Mental stress causes vasoconstriction in subjects with sickle cell disease and in normal controls
Payal Shah,
Maha Khaleel,
Wanwara Thuptimdang,
John Sunwoo,
Saranya Veluswamy,
Patjanaporn Chalacheva,
Roberta M. Kato,
Jon Detterich,
John C. Wood,
Lonnie Zeltzer,
Richard Sposto,
Michael C.K. Khoo,
Thomas D. Coates
Affiliations
Payal Shah
Division of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Maha Khaleel
Division of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Wanwara Thuptimdang
Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
John Sunwoo
Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
Saranya Veluswamy
Division of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Patjanaporn Chalacheva
Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
Roberta M. Kato
Division of Pulmonology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Jon Detterich
Division of Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
John C. Wood
Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles;Division of Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Lonnie Zeltzer
Pediatric Pain Program, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
Richard Sposto
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Michael C.K. Khoo
Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
Thomas D. Coates
Division of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
Vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD) and occurs when deoxygenated sickled red blood cells occlude the microvasculature. Any stimulus, such as mental stress, which decreases microvascular blood flow will increase the likelihood of red cell entrapment resulting in local vaso-occlusion and progression to VOC. Neurally mediated vasoconstriction might be the physiological link between crisis triggers and vaso-occlusion. In this study, we determined the effect of mental stress on microvascular blood flow and autonomic nervous system reactivity. Sickle cell patients and controls performed mentally stressful tasks, including a memory task, conflict test and pain anticipation test. Blood flow was measured using photoplethysmography, autonomic reactivity was derived from electrocardiography and perceived stress was measured by the State-Trait Anxiety Inventory questionnaire. Stress tasks induced a significant decrease in microvascular blood flow, parasympathetic withdrawal and sympathetic activation in all subjects. Of the various tests, pain anticipation caused the highest degree of vasoconstriction. The magnitude of vasoconstriction, sympathetic activation and perceived stress was greater during the Stroop conflict test than during the N-back memory test, indicating the relationship between magnitude of experimental stress and degree of regional vasoconstriction. Baseline anxiety had a significant effect on the vasoconstrictive response in sickle cell subjects but not in controls. In conclusion, mental stress caused vasoconstriction and autonomic nervous system reactivity in all subjects. Although the pattern of responses was not significantly different between the two groups, the consequences of vasoconstriction can be quite significant in SCD because of the resultant entrapment of sickle cells in the microvasculature. This suggests that mental stress can precipitate a VOC in SCD by causing neural-mediated vasoconstriction.
