Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients

Kim, Yoo Suk; Kim, Sung-Yul; Park, Do Yang; Wu, Hee Won; Hwang, Gyo‐Seung; Kim, Hyun Jun

doi:10.1097/scs.0000000000001782

Cited by 32 publications

(42 citation statements)

References 17 publications

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“…It has also been reported that sleep apnea or variability in blood pressure is associated with an increase in sympathetic nerve activity [33][34][35]. In the present study, there were no subjects with a current or past history of sleep apnea and the subjects were not evaluated sleep apnea by questionnaires or polysomnography.…”

Section: Discussionmentioning

confidence: 68%

The fluctuation in sympathetic nerve activity around wake-up time was positively associated with not only morning but also daily glycemic variability in subjects with type 2 diabetes

Matsushita

Takata

Kawamura

et al. 2019

Diabetes Research and Clinical Practice

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It is known that autonomic nerve activity (ANA) affects glucose metabolism by regulating the secretion of insulin and glucagon. Sympathetic nerve stimulation results in increased blood glucose levels. ANA also showed a circadian variation, and sympathetic nerve activity was minimal at night and began to rise at arousal. Therefore, a drastic alteration in ANA around wake-up would be associated with glycemic variability (GV) known risk factor for cardiovascular disease. We investigated the relation between ANA around wake-up and either morning or daily GV. Methods: We simultaneously performed Holter ECG and continuous glucose monitoring system in 41 patients with type 2 diabetes (T2D). ANA was assessed by heart rate variability (HRV) analysis. Delta (D) wake-up was defined as the difference between the maximum and minimum value during 1 h before and after wake-up time, before breakfast. Results: D of low frequency/high frequency (LF/HF) around wake-up time (D LF/HF wake-up) was positively associated with D glucose wake-up , standard deviation (SD) glucose wake-up , the mean amplitude of glucose excursions (MAGE 24h), and SD glucose 24h after adjustment for age, sex, BMI, the duration of diabetes, and the prevalence of diabetic polyneuropathy (b = 0.47, p = 0.011, b = 0.48, p = 0.009, b = 0.54, p = 0.002 and b = 0.41, p = 0.0025, respectively). No association was found between D LF/HF wake-up and either mean blood glucose for 24 h, or HbA1c as parameters of chronic hyperglycemia. Conclusions: In T2D, the fluctuation in fasting sympathetic nerve activity around wake-up was positively associated with not only morning but also daily GV.

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Section: Discussionmentioning

confidence: 68%

The fluctuation in sympathetic nerve activity around wake-up time was positively associated with not only morning but also daily glycemic variability in subjects with type 2 diabetes

Matsushita

Takata

Kawamura

et al. 2019

Diabetes Research and Clinical Practice

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“…In our study, we found that the MI was significantly and positively correlated with SDNN. Similarly, Kim et al concluded that SDNN was higher in patients with OSAS than controls [ 17 , 24 ]. Because SDNN only quantifies the total variability of heart rate during recording, it provides limited information when a sympathovagal imbalance is detected.…”

Section: Discussionmentioning

confidence: 99%

“…Park found that the AHI was significantly correlated with VLF power, LF power and the LF/HF ratio [ 17 ]. Likewise, Kim et al analyzed the correlations between the AHI and HRV parameters and found that the correlation with the LF/HF ratio was significant among patients with OSAHS [ 24 ]. The present study found complementary findings.…”

Section: Discussionmentioning

confidence: 99%

Correlation Analysis between Polysomnography Diagnostic Indices and Heart Rate Variability Parameters among Patients with Obstructive Sleep Apnea Hypopnea Syndrome

