Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

Relationship between Fatigue Severity and Heart Rate Variability in Middle-Aged Male Workers

중년 직장 남성의 피로도와 심박동변이

Song, Sang-Wook;Shin, Jin-Hee;Findly, Thomas
손상욱;신진희

  • Published : 20050300
⟨ Previous Next ⟩

Abstract

Objectives: This study investigated the relationship between the severity of fatigue and the cardiac autonomic function by analyzing the heart rate variability on middle-aged male workers. Methods: The severity of fatigue and heart rate variability were assessed with the control measures of age, body mass index, blood pressure, alcohol consumption, smoking history, regular exercise on 82 healthy middle-aged male workers in an annual health checkup. The severity of fatigue was evaluated by the Fatigue Severity Scale (FSS), which was developed by Krupp. The 5-minute electrocardiographic recordings were analyzed as a function of the time and the frequency domain methods of the heart rate variability (HRV). Standard Deviation of the NN intervals (SDNN), Root-Mean-Square of Successive Differences (rMSSD), Total Power (TP), Low Frequency (LF: 0.04~0.15 Hz) power, High Frequency (HF: 0.15-0.4 Hz) power, LF/HF ratio were used as the indices of the HRV. For a comparison of autonomic nervous functions and other variables, the subjects were divided into three fatigue groups based on the FSS score as follows: low (N=31), moderate (N=33), high (N=18) fatigue groups R e s u l t s: There were no significant differences in age, blood pressure, heart rate, body mass index, alcohol consumption, or regular exercise except for the smoking history among the groups. In addition, there were no significant differences in the time domain analysis (SDNN, rMSSD) of HRV among the groups. Spectral analysis of the HRV showed that the mean amplitudes of the HF and LF component were lower in the high fatigue group, whereas there was no significant difference in the LF/HF ratio among the fatigue groups. There were no significant differences in the HRV indices between the smoking and non-smoking groups. No significant interacting effects between the severity of fatigue and smoking on the HRV were observed. Conclusions: The association between severe fatigue and the reduced high and low frequency components of the HRV in middle-aged male workers reflects a dysregulation of the cardiac autonomous control. Although the pathophysiological mechanism of this association remains unclear, these results might explain their increased risk for cardiovascular disease. However, these effects need to be confirmed through a well-designed prospective study.

목적: 이 연구는 중년 직장 남성의 피로도와 심장 자율신경 기능과의 관련성을 심박동변이의 분석을 통해서 알아보고자 하였다. 방법: 대학 부속 병원에서 종합건강검진을 받은 자동차생산 공장의 중년 남성 근로자 중 특이 병력이 없는 82명을 연구 대상으로 하여 연령, 키, 체중, 혈압, 음주 및 흡연력, 규칙적인 운동 여부 등과 함께 피로도 및 심박동변이를 평가하였다. 피로도 평가는 Krupp 등에 의해서 개발된 자가-보고 형식의 Fatigue Severity Scale(FSS)을 이용하였으며, 피로도 점수에 따라 연구 대상을 저피로군(N=31), 중등도 피로군(N=33), 고피로군(N=18)으로 분류하였다. 심박동변이의 평가는 안정 상태에서의 5분 동안 심전도 기록을 시간 범주인 Standard Deviation of NN intervals(SDNN), Root-Mean-Square of Successive Differences(rMSSD)와 주파수 범주인 Total Power(TP), Low Frequency(LF: 0.04~0.15 Hz) power, High Frequency(HF: 0.15~0.4 Hz) power, LF/HF 비로 나누어 분석하였다. 결과: 피로 정도에 따라 분류한 세 군의 평균 피로도 점수는 저피로군이 2.1$\pm$0.7, 중등도 피로군이 3.7$\pm$0.4, 고피로군이 5.2$\pm$0.4 이었다(p<0.001). 세 군간의 인구사회학적 특성 비교에서 흡연 유무에 있어서는 차이를 보였지만 이외에 나이, 수축기 및 이완기 혈압, 심박수, 체질량지수, 음주 유무, 규칙적인 운동 여부에 있어서는 통계적으로 유의한 차이를 나타내지 않았다. 세 군간의 심박동변이 값의 차이는 시간 범주 분석 항목에서는 통계적으로 유의한 차이를 나타내지 않았지만 주파수 범주 분석 항목 중에서는 ln(natural logarithm) LF 및 HF 값이 고피로군에서 저피로군에 비해 유의하게 감소하는 것으로 나타났다(p=0.009, p=0.015). 그 외 ln TP 및 LF/HF ratio 값은 세 군간에 통계적으로 유의한 차이를 나타내지 않았다. 흡연 유무에 따른 심박동변이 값은 시간 및 주파수 범주 분석 항목 모두에서 유의한 차이가 없었으며, 심박동변이 값에 대한 피로도와 흡연 유무와의 유의한 교호 작용 또한 관찰되지 않았다. 결론: 중년 직장 남성의 극심한 피로 상태가 심박동변이 분석에서 교감 및 부교감 신경 기능의 감소와 관련이 있음을 알 수 있었다. 이는 심장에 대한 자율신경 조절의 이상을 반영하며, 아직까지 정확한 기전을 알 수는 없지만 이들에게서 심혈관 질환의 발생 위험이 증가할 수 있음을 시사한다. 아울러 향후에는 잘 계획된 전향적 연구를 통하여 이에 대한 추적 관찰이 필요할 것이다.

