Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

Nano, Marina-Marinela; Fonseca, Pedro; Vullings, Rik; Aarts, RM Ronald

doi:10.1371/journal.pone.0186716

Cited by 37 publications

(27 citation statements)

References 111 publications

(326 reference statements)

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“…Abnormalities in autonomic modulation may in part explain the elevated risk of cardiovascular disease in insomniacs (61, 62). Studies on heart rate variability and insomnia reveal increased sympathetic activity while awake before sleep and during stage-2 non-REM sleep which support the theory that autonomic hyper-arousal is a major cause of insomnia (63, 64). This state of increased nocturnal autonomic arousal in insomnia patients who are simultaneously exhausted is known in sleep clinics as “tired but wired” (56).…”

Section: Stress and The Autonomic Nervous Systemsupporting

confidence: 55%

Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia

Jerath¹,

Beveridge²,

Barnes

2019

Front. Psychiatry

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Sleep is a quiescent behavioral state during which complex homeostatic functions essential to health and well-being occur. Insomnia is a very common psychiatric disorder leading to a myriad of detrimental effects including loss of concentration, memory, and performance as well as disease. Current pharmaceutical treatments can be expensive, impairing, unhealthy, and habit-forming. Relaxation techniques, such as meditation target the brain and body in contrast to pharmaceutical interventions which solely target neurotransmitter systems in the brain. In this article we present a viewpoint on the treatment of insomnia that techniques of slow, deep breathing (0.1 Hz) in adjunct to sleep hygiene and relaxation therapies may be highly effective in initiating sleep as well as facilitating falling back asleep. The autonomic nervous system is integral to sleep initiation, maintenance, and disruption. Understanding the relationship between the autonomic nervous system and sleep physiology along with the nature of sleep itself remains a challenge to modern science. We present this perspective in light of a prevailing “dysevolution” theory on the pathology of insomnia that proposes hyper-arousal characterized in part by chronic sympathetic hyperactivation and/or parasympathetic hypoactivation disrupts normal sleep onset latency, sleep quality, and sleep duration. We additionally discuss physiological mechanisms responsible for the effectiveness of the breathing treatment we describe. A better understanding of these mechanisms and autonomic pathologies of insomnia may provide support for the effectiveness of such techniques and provide relief to sufferers of this health epidemic.

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Section: Stress and The Autonomic Nervous Systemsupporting

confidence: 55%

Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia

Jerath¹,

Beveridge²,

Barnes

2019

Front. Psychiatry

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“…Melatonin administration in otherwise melatonin-nonproficient patients induced a drastic increase of HRV indices as measures of autonomic cardiac modulation. Accumulating evidence indicates that autonomic cardiac disfunction is implicated as a pathophysiological link between sleep disorders and their physiological consequences (25)(26)(27)(28). Polysomnogram HRV as a measure of cardiac autonomic modulation is a noninvasive, automatable biomarker of cardiovascular risk (29), and is independently associated with carotid atherosclerosis (30).…”

Section: Discussionmentioning

confidence: 99%

Melatonin Therapy Improves Cardiac Autonomic Modulation in Pinealectomized Patients

Campos¹,

Bueno

Barcelos

et al. 2020

Front. Endocrinol.

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The purpose of this investigational study was to assess the effects of melatonin replacement therapy on cardiac autonomic modulation in pinealectomized patients. This was an open-label, single-arm, single-center, proof-of-concept study consisting of a screening period, a 3-month treatment period with melatonin (3 mg/day), and a 6-month washout period. The cardiac autonomic function was determined through heart rate variability (HRV) measures during polysomnography. Pinealectomized patients (n = 5) with confirmed absence of melatonin were included in this study. Melatonin treatment increased vagal-dominated HRV indices including root mean square of the successive R-R interval differences (RMSSD) (39.7 ms, 95% CI 2.0-77.4, p = 0.04), percentage of successive R-R intervals that differ by more than 50 ms (pNN50) (17.1%, 95% CI 9.1-25.1, p = 0.003), absolute power of the high-frequency band (HF power) (1,390 ms 2 , 95% CI 511.9-2,267, p = 0.01), and sympathetic HRV indices like standard deviation of normal R-R wave interval (SDNN) (57.6 ms, 95% CI 15.2-100.0, p = 0.02), and absolute power of the low-frequency band (LF power) (4,592 ms 2 , 95% CI 895.6-8,288, p = 0.03). These HRV indices returned to pretreatment values when melatonin treatment was discontinued. The HRV entropy-based regularity parameters were not altered in this study, suggesting that there were no significant alterations of the REM-NREM ratios between the time stages of the study. These data show that 3 months of melatonin treatment may induce an improvement in cardiac autonomic modulation in melatonin-non-proficient patients. ClinicalTrials.gov Identifier: NCT03885258.

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“…In a small number of participants the AHI was considerably over- or underestimated. Considerable AHI overestimation mainly occurred in participants with comorbid sleep disorders that have an impact on cardiovascular features, such as insomnia and sleep-related movement disorders 34–36 . The effect of these sleep disorders on the features is also confirmed by the relatively large amount of epochs with movements that are misdetected by our method as RE-epochs.…”

Section: Discussionmentioning

confidence: 99%

Estimation of the apnea-hypopnea index in a heterogeneous sleep-disordered population using optimised cardiovascular features

Papini

Fonseca

Gilst

et al. 2019

Sci Rep

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Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, which results in daytime symptoms, a reduced quality of life as well as long-term negative health consequences. OSA diagnosis and severity rating is typically based on the apnea-hypopnea index (AHI) retrieved from overnight poly(somno)graphy. However, polysomnography is costly, obtrusive and not suitable for long-term recordings. Here, we present a method for unobtrusive estimation of the AHI using ECG-based features to detect OSA-related events. Moreover, adding ECG-based sleep/wake scoring yields a fully automatic method for AHI-estimation. Importantly, our algorithm was developed and validated on a combination of clinical datasets, including datasets selectively including OSA-pathology but also a heterogeneous, “real-world” clinical sleep disordered population (262 participants in the validation set). The algorithm provides a good representation of the current gold standard AHI (0.72 correlation, estimation error of 0.56 ± 14.74 events/h), and can also be employed as a screening tool for a large range of OSA severities (ROC AUC ≥ 0.86, Cohen’s kappa ≥ 0.53 and precision ≥70%). The method compares favourably to other OSA monitoring strategies, showing the feasibility of cardiovascular-based surrogates for sleep monitoring to evolve into clinically usable tools.

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Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

Cited by 37 publications

References 111 publications

Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia

Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia

Melatonin Therapy Improves Cardiac Autonomic Modulation in Pinealectomized Patients

Estimation of the apnea-hypopnea index in a heterogeneous sleep-disordered population using optimised cardiovascular features

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