cholesterol (TC), triglyceride (TG), and uric acid (UA) than nAHImt/junior men. In the AHImt/junior group, women had shorter neck circumferences, lower waist/hip ratios, ESS, BP, TG, and UA than AHImt junior men. In the nAHImt/senior group, women had lower AHI, neck circumferences, waist/hip ratios, diastolic BP, and UA than men. In contrast, in the AHImt/senior group, most cardiometabolic parameters were similar between women and men. After further matching for the AHI, many elements of gender differences disappeared. CONCLUSIONS Compared with AHImt men, women had lower UA, TG, BP, and daytime sleepiness before menopause, but gender differences became indistinguishable postmenopause. We suggested that matching sleep quality or adjusting AHI would be noteworthy and required for studying gender differences.

Effects of bilateral T2-sympathectomy on static and dynamic heart rate responses to exercise in hyperhidrosis patients

The static/dynamic changes of gas exchange, heart rate (HR) and blood pressure in terms of work rate (WR) and WR changes in ramp exercise were investigated by cardio-pulmonary exercise tests (CPETs) in hyperhidrosis patients before (W0), one week (W1) and four weeks (W4) after bilateral T2-sympathectomy. Accompanied by constant oxygen consumption and WR at peak exercise and similar oxygen debt in recovery, the HR significantly (p<0.05) decreased statically in all stages of CPET, but was not altered dynamically, i.e., similar slope but significantly diminished intercept in HR changes versus WR changes (70+/-6.0 vs. 82+/-19 beats/min, p<0.01), in W1 (n=11), compared to W0 (n=13). However, this surgical effect on static HR changes seemed to have disappeared in W4 (n=8), albeit at that time the static blood pressure decreased significantly during exercise. These findings suggest that bilateral T2-sympathectomy will reduce static HR without causing cardiovascular insufficiency in one week, and would then recover by one month in hyperhidrosis patients.

Objective Sleep Measures in Inpatients With Subacute Stroke Associated With Levels and Improvements in Activities of Daily Living

OBJECTIVE To investigate whether objective polysomnographic measures of prevalent sleep problems such as sleep-disordered-breathing (SDB) and insomnia are associated with activities of daily living levels in inpatients at rehabilitation units. DESIGN Retrospective and observational study. SETTING Single rehabilitation center. PARTICIPANTS Inpatients with subacute stroke (N=123) (61.6±13.1 years; 23.8±3.4 kg/m2; 33% women; 90.5±36.7 days post-stroke) underwent a 1-night polysomnographic study and a 1-month inpatient rehabilitation program. MAIN OUTCOME MEASURES Admission and discharge Barthel Index (BI) scores and its change scores. RESULTS One hundred three (92%) patients had moderate-to-severe SDB (46.7±25.1 events/h in the apnea-hypopnea index), and 24 (19.5%) patients had acceptable continuous positive airway pressure adherence. Diverse values were found for total sleep time (259±71 min), sleep efficiency (69.5%±19.3%), sleep latency (24.3±30.9 min), and wakefulness after sleep onset (93.1±74.2 min). Admission BI scores and the BI change scores were 33.8±23.2 and 10.1±9.2, respectively. The National Institutes of Health Stroke Scale (NIHSS, 10.2±5.6), available in 57 (46%) patients, was negatively associated with admission levels and gains in BI change scores (P<.001, =0.002, respectively) in a univariate analysis. In regression models with backward selection, excluding NIHSS score, both age (P=.025) and wakefulness after sleep onset (P<.001) were negatively associated (adjusted R2=0.260) with admission BI scores. Comorbidity of hypertension; sleep latency percentage of stage 1, non-rapid eye movement sleep; and desaturation events ≥4% (P<.001, 0.001, 0.021, and 0.043, respectively; adjusted R2=0.252) were negatively associated with BI score gains. CONCLUSIONS Based on objective sleep measures, insomnia rather than SDB in inpatients with subacute stroke was associated negatively with admission levels of activity of daily living and its improvement after a 1-month rehabilitation course.