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    The Role of Anxiety in the Arterial Pressure Response to Chemoreflex Stress
    (2015-03) Doan, James; Jouett, Noah; Nguyen, Amanda; Sharma, Sneha; Franks, Susan; Smith, Michael L.
    Background: Anxiety disorders are remarkably prevalent in the United States, with an estimated 25% of the population suffering from some kind of anxiety disorder. Many studies have elucidated the link between high anxiety and cardiovascular disease (CVD), indicating a link between mental disorders and cardiovascular control. This study tested the hypothesis that the State-Trait Anxiety Index (STAI) and modified Borg Anxiety Scores can predict the blood pressure response to voluntary apnea. Methods: STAI surveys were given before experimentation, with separate scores calculated for state (conditional/situational anxiety) and for trait (background/intrinsic anxiety). 10 young and healthy subjects (5 male, 5 female) were recruited. Subjects had no reported anxiety disorder and were not taking any anxiety medications. Subjects were exposed to 12% oxygen and then initiated 6 end-expiratory apneas with a 2 minute recovery period in between each apnea. Blood pressure, heart rate and the nadir of SaO2 were measured. Prior to and immediately after each apnea, subjects were asked to rate their level of anxiety on a modified Borg scale (6-20) to capture an instantaneous measure of acute anxiety. Results: We found that trait anxiety had a significant correlation with increases in mean arterial pressure (r = 0.725, P = 0.027) and with changes in systolic blood pressure (r = 0.856, p = 0.003), but not diastolic pressure (P>0.05). There was a trend for a correlation between state anxiety and changes in systolic blood pressure (r = 0.6, P = 0.082), but no trend or significant correlation for diastolic or mean arterial pressure (P>0.05). Modified Borg scales did not predict the systolic, diastolic or mean arterial pressure response (P>0.05) Conclusion: We conclude that background/intrinsic anxiety (trait) is a better predictor of arterial pressure responses to apnea than conditional/situational anxiety (state). Furthermore, instantaneous anxiety as measured via modified Borg scale failed to adequately predict this pressor response. This study offers evidence that psychological functioning and not instantaneous anxiety can alter the physiological response to acute chemoreflex stress.