Transcutaneous cervical vagal nerve stimulation reduces sympathetic responses to stress in posttraumatic stress disorder: A double-blind, randomized, sham controlled trial,Neurobiology of Stress

当前位置： X-MOL 学术 › Neurobiol. Stress › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Transcutaneous cervical vagal nerve stimulation reduces sympathetic responses to stress in posttraumatic stress disorder: A double-blind, randomized, sham controlled trial
Neurobiology of Stress ( IF 4.3 ) Pub Date : 2020-10-20 , DOI: 10.1016/j.ynstr.2020.100264
Nil Z Gurel ₁ , Matthew T Wittbrodt ₂ , Hewon Jung ₁ , Md Mobashir H Shandhi ₁ , Emily G Driggers ₂ , Stacy L Ladd _{2,

3} , Minxuan Huang ₄ , Yi-An Ko ₅ , Lucy Shallenberger ₄ , Joy Beckwith ₂ , Jonathon A Nye ₃ , Bradley D Pearce ₄ , Viola Vaccarino _{4,

6} , Amit J Shah _{4,

6,

7} , Omer T Inan _{1,

8} , J Douglas Bremner _{2,

3,

7}

Affiliation

Objective

Exacerbated autonomic responses to acute stress are prevalent in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the effects of transcutaneous cervical VNS (tcVNS) on autonomic responses to acute stress in patients with PTSD. The authors hypothesized tcVNS would reduce the sympathetic response to stress compared to a sham device.

Methods

Using a randomized double-blind approach, we studied the effects of tcVNS on physiological responses to stress in patients with PTSD (n = 25) using noninvasive sensing modalities. Participants received either sham (n = 12) or active tcVNS (n = 13) after exposure to acute personalized traumatic script stress and mental stress (public speech, mental arithmetic) over a three-day protocol. Physiological parameters related to sympathetic responses to stress were investigated.

Results

Relative to sham, tcVNS paired to traumatic script stress decreased sympathetic function as measured by: decreased heart rate (adjusted β = −5.7%; 95% CI: ±3.6%, effect size d = 0.43, p < 0.01), increased photoplethysmogram amplitude (peripheral vasodilation) (30.8%; ±28%, 0.29, p < 0.05), and increased pulse arrival time (vascular function) (6.3%; ±1.9%, 0.57, p < 0.0001). Similar (p < 0.05) autonomic, cardiovascular, and vascular effects were observed when tcVNS was applied after mental stress or without acute stress.

Conclusion

tcVNS attenuates sympathetic arousal associated with stress related to traumatic memories as well as mental stress in patients with PTSD, with effects persisting throughout multiple traumatic stress and stimulation testing days. These findings show that tcVNS has beneficial effects on the underlying neurophysiology of PTSD. Such autonomic metrics may also be evaluated in daily life settings in tandem with tcVNS therapy to provide closed-loop delivery and measure efficacy.

ClinicalTrials.gov Registration # NCT02992899.

中文翻译：

经皮颈迷走神经刺激可降低创伤后应激障碍患者对压力的交感神经反应：一项双盲、随机、假对照试验

客观的

在创伤后应激障碍 (PTSD) 中普遍存在对急性应激的自主神经反应加剧。本研究的目的是评估经皮颈椎 VNS (tcVNS) 对 PTSD 患者急性应激自主神经反应的影响。作者假设与假装置相比，tcVNS 会减少对压力的交感神经反应。

方法

使用随机双盲方法，我们研究了 tcVNS 对使用非侵入性传感方式的 PTSD 患者（n = 25）对压力的生理反应的影响。在为期三天的方案中暴露于急性个性化创伤脚本压力和精神压力（公开演讲、心算）后，参与者接受假（n = 12）或主动 tcVNS（n = 13）。研究了与应激交感神经反应相关的生理参数。

结果

相对于假手术，tcVNS 与创伤性脚本压力配对会降低交感神经功能，测量方式如下：心率降低（调整后的 β = −5.7%；95% CI：±3.6%，效应量 d = 0.43，p < 0.01），光电体积描记图振幅增加（外周血管舒张）（30.8%；±28%，0.29，p < 0.05），以及增加的脉冲到达时间（血管功能）（6.3%；±1.9%，0.57，p < 0.0001）。当在精神压力或没有急性压力后应用 tcVNS 时，观察到类似的 (p < 0.05) 自主神经、心血管和血管效应。