Circadian Variation of Heart Rate Variability Across Sleep Stages

Boudreau, Philippe; Yeh, Wei-Hsien; Dumont, Guy A.; Boivin, Diane B.

doi:10.5665/sleep.3230

Cited by 165 publications

(148 citation statements)

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“…In both women and men, SE, SOL, ROL, TST, stage 1 sleep, stage 2 sleep, SWS, REM sleep, and/or NREM sleep significantly varied with time of day, as previously reported for a subset of participants (13)(14)(15) and with others who used imposed experimental non-24-h sleep-wake cycle procedures to desynchronize the sleep-wake and circadian cycles (16,17). The greatest and lowest sleep propensity occurred near the trough and crest of the CBT rhythm, respectively.…”

Section: Discussionsupporting

confidence: 54%

“…Each subject provided informed consent before participation. Each study had similar screening procedures, inclusion/exclusion criteria, prestudy sleep-wake schedule requirements, and baseline in-patient study conditions, as previously reported (13)(14)(15)37). None of our female participants were on contraceptives when we first contacted them during our recruitment procedures (see further details in SI Appendix, Methods).…”

Section: Methodsmentioning

confidence: 99%

“…Results from 11 healthy women in their MF phase (mean age ± SD, 25.8 ± 3.5 y) and 15 healthy men (23.4 ± 3.7 y) who participated in one of three studies [two published (13,15)] carried out between 2004 and 2011 at the Douglas Mental Health University Institute were included in the present study (see SI Appendix, Table S1 for demographic details). Each subject provided informed consent before participation.…”

Section: Methodsmentioning

confidence: 99%

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Diurnal and circadian variation of sleep and alertness in men vs. naturally cycling women

Boivin

Shechter

Boudreau

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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This study quantifies sex differences in the diurnal and circadian variation of sleep and waking while controlling for menstrual cycle phase and hormonal contraceptive use. We compared the diurnal and circadian variation of sleep and alertness of 8 women studied during two phases of the menstrual cycle and 3 women studied during their midfollicular phase with that of 15 men. Participants underwent an ultradian sleep-wake cycle (USW) procedure consisting of 36 cycles of 60-min wake episodes alternating with 60-min nap opportunities. Core body temperature (CBT), salivary melatonin, subjective alertness, and polysomnographically recorded sleep were measured throughout this procedure. All analyzed measures showed a significant diurnal and circadian variation throughout the USW procedure. Compared with men, women demonstrated a significant phase advance of the CBT but not melatonin rhythms, as well as an advance in the diurnal and circadian variation of sleep measures and subjective alertness. Furthermore, women experienced an increased amplitude of the diurnal and circadian variation of alertness, mainly due to a larger decline in the nocturnal nadir. Our results indicate that women are likely initiating sleep at a later circadian phase than men, which may be one factor contributing to the increased susceptibility to sleep disturbances reported in women. Lower nighttime alertness is also observed, suggesting a physiological basis for a greater susceptibility to maladaptation to night shift work in women.sex difference | circadian variation of sleep | circadian variation of alertness | core body temperature | melatonin A meta-analysis has indicated an overall increased risk ratio of 1.41 in women vs. men for experiencing insomnia, and this risk ratio increases to 1.64 when considering high-quality studies with rigorous methodology (1). The etiology of sex-based differences in vulnerability to sleep disturbances remains to be fully elucidated, but evidence points to a role for sex-based differences in sleep, its timing, and circadian rhythms as potential contributors (2).There is sufficient evidence to support a role for circadian factors in the pathophysiology of chronic insomnia, as the timing of sleep relative to the endogenous circadian system can substantially affect sleep initiation and maintenance (3). Interestingly, morphological differences, as well as variations in circulating hormones and their receptors, have been reported between sexes and can affect circadian physiology. For example, the localization of sex steroid receptors to the suprachiasmatic nucleus (SCN) and a sex difference in the expression of androgen and estrogen receptors there indicate a direct and differential role of specific gonadal steroid hormones in the circadian system (4). Moreover, a sexual dimorphism in structure and sex steroid receptor expression also exists in efferent targets of the SCN, including the preoptic area of the hypothalamus, which is known to influence sleep (4). In a recent postmortem brain study, the circadian vari...

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Section: Discussionsupporting

confidence: 54%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Diurnal and circadian variation of sleep and alertness in men vs. naturally cycling women

Boivin

Shechter

Boudreau

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

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“…It has been consistently shown that sympathetic activity is increased during rapid eye movement (REM) sleep and reduced during slow wave sleep (6,44,45). Fung et al (17) demonstrated a significant correlation between the percentage of slow-wave sleep and the incidence of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Sleep efficiency and nocturnal hemodynamic dipping in young, normotensive adults

