Screening of obstructive sleep apnoea: heart rate spectral analysis of nocturnal pulse oximetric recording

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

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Obstructive Sleep Apnoea Impairs Heart Rate Variability in Patients with the Metabolic Syndrome

Heart Lung and Circulation ◽

10.1016/j.hlc.2007.06.215 ◽

2007 ◽

Vol 16 ◽

pp. S84

Author(s):

B. Weatherhead ◽

C. Neil ◽

M. Barnes ◽

R. Pierce ◽

A. Collins ◽

...

Keyword(s):

Metabolic Syndrome ◽

Heart Rate ◽

Heart Rate Variability ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

The Metabolic Syndrome ◽

Obstructive Sleep

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P095 Heart Rate Variability during Sleep in Paroxysmal Atrial Fibrillation patients with and without Obstructive Sleep Apnoea

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.139 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A52-A52

Author(s):

A Mohammadieh ◽

H Dissanayake ◽

K Sutherland ◽

S Ucak ◽

P de Chazal ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Obstructive Sleep Apnoea ◽

Paroxysmal Atrial Fibrillation ◽

Sleep Apnoea ◽

Relative Reduction ◽

Obstructive Sleep ◽

Sympathetic Modulation ◽

Ectopic Beats

Abstract Introduction Physiological studies have demonstrated the importance of the autonomic nervous system in mediating acute apnoea-induced atrial fibrillation (AF). We aimed to compare Heart Rate Variability (HRV) markers of autonomic function in paroxysmal atrial fibrillation (PAF) patients with and without obstructive sleep apnoea (OSA). A secondary aim was the analysis of ectopic beats in these groups. Methods Nocturnal ECG traces from 89 PAF patients who underwent in-laboratory polysomnography were included. After identifying ectopic beats in the ECGs, periods of arrhythmia as well as sleep apnoea events were excluded. HRV time and frequency domains were reported by sleep stage (REM vs Non-REM) for patients with and without OSA. Results Frequency domain analysis of HRV during non-REM sleep in PAF patients with OSA showed increased cardiac parasympathetic modulation (HF-nu: 39.13 ± 15.74 vs 47.98 ± 14.60, p = 0.008*) and reduced cardiac sympathetic modulation (LF/HF ratio: 2.05 ± 2.02 vs 1.17 ± 0.98, p = 0.007*). Results remained significant after adjusting for age, sex and BMI (adjusted p values 0.024 and 0.018 respectively). PAF patients with severe OSA (AHI ≥ 30/hr) had more AF beats and Ventricular Ectopic Beats than those without severe OSA (22.7 ± 42.8% vs 3.7 ± 17.9%, p = 0.006*, 1.7 ± 3.8 vs 0.3 ± 0.9%, p = 0.004* respectively). Conclusions This is the first study of HRV in AF patients with and without OSA. It suggests a chronic increase in parasympathetic nervous modulation and relative reduction in sympathetic modulation in PAF patients with OSA.

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Alterations in Sleep Electroencephalography and Heart Rate Variability During the Obstructive Sleep Apnoea and Hypopnoea

Recent Advances in Biomedical Engineering ◽

10.5772/7482 ◽

2009 ◽

Cited By ~ 1

Author(s):

Dean Cvetkovic ◽

Haslaile Abdullah ◽

Elif Derya ◽

Gerard Holland ◽

Irena Cosic

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Obstructive Sleep

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0881 CENTRAL ADIPOSITY PREDICTS INCREASED HEART RATE IN CHILDREN AND ADOLESCENTS WITH OBSTRUCTIVE SLEEP APNOEA

SLEEP ◽

10.1093/sleepj/zsx050.880 ◽

2017 ◽

Vol 40 (suppl_1) ◽

pp. A327-A327

Author(s):

LM Walter ◽

K Tamanyan ◽

LC Nisbet ◽

A Weichard ◽

MJ Davey ◽

...

Keyword(s):

Heart Rate ◽

Children And Adolescents ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Central Adiposity ◽

Obstructive Sleep

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The effect of adenotonsillectomy for childhood sleep apnoea on cardiorespiratory control

ERJ Open Research ◽

10.1183/23120541.00003-2016 ◽

2016 ◽

Vol 2 (2) ◽

pp. 00003-2016 ◽

Cited By ~ 7

Author(s):

Mathias Baumert ◽

Yvonne Pamula ◽

James Martin ◽

Declan Kennedy ◽

Anand Ganesan ◽

...

