Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

Hietakoste, Salla; Korkalainen, Henri; Kainulainen, Samu; Sillanmäki, Saara; Nikkonen, Sami; Myllymaa, Sami; Duce, Brett; Töyräs, Juha; Leppänen, Timo

doi:10.1038/s41598-020-77780-x

Cited by 27 publications

(23 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pleural pressure swings are believed to be the central mechanism generating arousals in OSA. OSA induces intermittent hypoxia/hypercapnia and increased activation of the sympathetic nervous system, leading to decreased long-term HRV [ 40 ]. PPG can thus be used to detect OSA.…”

Section: Photoplethysmography Applications In Sleep-disordered Breathing Diagnosismentioning

confidence: 99%

Photoplethysmography in Normal and Pathological Sleep

Vulcan

André

Bruyneel

2021

Sensors

View full text Add to dashboard Cite

This article presents an overview of the advancements that have been made in the use of photoplethysmography (PPG) for unobtrusive sleep studies. PPG is included in the quickly evolving and very popular landscape of wearables but has specific interesting properties, particularly the ability to capture the modulation of the autonomic nervous system during sleep. Recent advances have been made in PPG signal acquisition and processing, including coupling it with accelerometry in order to construct hypnograms in normal and pathologic sleep and also to detect sleep-disordered breathing (SDB). The limitations of PPG (e.g., oxymetry signal failure, motion artefacts, signal processing) are reviewed as well as technical solutions to overcome these issues. The potential medical applications of PPG are numerous, including home-based detection of SDB (for triage purposes), and long-term monitoring of insomnia, circadian rhythm sleep disorders (to assess treatment effects), and treated SDB (to ensure disease control). New contact sensor combinations to improve future wearables seem promising, particularly tools that allow for the assessment of brain activity. In this way, in-ear EEG combined with PPG and actigraphy could be an interesting focus for future research.

show abstract

Section: Photoplethysmography Applications In Sleep-disordered Breathing Diagnosismentioning

confidence: 99%

Photoplethysmography in Normal and Pathological Sleep

Vulcan

André

Bruyneel

2021

Sensors

View full text Add to dashboard Cite

show abstract

“…Therefore, novel computational parameters utilizing integrated area under the blood oxygen saturation curve have been developed [14,15] having a stronger association with the consequences of OSA compared to AHI [15][16][17][18]. Longer respiratory events cause more severe desaturations and increased heart rate after the event [4,19] and are associated with higher ultra-short-term (<5 min) HRV [12]. Nonetheless, the effect of desaturations on HRV has not been comprehensively studied in patients with OSA.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea-related respiratory events and desaturation severity are associated with the cardiac response

et al. 2022

Self Cite

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) causes e.g. intermittent blood oxygen desaturations increasing the sympathetic tone. Yet, the effect of desaturations on heart rate variability (HRV), a simple, non-invasive method for assessing sympathovagal balance, has not been comprehensively studied. We aimed to study whether the desaturation severity affects the immediate HRV. We retrospectively analysed the electrocardiography (ECG) signals in 5-minute segments (N=39 132), recorded during clinical polysomnography, of 642 suspected OSA patients. HRV parameters were calculated for each segment. The segments were pooled into severity groups based on the desaturation severity (DesSev, the integrated area under the blood oxygen saturation curve) and the respiratory event rate within the segment (Ev). Covariate-adjusted regression analyses were performed to investigate the possible confounding effects of e.g., comorbidities. With increasing Ev, the normalized high-frequency band power (HFNU) decreased from 0.517 to 0.364 (p<0.01), the normalized low-frequency band power (LFNU) increased from 0.483 to 0.636 (p<0.01), and the mean RR interval decreased from 915 to 869 ms (p<0.01). Similarly, with increasing DesSev, the HFNU decreased from 0.499 to 0.364 (p<0.01), the LFNU increased from 0.501 to 0.636 (p<0.01), and the mean RR interval decreased from 952 to 854 ms (p<0.01). DesSev-related findings were confirmed by considering the confounding factors in the regression analyses. In conclusion, the short-term HRV response differs based on the desaturation severity and the respiratory event rate in suspected OSA patients. Therefore, a more detailed analysis of the HRV and desaturation characteristics could enhance the OSA severity estimation.