Keywords

References

  1. 구정완, 이승한. 은행원의 VDT작업에 따른 피로자각증상. 예방의학회지 1991;24(3):305-13
  2. 권일훈. 작업관련 뇌혈관 및 심장질환. 작업관련 뇌혈관 및 심장질환에 관한 심포지움 자료집. 산업안전공단. 서울. 1997. pp58-61
  3. 김수근. 직장의 뇌심혈관질환 예방을 위한 사업장 접근 방법의 실제. 산업안전공단. 서울. 2000
  4. 박내경, 김정윤, 조영채, 이동배. 일부산업장 근로자들의 피로 자각증상과 일상생활요인과의 관련성. 대한산업의학회지 1998;10(2):214-26
  5. 박종안. 철강산업 근로자들의 자각증상에 의한 피로도 조사. 최신의학 1980;24(2):105-12
  6. 신호철, 김철환, 박용우, 조비룡, 송상욱 등. 우울증 선별 도구로서 Zung's Self-rating Depression Scale(SDS)의 타당성. 가정의학회지 2000;21(10) :1317-30
  7. 신호철, 최창진, 송상욱, 최환석. 가정의학과 외래에 피로를 주소로 내원한 환자분석-전향적 연구를 위한 기초 조사. 가정의학회지 1993;14(12):833-42
  8. 양인애. 미혼 여성 노동자의 피로자각 증상에 관한 연구, 석사 학위논문, 전남대학교 대학원. 1990
  9. 이은옥, 한영자, 최명애. 종합병원근무 간호원들의 피로도에 관한 조사연구. 중앙의학 1974:27(2):170-6
  10. 이해진, 김택준, 전정일, 구정완, 정치경. 약사의 피로자각증상. 대한산업의학회지 1997;9(1):26-39
  11. 정규인, 송찬희. 피로와 우울, 불안증 환자에서 fatigue severity scale의 임상적 유용성. 정신신체의학 2001;9(2):164-73
  12. 조규상. 산업보건학. 수문사. 서울. 1991. pp107-14
  13. 田中純子. 中小企業勞動者の自覺的疲勞について-1週4日間の 調査から. 廣島醫學 1988;41:2065-77
  14. Adams RD, Victor M, Ropper AH. Fatigue. asthenia, anxiety and depressive reactions In: Adams RD, Victor M, Ropper AH, eds. Principles of neurology, 6th ed. McGraw-Hill, New York, 1997. pp497-507
  15. Aguillard RN, Riedel BW, Lichstein KL, Grieve FG, Johnson CT, et al. Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness. Appl Psychophysiol Biofeedback. 1998;23(4):207-17 https://doi.org/10.1023/A:1022257514209
  16. Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, et al. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981;213(4504):220-2 https://doi.org/10.1126/science.6166045
  17. Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death. Circulation 1993;88(1):180-5 https://doi.org/10.1161/01.CIR.88.1.180
  18. Apple A, Mulder P. Excess fatigue as a precursor of myocardial infarction. Eur Heart J 1988;9(7):758-64 https://doi.org/10.1093/eurheartj/9.7.758
  19. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, et al. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 1992;85(1):164-71 https://doi.org/10.1161/01.CIR.85.1.164
  20. Cole, SR, Kawachi I, Sesso HD, Paffenbarger RS, Lee IM. Sense of exhaustion and coronary heart disease among college alumni. Am J Cardiol 1999;84(12):1401-5 https://doi.org/10.1016/S0002-9149(99)00585-8
  21. Fagard RH, Pardaens K, Staessen JA. Influence of demographic, anthropometric and lifestyle characteristics on heart rate and its variability in the population. J Hypertens 1999;17(11):1589-99 https://doi.org/10.1097/00004872-199917110-00013
  22. Friedberg F. Coping With Chronic Fatigue Syndrome: Nine Things You Can Do. New Harbinger Pub. New York. 1995. pp32-3
  23. Grimm DR, De Meersman RE, Almenoff PL, Spungen AM, Bauman WA. Sympathovagal balance of the heart in subjects with spinal cord injury. Am J Physiol 1997;272(2):H835-42
  24. Hayano J, Yamada A, Mukai S, Sakakibara Y, Yamada M, et al. Severity of coronary atherosclerosis correlates with the respiratory component of heart rate variability. Am Heart J. 1991;121:1070-9 https://doi.org/10.1016/0002-8703(91)90664-4
  25. Hayano J, Yamada M, Sakakibara Y, Fujinami T, Yokoyama K, et al. Short- and long-term effects of cigarette smoking on heart rate variability. Am J Cardiol. 1990;65(1):84-8
  26. Hon EH, Lee ST. Electronic evaluation of the fetal heart rate. VIII. Patterns preceding fetal death, further observations. Am J Obstet Gynecol 1963;87:814-26
  27. Hossain JL, Reinish LW, Kayumov L, Bhuiya P, Shapiro CM. Underlying sleep pathology may cause chronic high fatigue in shift-workers. J Sleep Res 2003;12(3):223-30 https://doi.org/10.1046/j.1365-2869.2003.00354.x
