Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

Abstract

Summary We aimed at assessing cardiac autonomic function by heart rate variability during sleep in patients with obstructive sleep apnea and periodic limb movements during sleep, and to compare it with that of patients with obstructive sleep apnea only, periodic limb movements during sleep only, and controls. We also aimed at investigating the interaction effect between apnea–hypopnea index and periodic limb movement index on heart rate variability. Four groups of patients (n = 42 each, total = 168) were identified based on the presence/absence of obstructive sleep apnea and periodic limb movements during sleep: + obstructive sleep apnea/− periodic limb movements during sleep (5 ≤ apnea–hypopnea index < 30 events per hr), − obstructive sleep apnea/+ periodic limb movements during sleep (periodic limb movement index > 15 events per hr), + obstructive sleep apnea/+ periodic limb movements during sleep, − obstructive sleep apnea/− periodic limb movements during sleep (controls). All groups were matched for age, sex and body mass index. Time‐ and frequency‐domain heart rate variability measures were calculated over 5‐min periods of stable stage 2 non‐rapid eye movement sleep. In patients with both obstructive sleep apnea and periodic limb movements during sleep, LFnu and LF/HF ratio were higher than in those with obstructive sleep apnea only, periodic limb movements during sleep only, and controls, while HFnu was the lowest among the four groups. LFnu, HFnu and LF/HF ratio were significantly and independently associated with minimal oxygen saturation in the + obstructive sleep apnea/+ periodic limb movements during sleep group. There was a significant interaction effect between apnea–hypopnea index and periodic limb movement index on LF/HF ratio (p = 0.038) in patients with obstructive sleep apnea. Patients with elevated apnea–hypopnea index and elevated periodic limb movement index exhibited higher sympathovagal balance compared with those with high apnea–hypopnea index and low periodic limb movement index, and compared with those with low apnea–hypopnea index (regardless of periodic limb movement index). Increased sympathetic activation and decreased parasympathetic control appear to be related to the severity of oxygen desaturation. Apnea–hypopnea index and periodic limb movement index had interactive effects on increased sympathovagal balance in patients with obstructive sleep apnea.

Automatic Detection of Periodic Limb Movements in Sleep (PLMS), And Analysis of Their Relationship to Heart Rate Signals

“…Moreover, given that the 'A' regions probably masked the SA regions in this subject, and that either of them would have had a similar effect on the HR, it is also less likely here that the 'A' regions from this subject would be misclassified. Aside from that, interestingly, as published by a recent (2019) paper, it has been found that, for individuals with PLM and SA (as was the case for the subject being analyzed here), that the HR, i.e., reflecting the autonomic system, would have a 'synergistic' effect [68]. In other words, rather than for individuals with PLM or SA alone, the HRV parameters in their study (the LF-based feature, for example) for individuals with both PLM and SA were found to be higher [68].…”

“…Aside from that, interestingly, as published by a recent (2019) paper, it has been found that, for individuals with PLM and SA (as was the case for the subject being analyzed here), that the HR, i.e., reflecting the autonomic system, would have a 'synergistic' effect [68]. In other words, rather than for individuals with PLM or SA alone, the HRV parameters in their study (the LF-based feature, for example) for individuals with both PLM and SA were found to be higher [68]. Hence, it isn't unexpected that the HR changes depicted in the longitudinal HR subplot (shown in Figure 4.17) for the subject here was distinct in that, the HR changes corresponding to the segmented PLM (possibly masking the SA regions) were clearly high (in the case of LFiA) or low (in the case of HFiA).…”

Association between periodic limb movements during sleep and neuroimaging features of cerebral small vessel disease: A preliminary cross‐sectional study

“…A previous study reported that patients with PLMS plus OSAS have better sleep efficiency than those with PLMS alone (Iriarte et al, 2009). Conversely, recent evidence has indicated that PLMS and OSAS would have interactive effects on greater sleep fragmentation and greater sympathetic excitation compared with PLMS or OSAS alone (Li et al, 2019). Given the limited sample size and insufficient statistical power, we were unable to divide patients into more groups, including patients with PLMS plus OSAS, patients with PLMS or OSAS alone, and controls without PLMS or OSAS (Li et al, 2019).…”

“…Conversely, recent evidence has indicated that PLMS and OSAS would have interactive effects on greater sleep fragmentation and greater sympathetic excitation compared with PLMS or OSAS alone (Li et al, 2019). Given the limited sample size and insufficient statistical power, we were unable to divide patients into more groups, including patients with PLMS plus OSAS, patients with PLMS or OSAS alone, and controls without PLMS or OSAS (Li et al, 2019). As a result, we could not assess the interactive effect of PLMS and OSAS in increasing the burden of CSVD, which needs to be explored by large‐sample studies in the future.…”

Acute Effect of Positive Airway Pressure on Heart Rate Variability in Obstructive Sleep Apnea

“…Both low-frequency power (LF) and LF-to-high-frequency power (HF) ratios consistently increased in OSA patients compared to healthy controls, pointing to a shift in the sympathovagal balance toward sympathetic hyperactivity [12][13][14][15]18]. Meanwhile, other studies have yielded somewhat inconsistent findings with regard to HF, an HRV parameter reflecting parasympathetic activity: decreased HF [8,[18][19][20][21] or increased HF [12,22] in OSA patients when compared to controls.…”