Sınav Stresinde Değişen Otonomik Fonksiyonlar: Kardiyovasküler-Pulmoner Etkileşimler

Öz

Amaç: Tıp eğitimi, öğrencilerin sık sık sınavlarla değerlendirildiği uzun ve kapsamlı bir müfredata sahiptir. Sınav öncesi stres, öğrencilerin sınavlardan önce karşılaştıkları yaygın bir durumdur ve özellikle tıp öğrencilerinin en müzdarip olduğu sorunlardan biridir. Çalışmanın amacı, sınav stresinin öğrencilerin otonom sinir sistemi aktivitelerine etkisini kardiyovasküler parametreler ve solunum testleri ile değerlendirmektir. Materyal ve Metod: Çalışmaya ikinci sınıf tıp öğrencilerinden 29 kişi dahil edildi. Bu kesitsel çalışma, Şubat-Mart 2020 tarihleri arasında Harran Üniversitesi, Türkiye'de gerçekleştirildi. Kullanılan parametreler; oksijen satürasyonu, nabız hızı, sistolik ve diyastolik kan basıncı ve solunum fonksiyon testleri idi. Veriler öğrencilerin sınav döneminde dört farklı zamanda toplandı. Bulgular: Sınav döneminde farklı zamanlarda ölçülen PR, SBP ve DBP arasında istatistiksel olarak anlamlı fark vardır (sırasıyla p˂0.001; p=0.001; p=0.003). Sınav stresinin akciğer fonksiyonunda artışa neden olduğu bulundu. Yapılan korelasyon analizinin sonuçları, PR ile Zorlu vital kapasite (FVC), birinci saniyedeki zorlu ekspiratuvar volüm (FEV1), vital kapasite (VC) arasında negatif bir ilişki olduğunu gösterdi. Sonuç: Sempatik sinir sistemi indüksiyonu sonucunda sınav anına kadar hemodinamik parametreler ve solunum testleri kademeli olarak arttı. PR ile FEV1, FVC ve VC arasında negatif bir korelasyonun varlığı, fizyolojik kompanzasyonun solunum döngüsü ve PR arasındaki dinamik denge yoluyla gerçekleştiğini gösterir. Solunumsal sinüs aritmisinin bu fizyolojik kompanzasyon mekanizmasına katkıda bulunduğu düşünülmektedir.

Anahtar Kelimeler

• stres
• hemodinamik
• solunum fonksiyon testi
• tıp öğrencisi
• sınav

Altered Autonomic Functions in Exam Stress: Cardiovascular-Pulmonary Interactions

Öz

Background: Medical training involves a long and exhaustive curriculum in which students are frequently evaluated by examinations. Pre-examination stress is a common condition faced by students prior to exams and is one of the most widely experienced problems for medical students. The aim of the study was to assess the effects of exam stress on autonomic nervous system functions of students through cardiovascular parameters and respiratory tests. Materials and Methods: The study group consisted of 29 second-year medical students. This cross-sectional study was carried out from February to March 2020 at Harran University, Turkey. The parameters used were oxygen saturation, pulse rate (PR), systolic (SBP) and diastolic blood pressure (DBP), and pulmonary function tests. Data were collected four times during an exam period. Results: There is a statistically significant difference between the measurements of PR, SBP, and DBP at different times (p˂0.001; p=0.001; p=0.003, respectively). It was found that exam stress caused an increase in lung function. The results of correlation analysis showed a negative relationship between PR, and Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity (VC). Conclusion: As a result of the sympathetic nervous system induction, hemodynamic and respiratory tests increased gradually until the examination. The presence of a negative correlation between PR and FEV1, FVC, and VC indicates that physiological compensation occurs through the dynamic balance between the respiratory cycle and PR. It is thought that respiratory sinus arrhythmia contributes to this physiological compensation mechanism.

Anahtar Kelimeler

• Stress
• Hemodynamics
• Pulmonary function test
• Medical student
• Exam

Kaynakça

1. 1. Sharma B, Wavare R, Deshpande A, Nigam R, Chandorkar R. A study of academic stress and its effect on vital parameters in final year medical students at SAIMS Medical College, Indore, Madhya Pradesh. Biomedical Research. 2011; 22(3):361-365.
2. 2. Singh R, Goyal M, Tiwari S, Ghildiyal A, Nattu SM, Das S. Effect of examination stress on mood, performance and cortisol levels in medical students. Indian Journal of Physiology and Pharmacology. 2012; 56(1):48-55.
3. 3. Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research. 2002; 53:865-871.
4. 4. Bali A, Jaggi AS. Clinical experimental stress studies: Methods and assessment. Rev Neurosci. 2015; 26(5):555-579.
5. 5. Shah SJ, Patel HM. Effect of Examination Stress on Parameters of Autonomic Functions in Medical Students. International Journal of Science and Research. 2014; 3(7):273-276.
6. 6. Piskorski J, Guzik P. Asymmetric properties of long-term and total heart rate variability. Med Biol Eng Comput. 2011; 49:1289-1297.
7. 7. Yasuma F, Hayano J. Respiratory Sinus Arrhythmia: Why Does the Heartbeat Synchronize with Respiratory Rhythm? Chest. 2004; 125(2):683-690.
8. 8. Overbeek TJM, Boxtel AV, Westerink JHDM. Respiratory sinus arrhythmia responses to cognitive tasks: Effects of task factors and RSA indices. Biological Psychology. 2014; 99:1-14.

