Sleep loss and psychosocial stress often co-occur in today's society, but there is limited knowledge on the combined effects. Therefore, this experimental study investigated whether one night of sleep deprivation affects the response to a psychosocial challenge. A second aim was to examine if older adults, who may be less affected by both sleep deprivation and stress, react differently than young adults. 124 young (18-30 years) and 94 older (60-72 years) healthy adults participated in one of four conditions: i. normal night sleep & Placebo-Trier Social Stress Test (TSST), ii. normal night sleep & Trier Social Stress Test, iii. sleep deprivation & Placebo-TSST, iv. sleep deprivation & TSST. Subjective stress ratings, heart rate variability (HRV), salivary alpha amylase (sAA) and cortisol were measured throughout the protocol. At the baseline pre-stress measurement, salivary cortisol and subjective stress values were higher in sleep deprived than in rested participants. However, the reactivity to and recovery from the TSST was not significantly different after sleep deprivation for any of the outcome measures. Older adults showed higher subjective stress, higher sAA and lower HRV at baseline, indicating increased basal autonomic activity. Cortisol trajectories and HRV slightly differed in older adults compared with younger adults (regardless of the TSST). Moreover, age did not moderate the effect of sleep deprivation. Taken together, the results show increased stress levels after sleep deprivation, but do not confirm the assumption that one night of sleep deprivation increases the responsivity to an acute psychosocial challenge.

Background: Low birth weight (LBW) is associated with cardiovascular morbidity in adulthood. Imbalance in the autonomic nervous system (ANS) has been implicated as a mechanism behind the developmental programming of cardiovascular function. We hypothesized that deviations in the ANS function are seen in children born with LBW. Methods: Eighty-six children were included: 31 born preterm (<32 wk gestational age), 27 born at term but small for gestational age (SGA), and 28 born at term with normal birth weight (control). Twenty-four-hour Holter-electrocardiogram monitoring was performed at an average age of 9 y. Heart rate variability results were analyzed using frequency and time domain methods. Results: All frequency components and both time domain parameters tested were significantly lower in the preterm and SGA children compared with controls. The low frequency/high frequency ratio was not significantly different between children born with LBW and controls. Conclusion: The autonomic control appears to be affected in children born with LBW despite gestational age at birth. Decreased total power, as an estimation of the ANS’s global activity, rather than the balance between parasympathetic and sympathetic modulation might be an early marker of cardiovascular disease later on in life for LBW born children.

En kvantitativ analys av Hogskoleverkets (HSV) utvarderingar av utbildningskvalitet har genomforts saval beskrivande som med forsok till statistisk provning av tankbara samband mellan olika kvantit ...

On March 27, 1977, an aircraft disaster occurred in Tenerife on the Canary Islands that sheds some light on the concept of the human factor. The background to the accident was a terrorist attack on the airport in Las Palmas, which led to the redirection of all air traffic to Tenerife including one Pan AM aircraft and one KLM aircraft. The crews of the two aircraft were very concerned about the redirection. In the case of the Pan Am aircraft, there was a risk that the regulated working hours would be exceeded before they reached their final destination in Las Palmas. The KLM aircraft was to return to the Netherlands, and delays were not accepted by the airline management.

Recently we showed that blood pressure and heart rate control is impaired in infants of mothers who smoke. This dysfunction resembles classic orthostatic intolerance and could indicate susceptibility to raised blood pressure later on. We analyzed whether this dysfunction reflects abnormal autonomic neural modulation of the heart, or the vasculature, or both. Methods: Subjects: term-born infants of mothers who smoked during pregnancy (15cigarettes/day; n=15) and infants of non-smokers (n=27). All were examined at least twice between 1 week and 18 months age. Supine blood pressure (BP; Finometer) and heart period (HP) were recorded for 4 min during quiet sleep. We used autoregressive cross-spectral analysis to compare age-related changes in low (LF; 0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) power of HP and systolic BP (SBP). The gain of the heart-pressure relationship (α) was estimated by frequency domain analysis. We considered (i) LFHP and LFSAP power as markers of the sympathetic efferent modulation of the heart and blood vessels, respectively, and (ii) α as an index of baroreflex sensitivity. Results: Absolute values of, and variance in HP / BP of infants of smokers and non-smokers were comparable. In tobacco-exposed infants LFSAP (but not LFHP) decreased and α increased with age. Conclusions: Early-life tobacco exposure attenuates sympathetic drive to the blood vessels and augments baroreflex gain but leaves cardiac sympatho-vagal drive unchanged.

