Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity

Abstract

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 non-linear 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=0.0006). 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 (0.97 vs. 0.63; p=0.009). Conclusions Time-domain and non-linear HRV measures during wakefulness were 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.

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“…Guidelines for measurement have been published, as well as some normal values ( Shaffer and Ginsberg, 2017 ), of which nocturnal values are given from the Hypnolaus study ( Berger et al, 2022 ). Various aspects of HRV were explored as short term values ( Lee et al, 2018 ), values in women ( Kesek et al, 2009 ), values in periodic leg movements ( Sforza et al, 2005 ), in patients suffering OSA ( Qin et al, 2021 ), and in those presenting with metabolic syndrome ( Assoumou et al, 2012a ).…”

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“…High increases in heart rate following apneic events are associated with 30-60% increases in mortality risk and nonfatal/fatal cardiovascular disease compared to normal heart rate responses (Azarbarzin et al, 2020). New evidence also suggests that heart rate variability during wakefulness could be a useful marker of OSA severity and excessive daytime sleepiness, whereby OSA severity is associated with reduced and less complex dynamics of heart rate variability (Qin et al, 2021). Pulse wave amplitude (a marker of vasoconstriction in the finger) features (e.g., amplitude, frequency) have been associated with hypertension, cardiovascular events and diabetes (Hirotsu et al, 2020).…”

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“…Another meta-analysis, including 19 medium-to-high quality RCTs, also demonstrated that mind–body practice could significantly benefit HRV parameters and improve sympathetic–vagal balance [ 123 ]. Higher HRV during wakefulness is associated with higher sleep efficiency and better sleep quality [ 124 , 125 , 126 ]. Therefore, the action of HRV alteration may be an important mechanism by which MBM ameliorates the symptoms of insomnia or poor sleep quality.…”