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processed data from two 5-minute segments: one during a stable baseline recording and
another during a deep-breath maneuver. The average values of the gains extracted from
the 2 segments were used to represent each experiment. The reason that two data
segments were used for each subject instead on one was to get a better representation of
the ABR and RCC gains for the subject. Moreover, the perturbation of the cardiovascular
system from the deep-breath maneuver could improve the signal-to-noise ratios of the
ABR and RCC gain estimations. Nonetheless, the baseline data segments allowed us to
assess the non-perturbed condition of each subject; therefore, we decided to use the
baseline data segments as well.
A sample of RRI, respiration, and SBP time-courses, as well as the corresponding
ABR and RCC impulse responses and transfer functions from a patient during a deep-breath
maneuver is shown in Figure 5.22. Heart rate increase (i.e. RRI decreases) during
an inspiration phase and reverse during expiration. This coupling is usually very strong
and thus lead to a strong respiration frequency component of HRV. This also caused the
impulse response of the RCC to have a clear negative peak (Figure 5.22D). The ABR, on
the other hand, usually has a slower impulse responses and a positive peak as shown in
Figure 5.22E, indicating that and increase in blood pressure results in an increase in RRI.
This is because when the blood pressure decreases, the body needs to increase the cardiac
output to supply sufficient oxygen to the periphery and thus responses to the blood
pressure drop through the arterial baroreflex, resulting in an increase of heart rate (i.e.
decrease in RRI) and subsequent a increase in cardiac output. These impulse responses
Object Description
| Title | Modeling of cardiovascular autonomic control in sickle cell disease |
| Author | Sangkatumvong, Suvimol "Ming" |
| Author email | sangkatu@usc.edu; mingsuvimol@hotmail.com |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Biomedical Engineering |
| School | Viterbi School of Engineering |
| Date defended/completed | 2011-03-03 |
| Date submitted | 2011 |
| Restricted until | Unrestricted |
| Date published | 2011-04-26 |
| Advisor (committee chair) |
Khoo, Michael C.K. Coates, Thomas |
| Advisor (committee member) |
Wood, John C. Meiselman, Herbert J. |
| Abstract | Sickle cell disease (SCD) is a genetic disorder that is characterized by recurrent episodes of vaso-occlusive crisis (VOC) from the sickling behavior of red blood cells. Currently, no technique can distinguish the cause or predict the occurrence of a crisis accurately and reliably. One area which has rarely been studied in SCD patients is their autonomic nervous system (ANS). Since the ANS is responsible for the moment-to-moment control of the vascular tone, we hypothesized that the ANS plays an important role in the initiation of their VOC. Computational techniques, including spectral analysis of HRV and a model which characterizes the dynamics of baroreflex and respiratory-cardiac coupling, were used to assess cardiovascular autonomic control in SCD patients and normal control (CTL) subjects. These analysis techniques were applied to responses elicited from the subjects during the application of non-invasive and easily reproducible physiological interventions, such as transient-controlled hypoxia and the cold face test.; Our results demonstrate impairment in the ANS in SCD patients. In particular, hypoxic responses in SCD subjects showed a significantly stronger parasympathetic withdrawal compared to the CTLs. Furthermore, the autonomic responses to the cold face stimulus in SCD subjects showed an absence of the shift to parasympathetic dominance, as evidenced in the CTLs. In addition to the HRV analysis, model-based assessment also revealed the absence of both arterial baroreflex and respiratory-cardiac coupling augmentations in SCD patients during the cold face stimulus, while in CTL subjects both mechanisms showed tendencies to increase during the test.; During the data analysis period, we noticed that spontaneous sighs triggered marked periodic drops in peripheral microvascular perfusion. While the sigh frequency was the same in both groups, the probability of a sigh inducing a perfusion drop was significantly higher in SCD subjects in comparison to the CTLs. Evidence for sigh-induced sympathetic nervous system dominance was seen in SCD subjects, but was not significant in CTL. HRV analysis suggested that the cardiac ANS responses to sighs are not different between the two groups, after adjusting for the effect of post-sigh respiration. However, the peripheral sympathetic response in SCD subjects appeared to be enhanced in this group relative to the CTLs; and, furthermore, sighs may play a role in initiation of vaso-occlusive events in this group of patients.; In brief, all assessments we performed in this study suggested that the ANS responses to perturbations in SCD patients are more biased toward parasympathetic withdrawal and sympathetic activation, compared to normal controls. The complete mechanism is still a topic of investigation. Thus far, we have shown a relationship between the degree of this abnormality and the degree of both the anemia and infection/inflammation. We suspect that a mechanism related to the inflammatory reflex might play an important role in the ANS impairment in this group of patients.; In conclusion, this study draws attention to an enhanced ANS-mediated peripheral sympathetic driven vasoconstriction in SCD that could increase red cell retention in the microvasculature, promoting vaso-occlusion. This cascade of events could be the mechanism which triggers the VOC. |
| Keyword | autonomic nervous system; heart rate variability; respiration; sickle cell disease; physiological system modeling; sympathetic; parasympathetic; minimal model; baroreflex; respiratory-cardiac coupling; hypoxia; sigh; cold face test; cardiovascular autonomic control |
| Geographic subject | medical facilities: Childrens' Hospital Los Angeles |
| Geographic subject (city or populated place) | Los Angeles |
| Geographic subject (state) | California |
| Geographic subject (country) | USA |
| Coverage date | 2005/2010 |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m3781 |
| Contributing entity | University of Southern California |
| Rights | Sangkatumvong, Suvimol "Ming" |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | cisadmin@lib.usc.edu |
| Filename | etd-Sangkatumvong-4436 |
| Archival file | uscthesesreloadpub_Volume23/etd-Sangkatumvong-4436.pdf |
Description
| Title | Page 168 |
| Contributing entity | University of Southern California |
| Repository email | cisadmin@lib.usc.edu |
| Full text | 150 processed data from two 5-minute segments: one during a stable baseline recording and another during a deep-breath maneuver. The average values of the gains extracted from the 2 segments were used to represent each experiment. The reason that two data segments were used for each subject instead on one was to get a better representation of the ABR and RCC gains for the subject. Moreover, the perturbation of the cardiovascular system from the deep-breath maneuver could improve the signal-to-noise ratios of the ABR and RCC gain estimations. Nonetheless, the baseline data segments allowed us to assess the non-perturbed condition of each subject; therefore, we decided to use the baseline data segments as well. A sample of RRI, respiration, and SBP time-courses, as well as the corresponding ABR and RCC impulse responses and transfer functions from a patient during a deep-breath maneuver is shown in Figure 5.22. Heart rate increase (i.e. RRI decreases) during an inspiration phase and reverse during expiration. This coupling is usually very strong and thus lead to a strong respiration frequency component of HRV. This also caused the impulse response of the RCC to have a clear negative peak (Figure 5.22D). The ABR, on the other hand, usually has a slower impulse responses and a positive peak as shown in Figure 5.22E, indicating that and increase in blood pressure results in an increase in RRI. This is because when the blood pressure decreases, the body needs to increase the cardiac output to supply sufficient oxygen to the periphery and thus responses to the blood pressure drop through the arterial baroreflex, resulting in an increase of heart rate (i.e. decrease in RRI) and subsequent a increase in cardiac output. These impulse responses |