  28. Jensen-Urstad K, Storck N, Bouvier F, Ericson M, Lindblad LE, et al. Heart rate variability in healthy subjects is related to age and gender. Acta Physiol Scand 1997;160(3):235-41 https://doi.org/10.1046/j.1365-201X.1997.00142.x
  29. Kageyama T, Nishikido N, Kobayashi Y, Kurokawa T, Kabuto M. Commuting, overtime, and cardiac autonomic activity in Tokyo. Lancet 1997;350(9078):639 https://doi.org/10.1016/S0140-6736(05)63328-4
  30. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3 https://doi.org/10.1001/archneur.1989.00520460115022
  31. Liao D, Barnes RW, Chambless LE, Simpson RJ Jr, Sorlie P, et al. Age, race, and sex differences in autonomic cardiac function measured by spectral analysis of heart rate variability-- the ARIC study. Atherosclerosis Risk in Communities. Am J Cardiol 1995;76(12):906-12 https://doi.org/10.1016/S0002-9149(99)80260-4
  32. Lichstein KL, Means MK, Noe SL, Aguillard RN. Fatigue and sleep disorders. Behav Res Ther. 1997;35(8):733-40 https://doi.org/10.1016/S0005-7967(97)00029-6
  33. Lishner M, Akselrod S, Avi VM, Oz O, Divon M, et al. Spectral analysis of heart rate fluctuations. A non-invasive, sensitive method for the early diagnosis of autonomic neuropathy in diabetes mellitus. J Auton Nerv Syst. 1987;19(2):119-25 https://doi.org/10.1016/0165-1838(87)90005-1
  34. Malik M, Camm AJ. Components of heart rate variability-what they really mean and what we really measure. Am J Cardiol 1993;72(11) :821-2 https://doi.org/10.1016/0002-9149(93)91070-X
  35. Pagani M, Lucini D, Mela GS, Langewitz W, Malliani A. Sympathetic overactivity in subjects complaining of unexplained fatigue. Clin Sci (Lond) 1994;87(6):655-61 https://doi.org/10.1042/cs0870655
  36. Parati G, Di Rienzo M. Determinants of heart rate and heart rate variability. J Hypertens 2003;21(3):477-80 https://doi.org/10.1097/00004872-200303000-00007
  37. Rissanen V, Romo M, Siltanen P. Premonitory symptoms and stress factors preceding sudden death from ischaemic heart disease. Acta Med Scand 1978;204(5):389-96 https://doi.org/10.1111/j.0954-6820.1978.tb08460.x
  38. Sasaki T, Iwasaki K, Oka T, Hisanaga N, Ueda T, et al. Effect of working hours on cardiovascular-autonomic nervous functions in engineers in an electronics manufacturing company. Ind Health 1999;37(1):55-61 https://doi.org/10.2486/indhealth.37.55
  39. Saul JP, Arai Y, Berger RD, Lilly LS, Colucci WS, et al. Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol. 1988;61(15):1292-9 https://doi.org/10.1016/0002-9149(88)91172-1
  40. Steinhart MJ. Depression and chronic fatigue in the patient with heart disease. Prim Care 1991;18(2):309-25
  41. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93(5):1043-65 https://doi.org/10.1161/01.CIR.93.5.1043
  42. Taylor RR, Jason LA, Torres A. Fatigue rating scales: an empirical comparison. Psychol Med. 2000;30(4):849-56 https://doi.org/10.1017/S0033291799002500
  43. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation. 1996;94(11):2850-5 https://doi.org/10.1161/01.CIR.94.11.2850
  44. Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, et al. Determinants of heart rate variability. J Am Coll Cardiol 1996;28(6):1539-46 https://doi.org/10.1016/S0735-1097(96)00342-7
  45. Watanabe T, Sugiyama Y, Sumi Y, Watanabe M, Takeuchi K, et al. Effects of vital exhaustion on cardiac autononomic nervous functions assessed by heart rate variability at rest in middle-aged male workers. Int J Behav Med 2002;9(1):68- 75 https://doi.org/10.1207/S15327558IJBM0901_05
  46. Wessely S. The epidemiology of chronic fatigue syndrome. Epidemiol Rev 1995;17(1):139-51 https://doi.org/10.1093/oxfordjournals.epirev.a036170