Ross

Yang

Larson

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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Blunted dipping of nocturnal systolic arterial pressure (SAP) and heart rate (HR) are independent risk factors for hypertension and all-cause mortality. While several epidemiological studies report a significant association between short sleep duration and hypertension, associations between sleep efficiency and the nocturnal drop of SAP remain controversial. Moreover, relations between sleep efficiency and HR diurnal patterns have been overlooked. We hypothesized that low sleep efficiency (<85%) would be associated with blunted nocturnal SAP and HR dipping. Twenty-two normotensive subjects (13 men, 9 women; age: 18–28 yr) wore an actigraphy watch for 7 days and nights, and an ambulatory blood pressure monitor for 24 h on a nonactigraph night. There were no differences in age, sex, body mass index, mean sleep time, number of awakenings, or 24-h blood pressure between the low ( n = 12) and high ( n = 10) sleep efficiency groups. However, the low sleep efficiency subjects demonstrated a blunted dip of nocturnal SAP (10 ± 1% vs. 14 ± 1%, P = 0.04) and HR (12 ± 3% vs. 21 ± 3%, P = 0.03) compared with the high sleep efficiency group. The low sleep efficiency group also demonstrated a higher mean nocturnal HR (63 ± 2 vs. 55 ± 2 beats/min; P = 0.02). These findings support growing evidence that sleep efficiency, independent of total sleep time, may be an important cardiovascular risk factor.

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“…6,15 On the other hand, there have been several evidence suggesting a relationship between circadian rhythm and car diac autonomic control. 22,23 Therefore, disturbance in circadian regulation may result in both sleepwake disturbance and OD. One more possibility may be that the occurrence of OD in a patient with CRSD is a presentation of a mere shift in the tim ing of normal orthostatic responses in CRSD, not a qualitative difference or pathological failure in the mechanisms of ortho static regulation.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Orthostatic Dysregulation among Circadian Rhythm Disorder Patients

Tsuchiya

Kitajima

Tomita

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Patients with circadian rhythm sleep disorders (CRSDs) often have coincidence of orthostatic dysregulation (OD). Both disorders have many common clinical features. However, the prevalence of OD in patients with CRSD has not been examined. Methods: Thirty-eight patients with CRSD with either delayed sleep phase disorder or free-running disorder were tested for OD using the new orthostatic test, which was originally established by Tanaka et al. (< 20 years) and the Schellong test, i.e., the active standing test (≥ 20 years). Results:The overall prevalence of OD in patients with CRSD was 57.9% (22/38), and prevalence of OD was 70% in patients under 20 years of age (14/20). These rates exceed the previously reported values in adolescents aged 14-15 years (15%), regarded as the age with highest OD prevalence. Prevalence was not significantly associated with CRSD severity and medications used. Conclusions:We observed a high prevalence of OD in patients with CRSD, suggesting some relationship between CRSD and OD. Large-scale case-control studies are warranted to investigate the underlying mechanisms for this comorbidity. I NTRO DUCTI O NCircadian rhythm sleep disorders (CRSDs) are characterized by persistent or recurrent patterns of sleep disturbance pri marily caused by alterations in the circadian timing system or misalignment between the endogenous circadian rhythm and external schedules. CRSD is associated with impairments in social, occupational, and other areas of functioning.1 Delayed sleep phase disorder (DSPD) is the most common CRSD diag nosis (excluding shift work disorder and jet lag disorder), with a prevalence of 0.1% to 0.4%.2,3 DSPD is more common among adolescents and young adults. Many of these schoolage pa tients often have school refusal; sometimes it is difficult to dis tinguish clinically whether school refusal is a cause or a result of the circadian rhythm disturbance. Previous studies reported that the nadir of core body temperature (CBT) was markedly delayed, and that the amplitude of circadian CBT rhythm was significantly smaller in subjects with school refusal behavior than in healthy controls. 4,5 These observations suggest that the clinical psychosomatic symptoms often observed in patients with school refusal behavior are related to the desynchroniza tion of the circadian rhythm of body temperature and sleep wake rhythm. 4,5 It is our clinical experience that patients with CRSD often have a diagnosis of orthostatic dysregulation (OD), a functional physical disorder with an impairment of circulatory adjustment against gravitational stress because of dysregulation of the au tonomic nervous system. 6,7 OD is common in adolescents and often affected by psychosocial factors; therefore, it is regarded as a psychosomatic disorder. The characteristics of OD among adults, alternatively named as orthostatic intolerance (OI) in America and Europe, has not been as clearly defined as those of OD among children. 8,9 It was reported that more than half of the Japanese children with sym...

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Circadian Variation of Heart Rate Variability Across Sleep Stages

Abstract: The circadian and sleep stage-specific effects on heart rate variability are clinically relevant and contribute to the understanding of the degree of cardiovascular vulnerability during sleep.

Cited by 165 publications

References 53 publications

Diurnal and circadian variation of sleep and alertness in men vs. naturally cycling women

Diurnal and circadian variation of sleep and alertness in men vs. naturally cycling women

Sleep efficiency and nocturnal hemodynamic dipping in young, normotensive adults

High Prevalence of Orthostatic Dysregulation among Circadian Rhythm Disorder Patients

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