Cardiac autonomic control in Brugada syndrome patients during sleep: The effects of sleep disordered breathing

Tobaldini, Eleonora; Brugada, Josep; Benito, Begoña; Molina, Irma; Montserrat, Josep M.; Kára, Tomáš; Leinveber, Pavel; Porta, Alberto; Macedo, Paula; Montano, Nicola; Somers, Virend K.

doi:10.1016/j.ijcard.2013.04.137

Cited by 20 publications

(15 citation statements)

References 47 publications

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“…Experimental and clinical studies have established that derangement of the autonomic nervous system may play a key role in the pathophysiology of the cardiovascular consequences that occur in patients with acute and chronic SCI. During sleep, in normal subjects, autonomic cardiac control is highly dynamic and active, with a predominant vagal modulation during NREM sleep and a shift of sympatho-vagal balance towards sympathetic predominance during REM sleep [Trinder et al 2001; Crasset et al 2001; Beharav et al 1995; Busek et al 2005; Tobaldini et al 2013]. However, no studies have so far investigated the autonomic cardiac changes during sleep in SCI patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, new non-linear methods, such as symbolic dynamics and entropy-derived measures, have been proposed as valid tools able to overcome important technical limitation of spectral analysis and capable of providing complementary information on the neural mechanisms which control and regulate cardiac sinus node function [Tobaldini et al 2009; Tobaldini et al 2013; Viola et al 2011; Porta et al 2007; Porta et al 2007]. …”

Section: Introductionmentioning

confidence: 99%

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Preserved cardiac autonomic dynamics during sleep in subjects with spinal cord injuries

Tobaldini¹,

Proserpio²,

Sambusida³

et al. 2015

Sleep Medicine

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Spinal cord injuries (SCI) are associated with altered cardiovascular autonomic control. Sleep is characterized by modifications of autonomic control across sleep stages; however, no data are available on the effects of SCI on CAC during sleep. The aim of our study was to assess cariac autonomic modulation during sleep in SCI patients. Overnight polysomnographic recordings were obtained in 27 patients with cervical (Cerv) and thoracic (Thor) SCI and in healthy subjects (Controls). ECG and respiration were extracted from PSG, divided into sleep stages (W, N2, N3 and REM) for assessment of CAC, using symbolic analysis and Corrected Conditional Entropy. SA identifies three main indices, 0V%, index of sympathetic modulation, and 2LV% and 2UV%, markers of vagal modulation. CCE evaluates the complexity of heart period time series. Symbolic analysis revealed a reduction of 0V% in N2 and N3 compared to W and REM and an increase of 2LV% and 2UV% in N2 and N3 compared to W and REM in SCI patients, independent of the level of the lesion, and similar to Controls. Corrected Conditional Entropy was higher in N2 and N3 compared to W and REM in all three groups. In SCI patients, cardiac autonomic control changed across sleep stages, with a reduction of sympathetic and an increase of parasympathetic modulation during NREM compared to W and REM and a parallel increase of complexity during NREM, similar to Controls. Cardiac autonomic dynamics during sleep are maintained in SCI, independent of the level of the lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preserved cardiac autonomic dynamics during sleep in subjects with spinal cord injuries

Tobaldini¹,

Proserpio²,

Sambusida³

et al. 2015

Sleep Medicine

Self Cite

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“…For this reason, cardiovascular autonomic assessment in severe OSA patients can importantly be affected by non-neural oscillations related to the continuous episodes of apnea which could thereby alter HRV analysis (Wang et al, 2008); this factor must be taken into account when analyzing PSG data and interpreting the results. To this regard, in a recent paper assessing HRV during sleep in patients with Brugada syndrome diagnosed with or without SDB, ECG recordings derived from polysomnographic studies were analyzed, carefully avoiding periods with apneas/hypopneas and considering only ECG segments associated with stable and regular breathing (Tobaldini et al, 2013). This approach allowed the observation that Brugada syndrome, a rare but life- threatening disease characterized by ventricular arrhythmias and sudden cardiac death, more frequent during nighttime, was associated with an impaired autonomic cardiovascular control in the presence of comorbid SDB (Tobaldini et al, 2013).…”

