research thesis proposal written and oral.

BREATHING PATTERNS TO MINIMIZE

CARDIOVASCULAR DISEASE RISK IN DEPRESSION

TOP 10 CAUSES OF

DEATH IN THE U.S.

2018

(Kochanek et al., 2019)

HOW DO WE MEASURE CVD RISK?

Traditional Risk Factors Nontraditional Risk Factors

Endothelial dysfunction

Stress

Garcia et al., 2016

HOW DO WE MEASURE CVD RISK?

Traditional Risk Factors Nontraditional Risk Factors

Endothelial dysfunction

Stress

Garcia et al., 2016

DEPRESSION

WORK $ 17.3 million American adults Leading cause of

disability worldwide $120.5 billion

economic burden

1 out of 3 are resistant to

current treatment practices

(NIH, 2019; WHO, 2017; Hasin et al., 2018; Rush & Jain, 2018)

HOW DO WE MEASURE CVD RISK?

Traditional Risk Factors Nontraditional Risk Factors

Endothelial dysfunction

Stress

Garcia et al., 2016

HOW DO WE MEASURE CVD RISK?

Traditional Risk Factors Nontraditional Risk Factors

Endothelial dysfunction

Stress

Garcia et al., 2016

SHORT TERM ASSESSMENT OF CVD RISK

Sympathetic nervous

system activity

Blood Pressure

Heart Rate

BLOOD PRESSURE REACTIVITY AND SURVIVAL RATES

Systolic Blood Pressure Diastolic Blood Pressure

Carroll, et al., 2012

HOW DO WE LOWER BLOOD PRESSURE?

Device guided slow breathing Mindful Meditation

Sympathetic nervous

system activity Blood Pressure

HYPOTHESIS

 Depressed young adults will show attenuated cardiovascular reactivity during the cold pressor test while

practicing device-guided slow breathing or mindful meditation

 Further, depressed young adults will show greater attenuations in cardiovascular reactivity during mindful

meditation compared to device guided slow breathing

METHODS

RECRUITMENT

Inclusion criteria

 18-35 years old

 Depressive symptoms

Exclusion criteria

 Mental illness aside from depression

 Medication for depression

 Suicidal/homicidal intent

 Alcohol or drug dependence

 Eating disorder

 Medication affecting brain or CV system function

 CVD, kidney, lung, or metabolic disease

 Tobacco use

 Pregnancy or amenorrhea (women)

25 young adults with depressive symptoms

EXPERIMENTAL APPROACH

Screening

Informed Consent

BP, HR, Temp & Blood Draw

Body Composition

Health History

MINI Interview

Technique Familiarization

Experimental Day 1

Device guided slow

breathing

Experimental Day 2

Device guided slow

breathing

Experimental Day 2

Mindful meditation

Experimental Day 1

Mindful meditation

Randomized

24 hrs

24 hrs

Figure 1. Schematic of the experimental visit. Abbreviations: electrocardiogram (ECG), blood pressure (BP), muscle sympathetic nerve activity

(MSNA), heart rate (HR), cold pressor test (CPT), slow breathing (SB).

Experimental Visit

VARIABLES

Independent Variables

 Stress intervention

 Device guided slow breathing

 Mindful meditation

Dependent Variables

 Muscle sympathetic nerve activity (MSNA)

 Burst frequency (bursts/min)

 Burst incidence (bursts/100 heart beats)

 Blood pressure

 Heart rate

 Respiratory rate

STATISTICAL ANALYSIS

Power analysis Project analysis

 Distributions tested for symmetry

 Matched pairs t-test

 Change score between CPT and CPT+intervention

 Non-parametric test

 Data shown as Means ± SD

 Alpha set to 0.05

(Fonkoue et al., 2018; Park et al., 2014; Scalco et al., 2009)

 A priori

 G-power

 MSNA values

 Young adults with PTSD

 Clinically significant values

 Detect group differences

 Change score between CPT and CPT+intervention

 3 bursts/min

 80% power

 Alpha= 0.05

 70% success rate for MSNA recording

ANTICIPATED FINDINGS AND INTERPRETATION

Anticipated Findings

 Depressed young adults will attenuated MSNA burst

frequency during the cold pressor test while

practicing device-guided slow breathing or mindful

meditation

 Further, depressed young adults will show greater

attenuations in MSNA burst frequency during

mindful meditation compared to device guided slow

breathing

Interpretation

 Mindful meditation may be useful to decrease

cardiovascular reactivity during stressful situations

for depressed young adults

 Mindful meditation may be useful to decrease CVD

risk in those with depression

REFERENCES

 Carroll, D., Ginty, A.T., Der, G., Hunt, K., Benzeval, M. & Phillips, A.C. (2012). Increased blood pressure reactions to acute mental stress are associated with 16- year cardiovascular disease mortality. Psychophysiology, 49, 1444-1448. DOI: 10.1111/j.1469-8986.2012.01463.x

 Fonkoue, I.T., Marvar, P.J., Norrholm, S.D., Kankam, M.L., Li, Y., DaCosta, D., Rothbaum, B.O., Park, J. (2018). Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder. Am J Physiol Heart Circ Physiol, 315, H141-H149. doi:10.1152/ajpheart.00098.2018

 Garcia, M., Mulvagh, S.L., Merz, N.B., Buring, J.E., Manson, J.E. (2016). Cardiovascular Disease in Women. Circulation Research, 118(8), 1273-1293. https://doi.org/10.1161/CIRCRESAHA.116.307547

 Haisn, D.S., Sarvet, A.L., Meyers, J.L., Saha, T.D., Ruan, W.J., Stohl, M., Grant, B.F. (2018). Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. Journal of the American Medical Association Psychiatry, 75(4), 336-346. DOI: 10.1001/jamapsychiatry.2017.4602

 Kochanek, K.D., Murphy S.L., Xu, J.Q., Arias, E. (2019). Deaths: Final data for 2017. National Vital Statistics Reports, 68(9), 1-77. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf

 National Institute of Mental Health. Major Depression, 2019.

 Park, J., Lyles, R. H., & Bauer-Wu, S. (2014). Mindfulness meditation lowers muscle sympathetic nerve activity and blood pressure in African-American males with chronic kidney disease. American journal of physiology. Regulatory, integrative and comparative physiology, 307(1), R93–R101. https://doi.org/10.1152/ajpregu.00558.2013

 Rush, J.A. & Jain, S.B. (2019). Clinical Implications of the STAR*D Trial. Handb Exp Pharmacol, 250, 51-99. doi: 10.1007/164_2018_153

 Scalco, A.Z., Rondon, M.U., Trombetta, I.V., Laterza, M.C., Azul, J.B., Pullenayegum, E.M., Scalco, M.Z., Kuniyoshi, F.H., Wajngarten, M., Negrao, C.E., Lotufo-Neto, F. (2009). Muscle sympathetic nervous activity in depressed patients before and after treatment with sertraline. Journal of Hypertension, 27(12), 2429-2436. doi: 10.1097/HJH.0b013e3283310ece

 WHO. Depression and other common mental disorders global health estimates, 2017.

QUESTIONS?