BACKGROUND The American Academy of Periodontology has recently stated that, "[risk assessment will become] increasingly important in periodontal treatment planning and should be part of every comprehensive dental and periodontal evaluation." (J Periodontol 2006;77:1608). Unaided risk assessment and prognostication show significant variability because chronic periodontitis is a multifactorial disease. This report summarizes the clinical validation of an algorithm for chronic periodontitis risk assessment and prognostication. The algorithm is a Web-based analytic tool that integrates some 20 risk predictors and calculates scores indicating levels of risk for chronic periodontitis for the dentition (Level I) and, if an elevated risk is found, prognosticates disease progression tooth by tooth (Level II). METHODS An independent clinical validation sample was generated in an open, prospective clinical trial and analyzed in a predetermined validation plan. RESULTS The analyses identified two threshold scores above which significant progression of periodontitis was found. Based on these scores, sufficiently high explanatory values with significant and increasing parameter estimates for increasing risk were established in Level I, justifying detailed analysis tooth by tooth in Level II. Subsequent prognostication of chronic periodontitis in Level II was found to be accompanied by clinically relevant measures of quality in relation to rates of disease progression. Three score intervals representing increasing levels of periodontitis progression were identified corresponding to increasing levels of significant annual marginal bone loss. CONCLUSIONS The predictors included in the algorithm reflect a relevant selection for periodontitis risk assessment. Risk assessment and prognostication with the algorithm provides the clinician with a validated, reliable, consistent, and objective tool supporting treatment planning.

BACKGROUND:Patients with severe forms of chronic periodontitis present with varying degrees of decreased inflammatory reactivity. A previously reported algorithm for chronic periodontitis risk assessment and prognostication is based on the analysis of some 20 risk predictors. One of these predictors is a skin provocation test that assesses the individual patient's reactivity to a lipid A challenge. The aim of this report was to analyze results from validation data for the algorithm with respect to the contribution of results of the skin provocation test as a risk predictor for the progression of chronic periodontitis and to compare these results with the contribution from other predictors, namely smoking, angular bony destruction, furcation involvement, abutment teeth, and endodontic pathology.METHODS:Data from a previously reported clinical validation sample were used for the analysis, including the calculation of quality measures and explanatory values using different types of regression analysis and non-parametric testing.RESULTS:Smoking, endodontic pathology, abutment teeth, angular bony destruction, and furcation involvement presented with individual explanatory values for periodontitis progression between 4% and 13% and highly significant parameter estimates. Explanatory values for the results of the skin provocation test ranged between 2.6% and 5.1% depending on the disease severity group, with a positive predictive value of 82% for the identification of high-risk patients.CONCLUSION:The skin provocation test provided a clinically significant contribution to the quality of analysis with the periodontitis risk and prognostication algorithm, in particular in the selection of high-risk patients for in-depth individual tooth analysis.

On March 27, 1977, an aircraft disaster occurred in Tenerife on the Canary Islands that sheds some light on the concept of the human factor. The background to the accident was a terrorist attack on the airport in Las Palmas, which led to the redirection of all air traffic to Tenerife including one Pan AM aircraft and one KLM aircraft. The crews of the two aircraft were very concerned about the redirection. In the case of the Pan Am aircraft, there was a risk that the regulated working hours would be exceeded before they reached their final destination in Las Palmas. The KLM aircraft was to return to the Netherlands, and delays were not accepted by the airline management.