et al. 2016

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Heart rate variability (HRV) can reflect the changes in the autonomic nervous system (ANS) that are affected by apnea or hypopnea events among patients with obstructive sleep apnea hypopnea syndrome (OSAHS). To evaluate the possibility of using HRV to screen for OSAHS, we investigated the relationship between HRV and polysomnography (PSG) diagnostic indices using electrocardiography (ECG) and PSG data from 25 patients with OSAHS and 27 healthy participants. We evaluated the relationship between various PSG diagnostic indices (including the apnea hypopnea index [AHI], micro-arousal index [MI], oxygen desaturation index [ODI]) and heart rate variability (HRV) parameters using Spearman’s correlation analysis. Moreover, we used multiple linear regression analyses to construct linear models for the AHI, MI, and ODI. In our analysis, the AHI was significantly associated with relative powers of very low frequency (VLF [%]) (r = 0.641, P = 0.001), relative powers of high frequency (HF [%]) (r = -0.586, P = 0.002), ratio between low frequency and high frequency powers (LF/HF) (r = 0.545, P = 0.049), normalized powers of low frequency (LF [n.u.]) (r = 0.506, P = 0.004), and normalized powers of high frequency (HF [n.u.]) (r = -0.506, P = 0.010) among patients with OSAHS. The MI was significantly related to standard deviation of RR intervals (SDNN) (r = 0.550, P = 0.031), VLF [%] (r = 0.626, P = 0.001), HF [%] (r = -0.632, P = 0.001), LF/HF (r = 0.591, P = 0.011), LF [n.u.] (r = 0.553, P = 0.004), HF [n.u.] (r = -0.553, P = 0.004), and absolute powers of very low frequency (VLF [abs]) (r = 0.525, P = 0.007) among patients with OSAHS. The ODI was significantly correlated with VLF [%] (r = 0.617, P = 0.001), HF [%] (r = -0.574, P = 0.003), LF [n.u.] (r = 0.510, P = 0.012), and HF [n.u.] (r = -0.510, P = 0.012) among patients with OSAHS. The linear models for the PSG diagnostic indices were AHI = -38.357+1.318VLF [%], MI = -13.389+11.297LF/HF+0.266SDNN, and ODI = -55.588+1.715VLF [%]. However, the PSG diagnostic indices were not related to the HRV parameters among healthy participants. Our analysis suggests that HRV parameters are powerful tools to screen for OSAHS patients in place of PSG monitoring.

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“…It is commonly recognized that the HF component of HRV is associated with parasympathetic activity, while the LF component might be an indicator of both sympathetic and parasympathetic activity [ 26 , 34 , 35 ]. Studies have demonstrated that OSA patients may develop enhanced sympathetic activity due to abnormal adaptability of cardiac autonomic system, leading to a decreased HF and increased LF [ 12 , 36 ]. In accordance with the previous studies, we observed a significant decreased HFnorm and increased LFnorm in the cross-sectional comparisons at baseline.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Dynamics in Patients with Obstructive Sleep Apnea: Heart Rate Variability and Entropy

Zhang

et al. 2019

Entropy

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Background: Obstructive sleep apnea (OSA), a highly prevalent sleep disorder, is closely related to cardiovascular disease (CVD). Our previous work demonstrated that Shannon entropy of the degree distribution (EDD), obtained from the network domain of heart rate variability (HRV), might be a potential indicator for CVD. Method: To investigate the potential association between OSA and EDD, OSA patients and healthy controls (HCs) were identified from a sleep study database. Then EDD was calculated from electrocardiogram (ECG) signals during sleep, followed by cross-sectional comparisons between OSA patients and HCs, and longitudinal comparisons from baseline to follow-up visits. Furthermore, for OSA patients, the association between EDD and OSA severity, measured by apnea-hypopnea index (AHI), was also analyzed. Results: Compared with HCs, OSA patients had significantly increased EDD during sleep. A positive correlation between EDD and the severity of OSA was also observed. Although the value of EDD became larger with aging, it was not OSA-specified. Conclusion: Increased EDD derived from ECG signals during sleep might be a potential dynamic biomarker to identify OSA patients from HCs, which may be used in screening OSA with high risk before polysomnography is considered.

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Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients

Abstract: Elucidating the imbalance of ANS in OSAS patients was feasible by HRV and its parameters.

Cited by 32 publications

References 17 publications

The fluctuation in sympathetic nerve activity around wake-up time was positively associated with not only morning but also daily glycemic variability in subjects with type 2 diabetes

The fluctuation in sympathetic nerve activity around wake-up time was positively associated with not only morning but also daily glycemic variability in subjects with type 2 diabetes

Correlation Analysis between Polysomnography Diagnostic Indices and Heart Rate Variability Parameters among Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Heart Rate Dynamics in Patients with Obstructive Sleep Apnea: Heart Rate Variability and Entropy

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