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The use of face masks and the impact on heart rate variability during baseline ECG
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Generalitat de Catalunya" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Hospital Universitario Basurto. Bilbao" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Àptima Centre Clínic. Mutua Terrassa" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Centre de Medicina de l'Esport. Ajuntament de Granollers" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Aspetar Hospital- NSMP Aspire Academy Sports Medicine Center" "etiqueta" => "e" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">The effect of hypercapnea on autonomous nervous system (ANS)<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> was studied by some authors in different conditions.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> However, the physiological changes associated with hypercapnea for the use of face mask during COVID-19 pandemic was not studied yet in healthy athlete population.</p><p id="para0006" class="elsevierStylePara elsevierViewall">The annual athlete medical screening were resumed during the COVID-19 pandemic at the Medical Unit on Centro de Tecnificacion deportiva de Catalunya, after 3 months of mandatory use of face mask for daily activities by regulations of Ministery of Publich Health (MoPH).</p><p id="para0007" class="elsevierStylePara elsevierViewall">We studied the impact of mild hypercapnea for the use of face mask on ANS on the ECG tested during anual medical screening in elite athlete.</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Material and method</span><p id="para0008" class="elsevierStylePara elsevierViewall">A routine annual medical screening was done during October 9, 2020 and February 22, 2021. Including baseline ECG, using face mask at same medical center by same nurse practitioner.</p><p id="para0009" class="elsevierStylePara elsevierViewall">We selected 30 young healthy athletes (15 of them women), age 16.75 ± 2.4 years old, with previous normal medical screening and baseline 12-seconds electrocardiograms (ECG-12).</p><p id="para0010" class="elsevierStylePara elsevierViewall">The use of face mask was mandatory in public spaces according regulations by MoPH for COVID-19 pancemic since 3 months before to start the annual screening. For that reason, the ECG was done using face mask.</p><p id="para0011" class="elsevierStylePara elsevierViewall">The inclusion criteria for this study were: healthy adolescents athletes with ECG at the same medical center with and without face mask at the moment to be tested. The ECG machine was “touch HD+ Cardioline”.</p><p id="para0012" class="elsevierStylePara elsevierViewall">A brief ECG-12 supine on rest was studied, following the criterion of Fred Shaffer and JP Ginsberg (2017),<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Salahuddin L, Cho J, Jeong MG, Kim D.<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> (2007) and Baek HJ, Cho CH, Cho J, Woo JM (2015)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">The study of heart rate variability (HRV) was following the methodology disclosed by V.S. Mishenko and V.D. Monogarov (1995)<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> proposed by RM Baevski et al.<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> from 1965. The "rr" distance of each cardiac cycle was measured manually by same technician, estimating to the tenth of a millimeter. All the mathematical operations were done in an Excel spreadsheet to obtain the parameters of each subject. Means and standard deviations and comparative statistics were performed between the two conditions studied.</p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Results</span><p id="para0014" class="elsevierStylePara elsevierViewall">The heart rate (HR) was lower when the test was performed with facial mask (M): 59.2 ± 7.5 bpm vs. No-mask(NM): 62.0 ± 10.4 bpm (no statistical significance: p < 0.134).</p><p id="para0015" class="elsevierStylePara elsevierViewall">In relation to heart rate variability (HRV), an increase on "root mean square of successive differences" RMSSD was recorded when were tested with M: 108.5 ± 90 ms vs. NM: 72.9±54.2 ms (p <0.002).</p><p id="para0016" class="elsevierStylePara elsevierViewall">The variables PNN50 (proportion of successive beats with more than 50 ms difference) was withM: 51.6% ± 28.1 vs. NM: 38.0% ± 29.0 (p < 0.001).aalso an increase on SDNN, when the test was performed with M: 86.2 ± 47.2 ms vs. NM: 65.9 ± 43.5 ms (p < 0.036).</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Discussion</span><p id="para0017" class="elsevierStylePara elsevierViewall">The results shows that using face mask is associated with some changes on ECG, that can be analyzed with ultrashort cardiac variability (HRV) techniques<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> when we compare it with a previous ECG. These differences affect many parameters as RMSSD, PNN50 and SDNN. This is due to (in short-term ECG recordings) the activation of autonomic regulation promoting the effect of breathing on heart rate.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> This is probably a consequence of breathing over-exertion for the use of face mask.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">We found similar results with studies<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> carried out under severe hypercapnic hypoxia, in which case the physiological response is analogous: parasympathetic predominance with a slowdown on the heart chronotropic adaptation and an increased a bathmotropic response.</p><p id="para0019" class="elsevierStylePara elsevierViewall">In the present study we didn't monitoring the bathmotropic response, but the small difference on chronotropic component doesnt have statistical significant.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Our data describe</span> the impact on the neurovegetative balance by the use of face mask in healthy young athletes. The physiological response is done even in conditions where asume that the intracavitary air volumen is modest and it isn't harmfull; but it shows a sensible physiological response (sympathetic/parasympathetic) for the use of face mask in some of the volunteers.</p><p id="para0021" class="elsevierStylePara elsevierViewall">A few clinical consequences could be observed a priori. Only suceptible population predisposed to bronchoespasm or other medical conditions. The conditions with predominance of parasympathetic system and type of face mask is prescribed should be considered.