Aim:The aim of this study was to investigate heart rate variability (HRV) in a clinical sample of female adolescents with anxiety disorders (AD) and/or major depressive disorder (MDD) compared with healthy controls and to assess the effect of selective serotonin reuptake inhibitors (SSRI) on HRV.Methods:Heart rate variability was measured in adolescent female psychiatric patients with AD and/or MDD (n = 69), mean age 16.8 years (range: 14.5-18.4), from 13 out-patient clinics and in healthy controls (n = 65), mean age 16.5 years (range: 15.9-17.7). HRV was registered in the sitting position during 4 min with no interventions.Results:Logarithmically transformed high frequency HRV (HF), low frequency HRV (LF) and standard deviation of inter beat intervals (SDNN) were lower in the clinical sample compared with the controls (Cohen's d for HF = 0.57, LF = 0.55, SDNN = 0.60). This was not explained by body mass index, blood pressure or physical activity. Medication with SSRI explained 15.5% of the total variance of HF, 3.0% of LF and 6.5% of SDNN.Conclusions:Adolescent female psychiatric patients with AD and/or MDD show reduced HRV compared with healthy controls. Medication with SSRI explained a part of this difference.

The present study examines psychophysiological responses to ascending melodic intervals and the specific influences of bodily movement. A total of 15 adult listeners were assessed in 2 conditions with and without voluntary bodily movements during listening to major third and major seventh intervals, while their heart rate was continuously recorded. Heart rate as well as the standard deviation of normal-to normal RR-intervals in the electrocardiogram within a given time interval (SD-NN-RR) served as dependent measures, the latter indicating parasympathetic activation. A repeated measures analysis of variance (ANOVA) revealed a significant interaction between interval and condition. Listening to the major seventh interval led to significantly higher SD-NN-RR values than listening to the major third in the condition without voluntary movement. With movement, these differences were not observed. The study extends previous findings by showing that task demands strongly influence physiological responses to isolated musical materials.

Heart rate variability (HRV) reflects the balance between cardiac parasympathetic and sympathetic autonomic influences. Reduced HRV has adverse prognostic implications. The time course for changes in HRV over prolonged periods of time and the influence of an acute coronary event on HRV are not well established.Heart rate variability was assessed in patients with chronic stable angina pectoris, who were followed for 3 years within the Angina Prognosis Study in Stockholm. Patients who suffered an acute myocardial infarction after the study were re-examined after this event. We assessed HRV by the simple geometric method differential index, and traditional time- and frequency-domain measurements of HRV.The differential index was essentially unchanged during the study (i.e. the ratio month 36/month 1 was 1.00 +/- 0.06, n = 261). Also most other time and frequency indices of HRV (SDNN, r-MSSD, SDNNIDX, total power, and VLF, LF, HF respectively; n = 63) remained largely unchanged; pNN50 and LF/HF were, however, less reproducible. In 21 patients with a subsequent acute myocardial infarction, SDNN, SDNNIDX, total power, LF and LF/HF were reduced following the event, whereas differential index, pNN50 and HF remained unchanged.Differential index and other indices of HRV are stable and reproducible in patients with chronic stable angina pectoris. High-frequency HRV (reflecting cardiac parasympathetic activity) and the differential index changed little following an acute coronary event, and may be suitable for predictions of the future risk of sudden death even in the presence of a recent acute coronary event.

This study investigated whether there is a relationship between heart rate variability (HRV) versus lifestyle and risk factors for cardiovascular disease in a population of healthy adolescents. HRV is as an index of tonic autonomic activity and in adults HRV is related to lifestyle and risk factors for cardiovascular disease, but it is not known if this is the case in adolescents. HRV was registered for 4 min in sitting position in 99 healthy adolescents (age range 15 years 11 months–17 years 7 months) and repeated after 6 months. On both occasions there were significant correlations ( P < 0.05) between physical activity and HRV, with respective r values: high frequency (HF) 0.26, 0.30; low frequency power (LF) 0.35, 0.29 and the standard deviation of inter-beat intervals (SDNN) 0.28, 0.37. There was no significant interaction between first and second measurements. In contrast, there were no correlations to sleeping patterns, eating habits and smoking. Risk factors for cardiovascular disease [body mass index (BMI = weight (kg)/length in m 2 ), systolic blood pressure and p-glucose] did not show any repeatable significant correlations to HRV. Multiple regression models showed that physical activity was a predictor for HF, LF and SDNN in both measurements. In conclusion HF, LF and SDNN were reproducible after 6 months and were related to physical activity on both occasions.

