Rhythmic Breath Holding and Its Effect on Arterial Blood Pressure and Its Correlation With Blood Gases
A single episode of breath-holding (BH) is known to elevate the blood pressure, and regular breathing exercise lowers the blood pressure. This prompted us to investigate how a series of BH epochs would affect the cardiovascular system. To observe arterial blood pressure (ABP) and heart rate (HR) changes associated with a series of “BH epochs” following maximum inspiration and maximum expiration and find the underlying mechanisms for the change by autonomic activity. Thirty-five healthy young adults were instructed to hold their breath repetitively, for 5 minutes, in two patterns, one following maximum inspiration and other following maximum expiration. ABP and ECG (for Heart Rate Variability) were continuously recorded at rest and during both the maneuvers. Capillary blood gases (BG) were zanalyzed at baseline and at the breakpoint of the last epoch of BH. ABP rose significantly at the breakpoint during both the maneuvers. No change in HR was observed. There was significant fall in PO2 from 94.7 (4.1) mmHg at baseline to 79.1 (9.0) mmHg during inspiratory and 76.90 (12.1) mmHg during expiratory BH. Similarly, SPO2 decreased from 96.3 (1.9) % at baseline to 95.4 (1.5) % and 94.5 (2.7) % during inspiratory and expiratory BH, respectively. Rise in PCO2 from 39.5(3.1) mmHg at baseline to 42.9 (2.7) mmHg and 42.1 (2.8) mmHg during inspiratory and expiratory BH respectively was observed. There was no significant correlation between blood gases and arterial blood pressure. Among HRV parameters, a significant decrease in SDNN, RMSSD, HFnu, total power and SD1/SD2 and the significant increase in LFnu, LF/HF and SD2 were observed during both BH patterns. Rhythmic BH patterns affect the cardiovascular system in similar way as a single episode of BH. Sympathetic overactivity could be the postulated mechanism for the same.
2. Bhargava R, Gogate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol. 1988; 32(4): 257–64.
3. Marabotti C, Scalzini A, Cialoni D, Passera M, L'Abbate A, Bedini R. Cardiac function and oxygen saturation during maximal breath-holding in air and during whole-body surface immersion. Diving Hyperb Med. 2013; 43(3): 131-7.
4. Parkes MJ, Green S, Stevens AM, Clutton-Brock TH. Assessing and ensuring patient safety during breath-holding for radiotherapy. Br J Radiol. 2014; 87(1043): 20140454.
5. Coetsee MF, Terblanche SE. The effects of breathhold on lactate accumulation, PO2, PCO2 and pH of blood. Aviat Space Environ Med. 1988; 59(6): 540–3.
6. Flume PA, Eldridge FL, Edwards LJ, Houser LM. Relief of distress of breathholding: separate effects of expiration and inspiration. Respir Physiol. 1995; 101(1): 41–6.
7. Skow RJ, Day TA, Fuller JE, Bruce CD, Steinback CD. The ins and outs of breath holding: simple demonstrations of complex respiratory physiology. Adv Physiol Educ. 2015; 39(3): 223–31.
8. Steinback CD, Salzer D, Medeiros PJ, Kowalchuk J, Shoemaker JK. Hypercapnic vs. hypoxic control of cardiovascular, cardiovagal, and sympathetic function. Am J Physiol Regul Integr Comp Physiol. 2009; 296(2): R402-410.
9. Shoemaker JK, Vovk A, Cunningham DA. Peripheral chemoreceptor contributions to sympathetic and cardiovascular responses during hypercapnia. Can J Physiol Pharmacol. 2002; 80(12): 1136–44.
10. Rowell LB, Blackmon JR. Human cardiovascular adjustments to acute hypoxaemia. Clin Physiol 1987; 7(5): 349–76.
11. Parkes MJ, Green S, Stevens AM, Parveen S, Stephens R, Clutton-Brock TH. Safely prolonging single breath-holds to >5 min in patients with cancer; feasibility and applications for radiotherapy. Br J Radiol. 2016; 89(1063): 20160194.
12. Gross PM, Whipp BJ, Davidson JT, Koyal SN, Wasserman K. Role of the carotid bodies in the heart rate response to breath holding in man. J Appl Physiol. 1976; 41(3): 336–40.
13. Lindholm P, Lundgren CEG. Alveolar gas composition before and after maximal breath-holds in competitive divers. Undersea Hyperb Med 2006; 33(6): 463–7.
14. Figura F, Cama G, Guidetti L. Heart rate, alveolar gases and blood lactate during synchronized swimming. J Sports Sci. 1993; 11(2): 103–7.
15. Matheson GO, McKenzie DC. Breath holding during intense exercise: arterial blood gases, pH, and lactate. J Appl Physiol. 1988; 64(5): 1947–52.
16. Nivethitha L, Mooventhan A, Manjunath N K. Effects of various Prāṇāyāma on cardiovascular and autonomic variables. Ancient Sci Life 2016; 36(2): 72-7.
17. Veerabhadrappa SG, Baljoshi VS, Khanapure S, Herur A, Patil S, Ankad RB, et al. Effect of yogic bellows on cardiovascular autonomic reactivity. J Cardiovasc Dis Res. 2011; 2(4): 223–7.
18. Mourya M, Mahajan AS, Singh NP, Jain AK. Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med. 2009; 15(7): 711–7.
19. Stern RM, Anschel C. Deep inspirations as stimuli for responses of the autonomic nervous system. Psychophysiology. 1968; 5(2): 132–41.
20. Reyes del Paso GA, Muñoz Ladrón de Guevara C, Montoro CI. Breath-Holding During Exhalation as a Simple Manipulation to Reduce Pain Perception. Pain Med. 2015; 16(9): 1835–41.
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