Longitudinal Autonomic Nervous System Measures Correlate With Stress and Ulcerative Colitis Disease Activity and Predict Flare

Robert P Hirten; Matteo Danieletto; Robert Scheel; Mark Shervey; Jiayi Ji; Liangyuan Hu; Jenny Sauk; Lin Chang; Bert Arnrich; Erwin Bӧttinger; Joel Dudley; Laurie Keefer; Bruce E Sands

doi:10.1093/ibd/izaa323

Longitudinal Autonomic Nervous System Measures Correlate With Stress and Ulcerative Colitis Disease Activity and Predict Flare

Inflamm Bowel Dis. 2021 Oct 18;27(10):1576-1584. doi: 10.1093/ibd/izaa323.

Authors

Robert P Hirten¹, Matteo Danieletto^{2

3}, Robert Scheel¹, Mark Shervey², Jiayi Ji⁴, Liangyuan Hu⁴, Jenny Sauk⁵, Lin Chang⁵, Bert Arnrich², Erwin Bӧttinger², Joel Dudley², Laurie Keefer¹, Bruce E Sands¹

Affiliations

¹ The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
² Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

PMID: 33382065
DOI: 10.1093/ibd/izaa323

Abstract

Background: Differences in autonomic nervous system function, measured by heart rate variability (HRV), have been observed between patients with inflammatory bowel disease and healthy control patients and have been associated in cross-sectional studies with systemic inflammation. High HRV has been associated with low stress.

Methods: Patients with ulcerative colitis (UC) were followed for 9 months. Their HRV was measured every 4 weeks using the VitalPatch, and blood was collected at baseline and every 12 weeks assessing cortisol, adrenocorticotropin hormone, interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein (CRP). Stool was collected at enrollment and every 6 weeks for fecal calprotectin. Surveys assessing symptoms, stress, resilience, quality of life, anxiety, and depression were longitudinally collected.

Results: Longitudinally evaluated perceived stress was significantly associated with systemic inflammation (CRP, P = 0.03) and UC symptoms (P = 0.02). There was a significant association between HRV and stress (low-frequency to high-frequency power [LFHF], P = 0.04; root mean square of successive differences [RMSSD], P = 0.04). The HRV was associated with UC symptoms (LFHF, P = 0.03), CRP (high frequency, P < 0.001; low frequency, P < 0.001; RMSSD, P < 0.001), and fecal calprotectin (high frequency, P < 0.001; low frequency, P < 0.001; RMSSD, P < 0.001; LFHF, P < 0.001). Significant changes in HRV indices from baseline developed before the identification of a symptomatic or inflammatory flare (P < 0.001).

Conclusions: Longitudinally evaluated HRV was associated with UC symptoms, inflammation, and perceived and physiological measures of stress. Significant changes in HRV were observed before the development of symptomatic or inflammatory flare.

Keywords: autonomic nervous system; heart rate variability; stress; ulcerative colitis; wearable device.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autonomic Nervous System* / physiopathology
Colitis, Ulcerative* / physiopathology
Colitis, Ulcerative* / psychology
Cross-Sectional Studies
Heart Rate
Humans
Inflammation*
Leukocyte L1 Antigen Complex
Quality of Life
Stress, Psychological*

Substances

Leukocyte L1 Antigen Complex