Background: People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings.
Objective: This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population.
Methods: We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device.
Results: Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t=2.55; P=.04; Cohen d=0.99) as well as adults (t=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD.
Conclusions: HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD.
Trial Registration: ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093.
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http://dx.doi.org/10.2196/37994 | DOI Listing |
Sleep
January 2025
Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA, USA.
Study Objectives: Although heart rate variability (HRV), a marker of cardiac autonomic modulation (CAM), is known to predict cardiovascular morbidity, the circadian timing of sleep (CTS) is also involved in autonomic modulation. We examined whether circadian misalignment is associated with blunted HRV in adolescents as a function of entrainment to school or on-breaks.
Methods: We evaluated 360 subjects from the Penn State Child Cohort (median 16y) who had at least 3-night at-home actigraphy (ACT), in-lab 9-h polysomnography (PSG) and 24-h Holter-monitoring heart rate variability (HRV) data.
Ultrasound Obstet Gynecol
January 2025
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
Objectives: To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor.
Methods: This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days.
Zhongguo Dang Dai Er Ke Za Zhi
January 2025
Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University/National Clinical Medical Research Centre for Children's Health and Diseases/National International Science and Technology Cooperation Base for Major Diseases of Children's Development/Key Laboratory of Children's Vital Organ Development and Diseases of Chongqing Municipal Health Commission/National Key Clinical Cardiovascular Specialty, Chongqing 400014, China.
Heart failure is a complex clinical syndrome and pediatric heart failure (PHF) has a high mortality rate. Early diagnosis is crucial for treatment and management of PHF. In clinical practice, various tests and examinations play a key role in the diagnosis of PHF, including continuously updated biomarkers, echocardiography, and cardiac magnetic resonance imaging.
View Article and Find Full Text PDFCrit Care
January 2025
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Background: Despite the physiological advantages of positive end-expiratory pressure (PEEP), its optimal utilization during one-lung ventilation (OLV) remains uncertain. We aimed to investigate whether individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV.
Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until April 1, 2024, to identify published randomized controlled trials that compared individualized PEEP titration by lung compliance with fixed PEEP during OLV.
Thromb J
January 2025
Pediatric Emergency Department, St. Christopher's Hopsoital for Children, Philadelphia, PA, USA.
Background: Acute pulmonary embolism (PE) is a serious and potentially fatal condition that is relatively rare in the pediatric population. In patients presenting with massive/submassive PE, catheter-directed Therapy (CDT) presents an emerging therapeutic modality by which PE can be managed.
Methods: Electronic databases were systematically searched through May 2024.
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