Obstructive sleep apnea syndrome and autonomic dysfunction

Lombardi, Carolina; Pengo, Martino F.; Parati, Gianfranco

doi:10.1016/j.autneu.2019.102563

Cited by 66 publications

(50 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypoxia activated chemoreflex leads to acutely increased short-term sympathetic tone during the occurrence of sleep apnea (54). Furthermore, hypoxia exerted long-lasting chronic effects during the daytime and impaired baroreflex sensitivity (162). Meanwhile whether or not sympathetic hyperactivity induces parasympathetic inhibition is still controversial.…”

Section: Hrv Changes Due To Hypoxiamentioning

confidence: 99%

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

et al. 2021

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.

show abstract

Section: Hrv Changes Due To Hypoxiamentioning

confidence: 99%

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

et al. 2021

View full text Add to dashboard Cite

show abstract

“…There is also a higher prevalence of obstructive sleep apnoea in prediabetes and the metabolic syndrome [69]. Several studies in individuals with obstructive sleep apnoea have shown autonomic nervous system alterations, in particular sympathetic overactivity, both acutely during apnoea events and chronically during the daytime [70].…”

Section: Prediabetes Ifg or Igt In Can Developmentmentioning

confidence: 99%

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

et al. 2020

View full text Add to dashboard Cite

Aims/hypothesis Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. Methods This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. Results Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. Conclusions/interpretation There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition.

show abstract

“…Though, latent and unknown sleep apnea events and motor dysfunction during sleep are common findings in insomnia patients and in PSG in general according to the International Classification of Sleep Disorders by the American Association of Sleep Medicine [41]. Studies have shown that these symptoms may potentially cause autonomic activation, especially the combined presence of OSA and PLM [42,43]. However, we identified only few participants with an elevated AHI and PLMI and they were equally present in both groups, the insomniacs and controls, minimizing the potential influence.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Overnight pulse wave analysis to assess autonomic changes during sleep in insomnia patients and healthy sleepers

et al. 2020

View full text Add to dashboard Cite

Insomnia has been associated with increased cardiovascular (CV) risk, which may be linked to sympathetic activation. Non-invasive overnight pulse wave analysis may be a useful tool to detect early signs of autonomic changes during sleep in insomniacs. Fifty-two participants (26 men, 37±13 years, BMI: 24±5 kg/m 2 , 26 insomniacs/ 26 controls) underwent overnight polysomnography with pulse oximetry and pulse wave analysis including pulse rate, vascular stiffness (pulse propagation time, PPT), and a composite cardiac risk index based on autonomic function and overnight hypoxia. We identified two subgroups of insomniacs, with and without objectively disturbed sleep (sleep efficiency SE�80%, n = 14 vs. SE>80%, n = 12), and observed increased pulse rate and vascular stiffness in insomnia cases when diagnosis was based on both, subjective and objective criteria. Both insomnia groups were associated with higher overnight pulse rate than controls (median/ IQR: low-SE (low sleep efficiency): 67/ 58-70bpm; high-SE: 66/ 63-69bpm; controls: 58/ 52-63bpm; p = 0.01). Vascular stiffness was higher (reduction of PPT) in low-SE insomniacs compared with high-SE insomniacs and controls (169/ 147-232ms; 237/ 215-254ms; 244/ 180-284ms; p = 0.01). The cardiac risk index was increased in low-SE insomniacs (0.

show abstract

Obstructive sleep apnea syndrome and autonomic dysfunction

Cited by 66 publications

References 41 publications

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

Overnight pulse wave analysis to assess autonomic changes during sleep in insomnia patients and healthy sleepers

Contact Info

Product

Resources

About