Section: Hrv and Sleep Disordersmentioning

confidence: 99%

“…To this regard, in a recent paper assessing HRV during sleep in patients with Brugada syndrome diagnosed with or without SDB, ECG recordings derived from polysomnographic studies were analyzed, carefully avoiding periods with apneas/hypopneas and considering only ECG segments associated with stable and regular breathing (Tobaldini et al, 2013). This approach allowed the observation that Brugada syndrome, a rare but life- threatening disease characterized by ventricular arrhythmias and sudden cardiac death, more frequent during nighttime, was associated with an impaired autonomic cardiovascular control in the presence of comorbid SDB (Tobaldini et al, 2013). …”

Section: Hrv and Sleep Disordersmentioning

confidence: 99%

Heart rate variability in normal and pathological sleep

Nobili²,

et al. 2013

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Sleep is a physiological process involving different biological systems, from molecular to organ level; its integrity is essential for maintaining health and homeostasis in human beings. Although in the past sleep has been considered a state of quiet, experimental and clinical evidences suggest a noteworthy activation of different biological systems during sleep. A key role is played by the autonomic nervous system (ANS), whose modulation regulates cardiovascular functions during sleep onset and different sleep stages. Therefore, an interest on the evaluation of autonomic cardiovascular control in health and disease is growing by means of linear and non-linear heart rate variability (HRV) analyses. The application of classical tools for ANS analysis, such as HRV during physiological sleep, showed that the rapid eye movement (REM) stage is characterized by a likely sympathetic predominance associated with a vagal withdrawal, while the opposite trend is observed during non-REM sleep. More recently, the use of non-linear tools, such as entropy-derived indices, have provided new insight on the cardiac autonomic regulation, revealing for instance changes in the cardiovascular complexity during REM sleep, supporting the hypothesis of a reduced capability of the cardiovascular system to deal with stress challenges. Interestingly, different HRV tools have been applied to characterize autonomic cardiac control in different pathological conditions, from neurological sleep disorders to sleep disordered breathing (SDB). In summary, linear and non-linear analysis of HRV are reliable approaches to assess changes of autonomic cardiac modulation during sleep both in health and diseases. The use of these tools could provide important information of clinical and prognostic relevance.

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“…We have recently shown that these autonomic dynamics may be preserved in pathological conditions, such as in patients affected by Brugada syndrome and in patients with spinal cord injuries (Tobaldini et al. ,c, ).…”

Section: Discussionmentioning

confidence: 99%

Cardiac autonomic control and complexity during sleep are preserved after chronic sleep restriction in healthy subjects

et al. 2017

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Acute sleep deprivation (SD) alters cardiovascular autonomic control (CAC) and is associated with an increased risk of cardiovascular disorders. However, the effects of partial SD on CAC are unclear. Thus, we aimed to investigate the effects of partial SD on CAC during sleep. We randomized seventeen healthy subjects to a restriction group (RES, n = 8, subjects slept two‐thirds of normal sleep time based on individual habitual sleep duration for 8 days and 8 nights) or a Control group (CON, n = 9, subjects were allowed to sleep their usual sleep time). Attended polysomnographic (PSG) studies were performed every night; a subset of them was selected for the analysis at baseline (day 3‐D3), the first night after sleep restriction (day 5‐D5), at the end of sleep restriction period (day 11‐D11), and at the end of recovery phase (day 14‐D14). We extracted electrocardiogram (ECG) and respiration from the PSG and divided into wakefulness (W), nonrapid eye movements (REM) sleep (N2 and N3) and REM sleep. CAC was evaluated by means of linear spectral analysis, nonlinear symbolic analysis and complexity indexes. In both RES and CON groups, sympathetic modulation decreased and parasympathetic modulation increased during N2 and N3 compared to W and REM at D3, D5, D11, D14. Complexity analysis revealed a reduction in complexity during REM compared to NREM sleep in both DEP and CON. After 8 days of moderate SD, cardiac autonomic dynamics, characterized by decreased sympathetic, and increased parasympathetic modulation, and higher cardiac complexity during NREM sleep, compared to W and REM, are preserved.

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Cardiac autonomic control in Brugada syndrome patients during sleep: The effects of sleep disordered breathing

Cited by 20 publications

References 47 publications

Preserved cardiac autonomic dynamics during sleep in subjects with spinal cord injuries

Preserved cardiac autonomic dynamics during sleep in subjects with spinal cord injuries

Heart rate variability in normal and pathological sleep

Cardiac autonomic control and complexity during sleep are preserved after chronic sleep restriction in healthy subjects

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