Postprandial attenuation of gastric slow waves in anxiety–depression, with and without functional dyspepsia: associations with heart rate variability and sleep quality
In the anxiety–depression without FD group, a PRI < 1 reflected a blunted meal-related slow-wave response despite preserved absolute normogastria values, which should be considered an exploratory research endpoint requiring prospective validation.
Abstract
Background and aims Functional dyspepsia (FD) commonly coexists with anxiety, depression, and sleep disturbances. However, it remains unclear whether the burden of psychological symptoms and sleep disturbances is associated with autonomic regulation and meal-induced gastric myoelectrical responses, particularly in individuals without overt FD. This study aimed to explore the relationships among heart rate variability (HRV), sleep quality, and postprandial electrogastrographic changes in adults with symptoms of anxiety–depression (AnxDep), with or without FD. Methods A single-center cross-sectional observational study enrolled 253 participants across four clinically defined phenotypes: healthy controls (n = 75), FD-only (n = 45), mild-to-moderate anxiety–depression without FD (n = 60), and severe anxiety–depression with FD (n = 73). The design was not a complete factorial design; therefore, group comparisons were interpreted as descriptive phenotype comparisons rather than as estimates of the interaction between anxiety–depression severity and FD status. Anxiety, depression, sleep quality, and FD symptoms were assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and a structured FD scale. Surface electrogastrography (EGG) was recorded before and after a standardized meal, and 24-h HRV was monitored. Postprandial response index (PRI) was calculated as the postprandial-to-preprandial normogastria ratio and was analyzed as an exploratory research index. Statistical analyses included group comparisons, correlations, collinearity-aware regression models, and sensitivity analyses; causal mediation analysis was not performed. Results HRV indices significantly differed across groups (all p < 0.001). Lower RMSSD and HF values were observed in the FD and anxiety–depression groups, with the lowest vagal-related indices in the severe anxiety–depression with FD group. LF/HF was reported only as a relative spectral ratio and was not interpreted as a direct measure of sympathovagal balance. The anxiety–depression without FD group had preserved absolute normogastria values but a reduced PRI (0.874 ± 0.066 vs. 1.145 ± 0.086 in controls), with all participants in this group showing PRI < 1. In sensitivity analyses, the difference in PRI between the anxiety–depression without FD group and controls persisted after adjustment for BMI or weight, medication exposure, and recruitment source, and after excluding participants using SSRI/SNRIs or sleep medications. Conclusion Anxiety–depression symptoms were associated with reduced vagal-related HRV, poorer sleep quality, and a blunted postprandial gastric slow-wave response. In the anxiety–depression without FD group, a PRI < 1 reflected a blunted meal-related slow-wave response despite preserved absolute normogastria values. PRI should be considered an exploratory research endpoint requiring prospective validation.
Background Pain, depressive and anxiety symptoms, sleep disturbance, and autonomic regulation may coexist in hospitalized patients with musculoskeletal pain. This study integrated item-level symptoms with resting-state photoplethysmography-derived heart rate variability (HRV) to characterize their regularized association structure. Methods This exploratory cross-sectional study retained 172 adults hospitalized with musculoskeletal pain-related conditions. Pain-duration information was available for all participants, and 169 complete cases entered the primary 58-node network. Regularized partial rank associations were estimated from Spearman correlations using EBICglasso (γ = 0.50) without additional thresholding. Sensitivity analyses examined participants with pain lasting at least 3 months and the influence of overlapping insomnia items. Results Median pain duration was 4.00 months (IQR, 0.57–24.33; range, 0.50–365.00), and 91 of 172 participants (52.9%) had pain lasting at least 3 months. The primary network retained 332 of 1653 possible edges. Prominent within- and cross-domain connections involved pain intensity and mood, gastrointestinal, cognitive, somatic, and insomnia symptoms. HRV indices formed a comparatively distinct physiological cluster; only 24 of 441 possible HRV–symptom edges were retained, all with absolute weights below 0.029. Strength and expected-influence estimates showed low bootstrap stability (CS coefficients = 0.000 and 0.207, respectively). In the ≥3-month subgroup, correlations with the primary network were 0.868 for edge weights, 0.552 for strength, 0.729 for expected influence, and 0.925 for bridge expected influence. Network structure and bridge patterns were partly preserved, but centrality rankings were more duration-sensitive. After overlapping insomnia items were removed, the global structure remained similar, but pain-related sleep interference fell from fourth to 27th in bridge expected influence. Conclusion Item-level network analysis identified closely connected pain and psychological symptom patterns, whereas short-term PPG-derived HRV showed sparse and weak direct network connectivity with clinical symptoms. Sleep-related bridging was partly attributable to overlapping insomnia content. These exploratory findings support multidimensional inpatient assessment but require validation in larger longitudinal studies.
Xi Chen, Guang-Yuan Ma, Jin-Chao Hu et al.· Journal of Pain Research· 0 citations
Purpose: Chronic anxiety, evidenced by a clinical diagnosis of generalized anxiety disorder (GAD) or symptoms consistent with GAD, has been linked to irregular sleep patterns that, when present, are accompanied by impaired vascular function and reduced acute blood pressure control, contributing to elevated cardiovascular disease risk. We performed a retrospective analysis to determine whether resistance exercise training (RET) improves outcomes in individuals with chronic anxiety previously identified as having elevated sleep irregularity and concomitant physiological impairments. Methods: Twenty young adults (25±4 years) with chronic anxiety completed 10 weeks of RET. Based on prior characterization, participants were stratified into High (≥67.67 minutes) and Low (<67.67 minutes) total sleep time irregularity (TSTI) groups, representing those with impaired versus relatively preserved vascular and autonomic function, respectively. Primary outcomes included macrovascular function (exercise-induced flow-mediated dilation; FMD) and cardiovagal baroreflex sensitivity (cBRS). Results: Significant Group × RET interactions were observed for all primary outcomes (p < 0.05). Post-hoc analyses showed that the High TSTI group improved FMD (p < 0.01) and cBRS (p = 0.04), whereas the Low TSTI group showed no significant changes (p > 0.05). Conclusions: In this retrospective analysis, individuals with chronic anxiety characterized by elevated sleep irregularity and baseline impairments exhibited significant improvements in vascular and autonomic function following RET. These findings suggest that RET may be particularly effective in targeting cardiovascular dysfunction in higher-risk anxiety phenotypes.