show abstract

“…Obstructive apneas have been consistently shown to increase sympathetic outflow, assessed by means of plasma catecholamines, heart rate variability, and MSNA ( Fatouleh et al, 2014 ). In obstructive sleep apnea periodicity is less evident and the HP usually shorter than in PB or Cheyne-Stokes respiration, also due to anatomical factors preventing the reopening of upper airways ( Fatouleh et al, 2014 ; Butler et al, 2019 ; Hietakoste et al, 2020 ). On the other hand, the apnea length is more variable and may reflect individual differences in anatomical factors, chemoreflex sensitivity (low or high) or arousability (low or high) ( Fatouleh et al, 2014 ; Butler et al, 2019 ; Hietakoste et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…In obstructive sleep apnea periodicity is less evident and the HP usually shorter than in PB or Cheyne-Stokes respiration, also due to anatomical factors preventing the reopening of upper airways ( Fatouleh et al, 2014 ; Butler et al, 2019 ; Hietakoste et al, 2020 ). On the other hand, the apnea length is more variable and may reflect individual differences in anatomical factors, chemoreflex sensitivity (low or high) or arousability (low or high) ( Fatouleh et al, 2014 ; Butler et al, 2019 ; Hietakoste et al, 2020 ). While shorter apneas have been associated with increased mortality ( Butler et al, 2019 ), longer ones have been associated with higher ultra-short term HRV ( Hietakoste et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, the apnea length is more variable and may reflect individual differences in anatomical factors, chemoreflex sensitivity (low or high) or arousability (low or high) ( Fatouleh et al, 2014 ; Butler et al, 2019 ; Hietakoste et al, 2020 ). While shorter apneas have been associated with increased mortality ( Butler et al, 2019 ), longer ones have been associated with higher ultra-short term HRV ( Hietakoste et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of hyperventilation length on muscle sympathetic nerve activity in healthy humans simulating periodic breathing

et al. 2022

View full text Add to dashboard Cite

Background: Periodic breathing (PB) is a cyclical breathing pattern composed of alternating periods of hyperventilation (hyperpnea, HP) and central apnea (CA). Differences in PB phenotypes mainly reside in HP length. Given that respiration modulates muscle sympathetic nerve activity (MSNA), which decreases during HP and increases during CA, the net effects of PB on MSNA may critically depend on HP length.Objectives: We hypothesized that PB with shorter periods of HP is associated with increased MSNA and decreased heart rate variability.Methods: 10 healthy participants underwent microelectrode recordings of MSNA from the common peroneal nerve along with non-invasive recording of HRV, blood pressure and respiration. Following a 10-min period of tidal breathing, participants were asked to simulate PB for 3 min following a computed respiratory waveform that emulated two PB patterns, comprising a constant CA of 20 s duration and HP of two different lengths: short (20 s) vs long (40 s). Results: Compared to (3 min of) normal breathing, simulated PB with short HP resulted in a marked increase in mean and maximum MSNA amplitude (from 3.2 ± 0.8 to 3.4 ± 0.8 µV, p = 0.04; from 3.8 ± 0.9 to 4.3 ± 1.1 µV, p = 0.04, respectively). This was paralleled by an increase in LF/HF ratio of heart rate variability (from 0.9 ± 0.5 to 2.0 ± 1.3; p = 0.04). In contrast, MSNA response to simulated PB with long HP did not change as compared to normal breathing. Single CA events consistently resulted in markedly increased MSNA (all p < 0.01) when compared to the preceding HPs, while periods of HP, regardless of duration, decreased MSNA (p < 0.05) when compared to normal breathing.Conclusion: Overall, the net effects of PB in healthy subjects over time on MSNA are dependent on the relative duration of HP: increased sympathetic outflow is seen during PB with a short but not with a long period of HP.

show abstract

Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

Cited by 27 publications

References 42 publications

Photoplethysmography in Normal and Pathological Sleep

Photoplethysmography in Normal and Pathological Sleep

Obstructive sleep apnoea-related respiratory events and desaturation severity are associated with the cardiac response

Effects of hyperventilation length on muscle sympathetic nerve activity in healthy humans simulating periodic breathing

Contact Info

Product

Resources

About