title: The effect of anxiety on heart rate variability, depression, and sleep in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The current study investigates heart rate variability (HRV) responses to a psychosocial stressor in chronic obstructive pulmonary disease (COPD) patients, and the potential role of anxiety as a confounding factor in this relationship. Additionally, this study also investigates the influence of anxiety on sleep and depressive symptoms among COPD patients.
  
  
  METHODS
  The study utilized a 2 (disease status)×2 (anxiety group) factorial design examining HRV associated with anxiety symptoms and COPD during a standardized acute social stress task. Participants (mean age 59.1±11.2 years; 50% female) completed pulmonary function testing, HRV monitoring, and self-report questionnaires assessing psychological factors. 30 COPD patients were age- and gender-matched with 30 healthy controls.
  
  
  RESULTS
  HRV response to a psychosocial stressor among participants with higher anxiety (both COPD and healthy) reflected autonomic dysregulation in both time and frequency domains that was not evident among non-anxious participants. COPD participants with higher anxiety reported greater symptoms of depression and poorer sleep quality than did COPD participants with low anxiety.
  
  
  CONCLUSIONS
  Anxiety is associated with dysregulated HRV response to a psychosocial stressor, but the negative influence of anxiety and COPD on autonomic function did not appear to be additive. Comorbid anxiety in patients with COPD is associated with increased behavioral and psychological symptoms of distress.
authors.affiliation: Korea University, Institute of Human Genomic Study, Republic of Korea.
authors.forename: Sooyeon
authors.initials: S
authors.lastname: Suh
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: John J
authors.initials: JJ
authors.lastname: Sollers
authors.forename: Julian F
authors.initials: JF
authors.lastname: Thayer
authors.forename: Hae-Chung
authors.initials: HC
authors.lastname: Yang
authors.forename: Charles F
authors.initials: CF
authors.lastname: Emery
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D001341:Autonomic Nervous System / Q000503:physiopathology; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D014797:Vital Capacity / Q000502:physiology