Objectives: To examine the usefulness of time domain heart rate variability (HRV) measurements by a simple graphical method, the differential index (DI), in prognostic assessments of patients with chronic stable angina pectoris. Methods: HRV measurements in the time domain by DI were compared to conventional measurements of standard deviation of all normal-to-normal intervals (SDNN), percent of differences between adjacent normal RR intervals >50 ms (PNN50) and square root of the mean of the sum of squares of differences between adjacent normal RR intervals (RMSSD) from 24-hour ambulatory electrocardiographic recordings in 678 patients in the Angina Prognosis Study in Stockholm. The patients received double-blind treatment with metoprolol or verapamil. Main outcome measures were cardiovascular death or non-fatal myocardial infarction during follow-up (median 40 months). Results: Patients suffering cardiovascular death (n = 30) had lower DI, SDNN and PNN50 (all p < 0.001). In a multivariate Cox model, DI below median independently predicted cardiovascular death (p = 0.002), as did SDNN (p = 0.016) and PNN50 (p = 0.030), but not RMSSD (p = 0.10). The separation of survival curves was most pronounced and specificity was slightly better with DI. DI and PNN50 increased with metoprolol but not verapamil treatment. Short-term treatment effects were not related to prognosis. Conclusions: Low time domain HRV carries independent prognostic information regarding cardiovascular death in stable angina pectoris. The simple DI method provided equally good or better prognostic information than conventional, more laborious HRV methods.

Musicians are sensitive to changes in their work environment. A 2-year longitudinal study with repeated observations was performed in two professional symphony orchestras. A representative sample from each one of them was selected, 15 and 16 members respectively. In one of them a wind player fainted twice in front of the audience shortly preceding and coinciding with the start of the study. Changes in two indicators that reflect regenerative/anabolic and parasympathetic tone, saliva testosterone concentration (STC) and very low-frequency power (VLFP) in heart rate variability were followed in relation to this dramatic change. Saliva samples and 24-h ECG heart rate variability recordings were collected on five occasions every 6 months during a 2-year period. No changes were seen in the control orchestra whereas the levels showed a pronounced rise in the intervention orchestra during the first part of the study, starting from low levels. VLFP showed a similar pattern, with initially low and then rising level in the intervention orchestra and higher stable level in the other group. In the total study group, a rise in STC over the whole observation period was significantly correlated with increase in VLFP and also significantly correlated with a decrease in low/high-frequency power ratio in heart rate variability. The changes observed in the anabolic/regenerative STC and the parasympathetically influenced VLFP may reflect changes in the work environment associated with the faintings.

Purpose: Case-control studies of sudden unexpected death in epilepsy (SUDEP) have reported that SUDEP is more likely to occur during sleep and thus presumably during night hours. The circadian variation of heart-rate variability (HRV) might be of relevance to this risk. We examined night versus daytime HRV in patients with newly diagnosed and refractory localization-related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio.Methods: We used spectral analysis to assess HRV and calculated the night-time (00.00-05.00)/daytime (07.30-21.30) ratio of HRV in 14 patients with newly diagnosed localization-related epilepsy before and during carbamazepine (CBZ) treatment and in 21 patients with temporal lobe epilepsy before and after epilepsy surgery. Both groups were compared with age- and sex-matched controls.Results: No significant differences were found from controls in the night/daytime ratios of HRV whether compared before or after initiation of treatment with CBZ in newly diagnosed epilepsy patients. When patients were used as their own controls, night/daytime ratios of standard deviation of RR intervals (p = 0.04) and total power (p = 0.04) were significantly lower during treatment than before. Compared with those of controls, the night/daytime ratios were lower in epilepsy surgery patients before surgery [low-frequency power (p = 0.04); high-frequency power (p = 0.04)]. Night/daytime ratios did not change significantly after surgery.Conclusions: The HRV of the patients was more affected during night-time when the risk of SUDEP seems to be highest in such patients.

