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. 2025 Aug 18.
doi: 10.1007/s00421-025-05933-9. Online ahead of print.

Relationship between the autonomic nervous system and cerebral autoregulation during controlled breathing

Agnieszka Uryga  1 , Monika Najdek  2 , Piotr Urbański  3 , Magdalena Kasprowicz  2 , Teodor Buchner  4
Affiliations

Relationship between the autonomic nervous system and cerebral autoregulation during controlled breathing

Agnieszka Uryga et al. Eur J Appl Physiol. .

Abstract

Introduction: Controlled breathing is a hemodynamic maneuver known to influence both baroreflex and chemoreflex sensitivity. This study investigated the impact of respiratory-driven oscillations on the relationship between cerebral autoregulation and autonomic nervous system (ANS) activity.

Methods: Sixty-one volunteers (median age: 23 years) underwent noninvasive measurements of arterial blood pressure (ABP), cerebral blood velocity (CBv), end-tidal CO2 (EtCO2), and respiratory rate during spontaneous breathing and during three 5-min sessions of controlled breathing at 6, 10, and 15 bpm. Cerebral autoregulation was assessed using transfer function analysis by calculating phase shift (PS) and gain between ABP and CBv in the very low frequency (VLF; 0.02-0.07 Hz) and breathing frequency (BF; [0.1, 0.17, 0.25] ± 0.02 Hz) ranges. ANS activity was assessed using baroreflex sensitivity (xBRS), heart rate variability (HRV) metrics in time and frequency domains, and entropy-based parameters. Cardiovascular coupling was assessed using the joint symbolic dynamics of beat-to-beat pulse interval and systolic blood pressure.

Results: Increasing respiratory rate led to decreased EtCO2 (p < 0.001), diminished cardiovascular coupling (p < 0.01), and reduced systemic ABP control, as indicated by lower normalized low-frequency HRV and xBRS (both p < 0.001). A linear mixed-effects model, adjusted for EtCO2 and respiratory rate, showed that PS at VLF and BF was modulated by ANS metrics, whereas gain was mainly affected by respiratory parameters, with a nonsignificant contribution from ANS.

Conclusions: Higher respiratory rates reduced cardiovascular coupling, diminished ANS activity, and modified its interaction with cerebral autoregulation. Respiratory parameters should be considered when assessing ANS-cerebral autoregulation relationship.

Keywords: Arterial blood pressure; Autonomic nervous system; Cerebral autoregulation; Cerebral blood velocity; Joint symbolic dynamics.

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Conflict of interest statement

Declarations. Competing interest: The authors have nothing to declare. Ethical approval: The study was approved by the bioethical committee of Wroclaw Medical University (approvals no. KB-179/2023/N and KB-170/2014). All volunteers were required to provide written consent before entering the study. The data were fully anonymized, and no data protection issues were involved.

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