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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 64-67

A study of heart rate variability among khaini users: A form of smokeless tobacco in India


1 Department of Physiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
2 Department of Physiology , Basaveshwara Medical College, Chitradurga, Karnataka, India
3 Department of Anesthesiology, Basaveshwara Medical College, Chitradurga, Karnataka, India

Date of Web Publication16-Sep-2013

Correspondence Address:
Amrith Pakkala
Department of Physiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.118225

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  Abstract 

Background: Use of tobacco in cigarettes indeed represents a health concern of growing magnitude among cigarette smokers. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit, with cumulative and deleterious effects on health. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risks and needs to be discouraged. Modernisation of life style has affected the population even in rural areas, leading to addiction. Smokeless tobacco is presumed to be less of an evil by the rural folk. Khaini addicts are likely to suffer from mental and physical exhaustion, leading to stress. Khaini is tobacco with slaked lime. This is important in view of the prevailing socio-economic as well as the healthcare system available in any developing country. Therefore, the present study is designed to measure the heart rate variability (HRV) among this special group of the population. Materials and Methods: Fifteen male subjects were enrolled from the rural farm labors' population who regularly chew khaini. They were free from any type of physical and mental health issues and were non-smokers. A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls. Each individual volunteer was subjected to an HRV analysis on three occasions: the first record was performed on the first day of their arrival in the hospital as subjects during the lean season. The second observation was recorded after 3 months. The final HRV analysis was performed after 6 months of the first recording. Two types of parameters were analyzed: time domain and frequency domain. Statistical analysis was performed using a paired t-test within the study group and the unpaired t-test between non-khaini chewing controls and subjects on Day 1 of the recording. Results: There was no statistically significant difference between the controls and the study group on Day 1 of recording. Both the HRV parameters - time and frequency domain, showed decreased values during the third month and sixth month recording as compared with the first week recording. The decrease is much more during the sixth month recording as compared with the third month recording. A statistically significant decrease is observed in the mean RR interval, heart rate, very large frequency and large frequency only when the first week recording is compared with the third month recording, but when the first week recording is compared with the sixth month recording, a significant decrease in the mean RR interval and heart rate is found. Conclusion: Subjects involved in taking khaini are likely to undergo a lot of physical and mental stress thus affecting their autonomic status. This adds up to the stress induced by their occupation. HRV analysis using short-term electrocardiogram recordings was used to detect changes consequent with this stress.

Keywords: Care giver, farming, frequency domain, heart rate variability, khaini users, NN50, occupational stress, RMSSD, RR interval


How to cite this article:
Pakkala A, Ganashree CP, Raghavendra T. A study of heart rate variability among khaini users: A form of smokeless tobacco in India. Muller J Med Sci Res 2013;4:64-7

How to cite this URL:
Pakkala A, Ganashree CP, Raghavendra T. A study of heart rate variability among khaini users: A form of smokeless tobacco in India. Muller J Med Sci Res [serial online] 2013 [cited 2019 Aug 21];4:64-7. Available from: http://www.mjmsr.net/text.asp?2013/4/2/64/118225


  Introduction Top


Use of tobacco in cigarettes indeed represents a health concern of growing magnitude among cigarette smokers. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit, with cumulative and deleterious effects on health. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risks and needs to be discouraged.

Lifestyle in the present day is full of stresses, even in the rural setting. This is an important cause for the rural folk engaged predominantly in farming activity, a form of manual labor in India, to take up addiction. Khaini chewing, a form of smokeless tobacco, is viewed to be relatively harmless by the rural folk. Khaini is tobacco with slaked lime. The negative consequences of stress as a risk factor for cardiovascular disease and reduced human performances are well studied. [1] Stress is known to change the balance existing between the sympathetic and the parasympathetic divisions of the autonomic nervous system. [2] Khaini chewers are likely to suffer from mental and physical exhaustion, leading to stress. Heart rate variability (HRV) is a non-invasive study of variation over a period of time between consecutive heart beats, and has been proven to be a reliable marker of autonomic nervous system activity [ANS]. [3] HRV analysis is one of the best parameters available today for evaluation of stress.

The level of HRV and the underlying stress is not well studied in developing countries. This is important in view of the prevailing socio-economic as well as the healthcare system available in a developing country like India. Therefore, the present study is designed to measure HRV among this special group of the population.


  Materials and Methods Top


The data was acquired from 15 male subjects in the age group of 22-25 years free from any type of physical and mental health issues as determined by taking a detailed history and a thorough physical examination. All subjects were non-smokers and had a history of khaini chewing of 3-5 years duration. On an average, they chewed about three sachets, which was about 30 g per day. A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls.

These subjects were enrolled from an Indian village. Informed consent was obtained from the subjects. Ethical clearance was obtained from the institutional ethical committee. Each volunteer was subjected to HRV analysis on three occasions: the first record was performed on the first day of their arrival in the hospital. The second observation was recorded after 3 months. The final HRV analysis was performed after 6 months. All recordings were obtained under similar conditions of time and body position after an adaptation time of 30 min.