</p><p id="para0022" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Limitations:</span> The distribution of ECG with and whitout mask was not random: We use a retrospective analysis for ECG without mask from previous year. The type of face mask used was not described, and the content of intracavitary hypercapnea was not tested.</p><p id="para0023" class="elsevierStylePara elsevierViewall">The impact of maturation and anatomo functional heart changes during the growth period were not taking in consideration for the retrospective component of our data. So far, the sample was on late puberty period were the changes in this system are not significatives. The design of this study was based on standard for best medical practice at that moment of this study.</p><p id="para0024" class="elsevierStylePara elsevierViewall">The analysis followed the classic manual method used 1990 in which the distance "rr" was measured manually in millimeters (on printed 12-second ECG), more imprecise than the current measurement in milliseconds.</p><p id="para0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Further investigations:</span> a prospective study is need it, with a faithful measurement of the "rr" intervals, with a record greater than 12 seconds, and verify through HRV, if the sympathetic-parasympathetic balance is affected by the use of face mask at rest on supine position.</p><p id="para0026" class="elsevierStylePara elsevierViewall">Probably these changes may justify physiologically the disconfort reported for some patients for the use of face mask he study has bee nfavorably informed by the Ethics Committee of the Sports Administration of Catalonia (certificate: 018 / CEICGC /2021.</p><p id="para0027" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conclusions:</span> The data suggests an increased predominance of the parasympathetic response, responsible for the regulation of the ANS when the subject is submitted to the ECG with face mask.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres2162599" "titulo" => "Sumary" "secciones" => array:3 [ 0 => array:1 [ "identificador" => "abss0001" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Results" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1834640" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0002" "titulo" => "Material and method" ] 4 => array:2 [ "identificador" => "sec0003" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0004" "titulo" => "Discussion" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-17" "fechaAceptado" => "2023-05-08" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1834640" "palabras" => array:3 [ 0 => "ECG" 1 => "HRV" 2 => "Facial mask" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Sumary" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">We compared electrocardiograms (ECGs) findings with one year difference between each other with and without use of face mask at the moment to be tested. The first ECG was done one year before without face mask, and the second ECG with a mask one year later after 3 months of mandatory use for epidemiological COVID-19 pandemic justifications in healthy youth elite athletes.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Results</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Regarding heart rate variability (HRV), an increase in RMSSD was recorded when the test was performed with a mask (M): 108.5 ± 90 ms vs. No mask (NM): 72.9 ± 54.2 ms (p <0.002). And also an increase in SDNN, when the test was done with a M: 86.2 ± 47.2 ms vs. NM: 65.9 ± 43.5 ms (p <0.036).</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Conclusions</span><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The results on ECG are consistent with the increasing predominance of parasympathetic regulation, which is responsible for regulation of the autonomic loop when the subject is using face mask.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abss0002" "titulo" => "Results" ] 1 => array:2 [ "identificador" => "abss0003" "titulo" => "Conclusions" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="notep0001">To consult the study data: <span class="elsevierStyleInterRef" id="interref0001" href="https://blocs.mesvilaweb.cat/ignasiblume17/the-use-of-masks-for-protection-against-covid-19-generates-variations-in-the-variability-of-the-heart-rate-during-the-obtaining-of-an-electrocardiogram-at-rest/">https://blocs.mesvilaweb.cat/ignasiblume17/the-use-of-masks-for-protection-against-covid-19-generates-variations-in-the-variability-of-the-heart-rate-during-the-obtaining-of-an-electrocardiogram-at-rest/</span></p> <p class="elsevierStyleNotepara" id="notep0002">(This study has not received any specific funding, being included in the usual work of the Medical Center.)</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of hypoxia and hypercapnia on human HRV and respiratory sinus arrhythmia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "SJ Brown" 1 => "MJ Barnes" 2 => "T. 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Sitges" 5 => "JA Gutierrez Rincon" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Apunts: Medicina De l'esport" "fecha" => "2016" "volumen" => "51" "numero" => "190" "paginaInicial" => "40" "paginaFinal" => "47" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://raco.cat/index.php/Apunts/article/view/312642" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "I. de Yzaguirre et al. COVID-19: analysis of cavitary air inspired through a mask, in competitive adolescent athletes. <a target="_blank" href="https://doi.org/10.1016/j.apunsm.2021.100349">https://doi.org/10.1016/j.apunsm.2021.100349</a>." ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "«Adaptation to the rarefied air of abysses and caves. A laboratory study»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. De Yzaguirre Maura" 1 => "J. Escoda" 2 => "J. Bosch" 3 => "J. Gutierrez Rincon" 4 => "D. Dulanto Zabala" 5 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 45 | 41 | 86 |
| 2024 September | 61 | 36 | 97 |
| 2024 August | 48 | 52 | 100 |
| 2024 July | 56 | 41 | 97 |
| 2024 June | 65 | 34 | 99 |
| 2024 May | 118 | 44 | 162 |
| 2024 April | 54 | 20 | 74 |
| 2024 March | 62 | 36 | 98 |
| 2024 February | 69 | 24 | 93 |
| 2024 January | 51 | 25 | 76 |
| 2023 December | 71 | 46 | 117 |
| 2023 November | 62 | 60 | 122 |
| 2023 October | 182 | 104 | 286 |
| 2023 September | 230 | 105 | 335 |
| 2023 August | 150 | 70 | 220 |
| 2023 July | 124 | 82 | 206 |
| 2023 June | 124 | 61 | 185 |
| 2023 May | 1 | 0 | 1 |
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