TY - JOUR
T1 - Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity
AU - Qin, Hua
AU - Keenan, Brendan T.
AU - Mazzotti, Diego R.
AU - Vaquerizo-Villar, Fernando
AU - Kraemer, Jan F.
AU - Wessel, Niels
AU - Tufik, Sergio
AU - Bittencourt, Lia
AU - Cistulli, Peter A.
AU - De Chazal, Philip
AU - Sutherland, Kate
AU - Singh, Bhajan
AU - Pack, Allan I.
AU - Chen, Ning Hung
AU - Fietze, Ingo
AU - Gislason, Thorarinn
AU - Holfinger, Steven
AU - Magalang, Ulysses J.
AU - Penzel, Thomas
N1 - Publisher Copyright:
© 2021 Sleep Research Society. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Study Objectives: Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample. Methods: 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. Results: Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms; p < 0.0001), RMSSD (21.5 vs. 27.9 ms; p < 0.0001), ShanEn (1.83 vs. 2.01; p < 0.0001), and Forbword (36.7 vs. 33.0; p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7; p = 0.009). Conclusions: Time-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients.
AB - Study Objectives: Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample. Methods: 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. Results: Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms; p < 0.0001), RMSSD (21.5 vs. 27.9 ms; p < 0.0001), ShanEn (1.83 vs. 2.01; p < 0.0001), and Forbword (36.7 vs. 33.0; p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7; p = 0.009). Conclusions: Time-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients.
KW - autonomic nervous activity
KW - frequency domain analysis
KW - heart rate variability
KW - nonlinear dynamic analysis
KW - obstructive sleep apnea
KW - time domain analysis
KW - wakefulness
UR - http://www.scopus.com/inward/record.url?scp=85106539408&partnerID=8YFLogxK
U2 - 10.1093/sleep/zsab018
DO - 10.1093/sleep/zsab018
M3 - 文章
C2 - 33506267
AN - SCOPUS:85106539408
SN - 0161-8105
VL - 44
JO - Sleep
JF - Sleep
IS - 5
M1 - zsab018
ER -