The anthropometric parameters of each subject were recorded. This was followed by a short-term 5-min three-lead electrocardiogram recording (ECG) using a Biomed polygraph. From the data thus obtained, HRV analysis was performed. The RR interval time series were extracted from the ECG records using the Biomed HRV analysis software. Two types of parameters were analyzed. Time domain parameters like mean RR interval and RMSSD (ms): square root of the mean of the sum of the squares of differences between adjacent NN intervals. This gives information regarding HRV in a short time interval, NN50: number of pairs of adjacent NN intervals differing by more than 50 ms in the entire recording, pNN50 (%): NN50 count divided by the total number of all NN intervals and frequency domain parameters like VLF (ms²): power in the very low-frequency range (<0.04 Hz), LF (ms²): power in the low-frequency range (0.04-0.15 Hz), HF (ms²): power in the high-frequency range(0.15-0.4 Hz) and LF/HF ratio.

The fraction of the total RR intervals, labelled as normal to normal (NN) intervals, was computed as the NN/RR ratio. This ratio has been used as a measure of data reliability with the purpose to exclude records with a ratio less than 90% of the threshold. [4],[5],[6]

Statistical Analysis

HRV features were depicted as the mean ± standard deviation during the three sets of recordings. Non-linear properties of HRV were analyzed by the following methods: time domain parameters and frequency domain parameters were compared using the paired t-test within the study group and the unpaired t-test between the study and the control groups.


  Results Top


From [Table 1] & [Table 2] it is clear that fifteen males were enrolled in the study with a mean age of 21.41 ± 2.52 years, height of 162.09 ± 0.08 cm, weight of 58.49 ± 1.44 kg and BMI of 22.63 ± 0.02 kg/m 2 . A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls.
Table 1: Comparison of HRV time domain parameters

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Table 2: Comparison of the HRV frequency domain parameters

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There was no statistically significant difference between the controls and the study group on Day 1 of the recording. Both the HRV parameters - time and frequency domain, showed decreased values during the third month and sixth month recording as compared with the first day recording. The decrease is much more during the sixth month recording as compared with the third month recording. A statistically significant decrease is observed in the mean RR interval, heart rate, VLF and LF only when the first day recording is compared with the third month recording, but when the first day recording was compared with the sixth month recording, a significant decrease was found in the mean RR interval and heart rate.


  Discussion Top


In the present study, various HRV parameters were computed among the khaini chewers of a village in India. Recordings were made within one day of the patient being admitted to the hospital. Subsequently, repeat recordings were obtained after 3 months and 6 months of the first recording.

There was no statistically significant difference between the controls and the study group on Day 1 of the recording. This indicates that there was no overt residual effect on these parameters under these circumstances. The mental and physical stress associated with intense manual labor is likely to produce a cardiosympathetic excitation. This has an additive effect on the reaction of the ANS to nicotine in khaini. This is reflected in a significant decrease in the mean RR interval. The mean RR interval is an indicator of the ratio of the cardiac sympathovagal balance. The results suggest an overall sympathetic dominance subsequent to taking up of farming activities among the subjects. The significant decrease in the mean RR interval and the increase in the mean heart rate after 3 months reflects a decreased total HRV in the presence of mental and physical stress. The mean value of the HF power is of lower magnitude after 3 and 6 months, but the decrease is not statistically significant, except in the case of VLF and LF power. However, the combined decrease in spectral power of all three bands contributes to the significant decrease in the total power during the care-giving period. Decreased HRV indicates diminished responsiveness of the cardiac autonomic system to normal physiological stimuli. The frequency and time domain parameters show no change between 3 months and 6 months. The HRV was unchanged during this period, probably because the level of stress induced in these subjects for 3 months might have started adaptive mechanisms counteracting the effect of stress.


  Conclusion Top


Subjects involved in taking khaini are likely to undergo a lot of physical and mental stress paradoxically, the very reason for which they presumably began with the habit thus affecting their autonomic status. HRV analysis using short-term ECG recordings was used to detect changes consequent to this stress.

It was found that almost all HRV parameters measuring heart rate complexity were decreased in the period of recording.

 
  References Top

1.Hubert C, Lambertz M, Nelesen RA, Bardwell W, Choi JB, Dimsdale JE. Effects of stress on heart rate complexity-a comparison between short term and chronic stress. Biol Psychol 2009;80:325-32.  Back to cited text no. 1
    
2.Kim D, Seo Y, Jaegeol C, Chul-Ho C. Detection of subjects with higher self reporting stress scores using heart rate variability patterns during the day. Engineering in Medicine and Biology Society, 2008 EMBS 2008. 30 th Annual International Conference of the IEEE; 2008. p. 682-5.  Back to cited text no. 2
    
3.Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, et al. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use, Eur Heart J 1996;17:354-81.  Back to cited text no. 3
    
4.Goldberger AL, Amaral LA, Glass L, Hausdorff JM, Ivanov PC, Mark RG, et al. Physio Bank, Physio Toolkit, and Physio Net: Components of a new research resource for complex physiologic signals. Circulation 2000;101:215-20.  Back to cited text no. 4
    
5.Zong W, Moody GB, Jiang D. A robust open source algorithm to detect onset and duration of QRS complexes. Comput Cardiol 2003:21-24,737-740.  Back to cited text no. 5
    
6.Melillo P, Fusco R, Sansone M, Bracale M, Pecchia L. Discrimination power of long term heart rate variability measures for chronic heart failure detection. Med Biol Eng Comput 2011;9:67-74.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Smokeless tobacco: Risk factor for cardiovascular and breathing in young Indian adolescent
A.K. Choudhary,A. Qudeer
Hipertensión y Riesgo Vascular. 2019;
[Pubmed] | [DOI]



 

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