title: Chronic obstructive pulmonary disease and heart rate variability: a literature update.
abstract: BACKGROUND
  The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects.
  
  
  METHODS
  A search was performed in Medline database, using the link between the keywords: "autonomic nervous system", "cardiovascular system", "COPD" and "heart rate variability".
  
  
  RESULTS
  The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation.
  
  
  CONCLUSIONS
  The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.
authors.affiliation: Post-graduate Program in Cardiology, Federal University of São Paulo - Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Adriano L
authors.initials: AL
authors.lastname: Roque
authors.affiliation: Post-graduate Program in Physical Therapy - Faculty of Science and Technology UNESP, Presidente Prudente, SP Brazil.
authors.forename: Vitor E
authors.initials: VE
authors.lastname: Valenti
authors.affiliation: Post-graduate Program in Rehabilitation Sciences - Faculty of Medicine, University of São Paulo, São Paulo, SP Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Thais
authors.initials: T
authors.lastname: Massetti
authors.affiliation: Post-graduate Program in Cardiology, Federal University of São Paulo - Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil ; Department of Environmental Health, Harvard School of Public Health, Boston, MA USA.
authors.forename: Talita Dias
authors.initials: TD
authors.lastname: da Silva
authors.affiliation: Post-graduate Program in Rehabilitation Sciences - Faculty of Medicine, University of São Paulo, São Paulo, SP Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Carlos Bandeira de Mello
authors.initials: CB
authors.lastname: Monteiro
authors.affiliation: Post-graduate Program in Cardiology, Federal University of São Paulo - Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Fernando R
authors.initials: FR
authors.lastname: Oliveira
authors.affiliation: Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Álvaro Dantas
authors.initials: ÁD
authors.lastname: de Almeida Junior
authors.affiliation: Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Sheylla Nadjane Batista
authors.initials: SN
authors.lastname: Lacerda
authors.affiliation: Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Gustavo Carreiro
authors.initials: GC
authors.lastname: Pinasco
authors.affiliation: Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Viviane Gabriela
authors.initials: VG
authors.lastname: Nascimento
authors.affiliation: Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Luiz Gonzaga
authors.initials: LG
authors.lastname: Granja Filho
authors.affiliation: Post-graduate Program in Cardiology, Federal University of São Paulo - Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil ; Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: de Abreu
authors.affiliation: Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Garner
authors.affiliation: Post-graduate Program in Cardiology, Federal University of São Paulo - Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil.
authors.forename: Celso
authors.initials: C
authors.lastname: Ferreira
keywords: Autonomic nervous system; COPD; Cardiovascular system; Heart rate variability