Quality analysis of a collected depth dataset is important in order to find the statistic accuracy and variance of the depth data. Any systematic errors have to be identified and if possible minimised. It is also important to establish if the data fulfils the accuracy standard stated in the survey specification. The accuracy of collected depth data depends on several parameters such as the accuracy of the sensors in the survey system, the accuracy of the sensor calibration and the accuracy of any additional reductions to the dataset. After a proper calibration of the sensors, the survey system may be tested against a ground truth object on the seafloor to verify the horizontal and vertical accuracy. Ground thruthing can also be used in order to determine the object detection capabilities of the survey system. Online control has to ensure that sensors and collected depths are within acceptable limits. Additional reductions like tide or geoidal models etc. have to be analysed to ensure acceptable accuracy. The quality analysis of the resulting depth data may include ensuring sufficient data density for object detection and standard deviation calculation, data gaps, outlier detection, standard deviation and variation, crosscheck analysis, surface comparison, etc. This paper discusses some practical methods of establishing the theoretical accuracy of the survey system, to perform online control during data collection and to perform quality analysis on the resulting depth data.

Background: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery. We have now examined the effect of surgery on cardiac autonomic control in the same patients.Methods: We used 24 h EKG recordings to assess heart rate variability (HRV) by spectral analysis in 21 consecutive patients after temporal lobe epilepsy surgery. The HRV was compared with healthy controls, with pre-surgical HRV in the same patients, and analyzed in relation to seizure control 1 year after surgery.Results: The patients with poor outcome after surgery had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. The patients with favorable outcome did not differ from the controls, and the postoperative HRV was not different from HRV before surgery in any of the patient groups.Conclusion: We could not demonstrate any effect on HRV of temporal lobe epilepsy surgery in these patients. The observed lower HRV in the poor outcome group was present already before epilepsy surgery as previously reported. Although our results need confirmation in a larger study, the observations suggest that the increased risk of SUDEP in patients failing epilepsy surgery may be due to a common factor predisposing to surgical failure, impaired HRV as well as to an increased risk of SUDEP. (c) 2006 Elsevier B.V. All rights reserved.

To better understand the pathogenesis of postoperative atrial fibrillation (AF), the mode of onset of AF after coronary artery bypass grafting was analyzed with respect to the autonomic balance, the heart rate (HR), and the presence of arrhythmias preceding the onset of sustained AF.

Background: Commonly used methods to evaluate heart rate variability require extensive filtering of the registrations in order to exclude artefacts and ectopic beats. We developed and validated a novel graphical method for time-domain measurements of heart rate variability, the differential index, which does not require filtering and is simple to use. Methods: The 24-h ambulatory long-term electrocardiogram recordings from 120 patients with angina pectoris and 49 control subjects were computerised without any filtering process. Sample density histograms of differences in the RR interval for successive beats were constructed and the widths of the histograms were used to obtain the differential index. For comparison, the same registrations were analysed by conventional methods. Results: The differential index was most closely related (P<0.001) to conventional short-term time domain (e.g. percent of differences between adjacent normal RR intervals >50 ms, pNN50, r=0.81) and frequency-domain (e.g. high frequency power, r=0.84) components, but also to long-term time domain (e.g. standard deviation of all normal-to-normal RR intervals for all 5-min segments of the entire registration, SDNNIDX, r=0.72) and frequency-domain (e.g. low frequency power, r=0.64) components. Conclusion: The differential index method shows good agreement with established indices of heart rate variability. The insensitivity to recording artefacts and short-lasting disturbances of sinus rhythm make the differential index method particularly suited when data quality is imperfect. The simplicity of the method is valuable when large numbers of registrations are to be evaluated.