Emily A Buck, J. Richardson, Jennifer B Weggen et al.· American Journal of Physiolo...· 0 citations
Poor sleep quality is closely associated with autonomic dysregulation and increased risks of cardiovascular, metabolic, and mental disorders. Foot reflexology is a widely used complementary therapy; however, its physiological mechanisms and comparative efficacy remain insufficiently explored. This study aimed to compare the effects of manual reflexology treatment (MRT) and foot massage equipment (FEM) on autonomic nervous system function, sleep quality, insomnia severity, and fatigue in adults with poor sleep quality. Using a randomized crossover design, 32 participants with poor sleep quality received MRT and FEM interventions for 6 weeks each (once weekly, 30-40min/session). Heart rate (HR), blood pressure, and heart rate variability (HRV; time- and frequency-domain indices) were assessed at weeks 1 and 6 before and after each intervention. Subjective outcomes included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Fatigue Assessment Scale (FAS). Following MRT, participants demonstrated significantly greater reductions in global PSQI scores and all PSQI components compared with FEM. MRT also resulted in larger improvements in insomnia severity and both mental and physical fatigue. In contrast, FEM primarily improved physical fatigue. Physiologically, MRT induced an immediate decrease in HR and significant increases in HRV time-domain indices (SDNN, RMSSD, pNN50), which were sustained after 6 weeks. Frequency-domain analysis further revealed reduced LF, increased HF, and a lower LF/HF ratio, indicating enhanced parasympathetic activity and cumulative autonomic modulation. In conclusion, programmed manual reflexology, delivered according to the TIDieR framework, is more effective than mechanical foot massage in improving autonomic balance, sleep quality, insomnia severity, and fatigue in individuals with poor sleep quality. These findings support MRT as a feasible and evidence-based non-pharmacological complementary intervention for sleep health promotion. TRIAL REGISTRATION: clinicaltrials.gov; NCT Number: NCT07402460; Registered 3 February 2026.
Shih-Pei Chen, M. Gao, Chun-Ching Huang et al.· Complementary Therapies in M...· 0 citations
Nocturia is associated with sleep disturbance and depressive symptoms, but the role of daytime sleepiness in this relationship remains unclear. This study examined the relationships among nocturia, sleep duration, daytime sleepiness, and depressive symptoms, with particular attention to the indirect associations through sleep duration and daytime sleepiness. Data from the 2015 to 2023 National Health and Nutrition Examination Survey were analyzed. Depressive symptoms were assessed using the Patient Health Questionnaire-9 and categorized as none or minimal, mild, moderate, moderately severe, or severe. Survey-weighted logistic regression was used to examine factors associated with nocturia. Interaction and direct and indirect association analyses were performed using linear regression and structural equation modeling with bootstrap confidence intervals. Among 17,731 participants, 6479 (36.5%) reported nocturia. Analyses involving daytime sleepiness included 12,634 participants. Nocturia frequency and daytime sleepiness were associated with higher Patient Health Questionnaire-9 scores, and a significant interaction was observed between them (β = 0.12, P < .001). The indirect association through sleep duration was not statistically significant (P = .083). The indirect association through daytime sleepiness was β = 0.136 (P < .001), representing 21.15% of the total association between nocturia and depressive symptoms. Nocturia was associated with depressive symptoms, and an indirect association through daytime sleepiness was observed. The temporal relationship among nocturia, daytime sleepiness, and depressive symptoms remains to be determined.
Objective Alterations in autonomic nervous system activity – measured by heart rate variability (HRV) and heart rate (HR) - have been proposed as a relevant biopsychological mechanism in several psychiatric disorders. However, only few studies have examined these parameters in OCD, and evidence from pediatric samples is particularly limited. The aim of this study was to investigate autonomic activity in pediatric OCD. Methods A five minute resting state electrocardiogram was recorded in adolescents with OCD (n = 64) and age- and IQ-matched healthy controls (HC, n = 52). Autonomic activity was compared using the logarithmized root mean square of differences between successive R-R intervals (logRMSSD), the logarithmized high-frequency HRV (logHF-HRV), the percentage of adjacent NN intervals differing from each other by more than 50 ms (pNN50) and HR. Associations with psychotropic medication status and symptom severity were assessed. Results Adolescents with OCD showed lower logRMSSD and higher HR than HC, whereas logHF-HRV and pNN50 did not differ between groups. No associations were found between cardiac measures and OCD symptom severity. Exploratory subgroup analyses suggested lower logHF-HRV and logRMSSD in medicated adolescents with OCD. Conclusions Our findings add to evidence for altered autonomic activity in pediatric OCD, reflected by elevated HR and lower RMSSD. The observed reduction in HRV did not increase with greater symptom severity and appeared most pronounced among medicated adolescents with OCD. Significance The autonomic imbalance observable in adolescents with OCD is common across anxiety disorders and has been linked to cardiovascular risk.
Manuel Burkart, Sophie P. Scheer, Lea L. Backhausen et al.· Clinical Neurophysiology Pra...· 0 citations