9. 9. Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A. Respiratory sinus arrhythmia as a non-invasive index of ‘brain-heart’ interaction in stress. Indian J Med Res. 2016; 144(11):815-822.
10. 10. Puri SS, Kaundinya SD. Cardiovascular changes due to examination stress in First Year MBBS students. Indian Journal of Basic and Applied Medical Research. 2016; 5(3):810-816.
11. 11. Kumari N, Kumar A, Kumar M. Comparison of cardiovascular, cognitive and stress parameters in presence and in absence of examination among medical students: An observational and prospective study. Indian Journal of Clinical Anatomy and Physiology. 2019; 6(4):462-467.
12. 12. Oyeyemi AY, Atama TI, Lawan A, Oyeyemi AL. Cardiovascular Parameters of Nigerian Physiotherapy Students Dur-ing an End of Semester Examination. Journal of Medical and Biomedical Sciences. 2015; 4(2):14.
13. 13. Sembulingam P, Sembulingam K, Ilango S, Sridevi G. Rate Pressure Product as a Determinant of Physical Fitness in Normal Young Adults. IOSR Journal of Dental and Medical Sciences. 2015; 14(4):8-12.
14. 14. De Meersman RE, Zion AS, Giardina EGV, Weir JP, Lieberman JS, Downey JA. Estrogen replacement, vascular distensibility, and blood pressures in postmenopausal women. Am J of Physiol. 1998; 274(5):1539-1544.
15. 15. Mahajan AS. Stress in Medical Education : a global issue or Much Ado About Nothing specific ? South-East Asian Journal of Medical Education. 2010; 4(2):9-13.
16. 16. Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: A cross-sectional study at a college of medicine in Saudi Arabia. Journal of Health, Population and Nutrition. 2011; 29(5):516-522.
17. 17. Dogan S, Nalcaci N, Dogan S, Badnjevic A, Kurtovic A, Marjanovic D. Changes in Blood Pressure and Heart Rate Measurement Undergraduate Students During Exam Period. Journal of Biometrics & Biostatistics. 2017; 8(2):1-5.
18. 18. Al-sandook TA, Al-nuaimy KMT, Al-saffar MT. Effect of stress on arterial blood pressure In dental students. Al-Rafidain Dental Journal. 2007; 7(2):118-121.
19. 19. DeMers D, Wachs D. Physiology, Mean Arterial Pressure [e-book]. StatPearls Publishing; 2019.
20. 20. Ritz,Thomas, Wilhelm FH, Meuret AE, Gerlach AL, Roth WT. Airway response to emotion- and disease-specific films in asthma, blood phobia, and health. Psychophysiology. 2011; 48(1):121-135.
21. 21. Jongste JCDE, Jongejan RC, Kerrebijn KF. Control of Airway Caliber by Autonomic Nerves in Asthma and in Chronic Obstructive Pulmonary Disease. American Review of Respiratory Disease. 1991; 143(6):1421-1426.
22. 22. Ritz T, Steptoe A, DeWilde S, Costa M. Emotions and stress increase respiratory resistance in asthma. Psychosomatic Medicine. 2000; 62(3):401-412.
23. 23. Kang DH, Fox C. Neuroendocrine and leukocyte responses and pulmonary function to acute stressors. Annals of Behavioral Medicine. 2000; 22(4):276-285.
24. 24. Tipton MJ, Harper A, Paton JFR, Costello JT. The human ventilatory response to stress: rate or depth? Journal of Physiology. 2017; 595(17):5729-5752.
25. 25. Acharya A, Sharma M. Acute effect of examination stress on cardiovascular parameters. International Journal of Medical and Health Research. 2017; 3(10):1-3.
26. 26. Fejes I, Ábrahám G, Légrády P. The effect of an exam period as a stress situation on baroreflex sensitivity among healthy university students. Blood Pressure. 2020; 29(3):175-181.
27. 27. Quintana DS, Heathers JAJ. Considerations in the assessment of heart rate variability in biobehavioral research. Frontiers in Psychology. 2014; 5:805.
28. 28. Fortunato CK, Gatzke-Kopp LM, Ram N. Associations between respiratory sinus arrhythmia reactivity and internalizing and externalizing symptoms are emotion specific. Cognitive, Affective and Behavioral Neuroscience. 2013; 13(2):238-251.