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Obstructive Sleep Apnoea ◽

Respiratory Sinus Arrhythmia ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Sinus Arrhythmia ◽

Cardiorespiratory Control ◽

Post Surgery ◽

Obstructive Sleep

The efficacy of adenotonsillectomy for relieving obstructive sleep apnoea symptoms in children has been firmly established, but its precise effects on cardiorespiratory control are poorly understood.In 375 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either adenotonsillectomy (n=194) or a strategy of watching waiting (n=181), respiratory rate, respiratory sinus arrhythmia and heart rate were analysed during quiet, non-apnoeic and non-hypopnoeic breathing throughout sleep at baseline and at 7 months using overnight polysomnography.Children who underwent early adenotonsillectomy demonstrated an increase in respiratory rate post-surgery while the watchful waiting group showed no change. Heart rate and respiratory sinus arrhythmia were comparable between both arms. On assessing cardiorespiratory variables with regard to normalisation of clinical polysomnography findings during follow-up, heart rate was reduced in children who had resolution of obstructive sleep apnoea syndrome, while no differences in their respiratory rate or respiratory sinus arrhythmia were observed.Adenotonsillectomy for obstructive sleep apnoea increases baseline respiratory rate during sleep. Normalisation of apnoea–hypopnoea index, spontaneously orviasurgery, lowers heart rate. Considering the small average effect size, the clinical significance is uncertain.

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Abstract 5430: Obstructive Sleep Apnoea Exacerbates Muscular Sympathetic Nervous Activity in Patients with Metabolic Syndrome

Circulation ◽

10.1161/circ.118.suppl_18.s_549-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ivani C Trombetta ◽

Cristiane M Nunes ◽

Luciano F Drager ◽

Raffael F Fraga ◽

Maria Janieire N Alves ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Heart Rate ◽

Oxygen Saturation ◽

Obstructive Sleep Apnoea ◽

Nervous Activity ◽

Sleep Apnoea ◽

Sympathetic Nervous Activity ◽

Obstructive Sleep ◽

Sympathetic Nervous

Obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) independently increases muscular sympathetic nervous activity (MSNA). Unknown is whether OSA has an additive effect on MSNA in patients with MetS. We tested the hypothesis that: OSA would have an additive effect on MSNA in patients with MetS. In addition, we studied whether the increase in MSNA in patients with MetS is associated with alteration in arterial baroreflex sensitivity (BRS). Twenty four patients with MetS diagnosed according ATP-III were divided in two groups: MetS+OSA (n=14) and MetS (n=10). They were matched for age, body mass index, waist circumference, and metabolic profile: OSA was defined by an apnoea/hypopnoea index (AHI)>15 events/hour by polysonography. MSNA was recorded directly from the peroneal nerve using the technique of microneurography. Blood pressure (BP) was monitored on a beat-by-beat basis (Finapress) and heart rate by ECG. BRS was analyzed by spontaneous BP and heart rate fluctuations. AHI was higher (42±9 vs. 7±1 events/h, P =0.0001) and minimum oxygen saturation lower (77±2 vs. 87±1 %, P =0.001) in MetS+OSA patients. Patients MetS+OSA had higher MSNA (55±3 vs. 43±2 bursts/100 beats, P =0.01) and systolic BP (158±4 vs.144±3 mmHg, P =0.01) when compared with patients with MetS without OSA. Further analysis showed that AHI and minimum oxygen saturation have significant correlation with MSNA (r=0.65; P =0.001 and r=−0.48; P =0.017, respectively). Patients with MetS+OSA had lower BRS for increases (7.8±0.9 vs. 13.4 ± 1.4 msec/mmHg, P =0.01) and decreases (7.2±0.9 vs. 13.2 ± 2.0 msec/mmHg, P =0.03) in blood pressure than patients with MetS without OSA. MSNA significantly correlated with BRS during spontaneous increases in blood pressure (r=−0.56, P =0.01). OSA exacerbates MSNA in patients with MetS. In addition, the augmented MSNA in patients with MetS+OSA is associated with reduced BRS. These findings suggest that OSA increases the risk for cardiovascular disease in patients with MetS.

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Influence of the Vagus Nerve on Changes in Heart Rate during Sleep Apnoea in Man

Clinical Science ◽

10.1042/cs0620163 ◽

1982 ◽

Vol 62 (2) ◽

pp. 163-167 ◽

Cited By ~ 4

Author(s):

C. I. Meanock

Keyword(s):

Heart Rate ◽

Vagus Nerve ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Vagus Nerves ◽

Normal Response ◽

Lung Inflation ◽

Obstructive Sleep

1. The changes in heart rate surrounding a period of apnoeic asphyxia, produced by either central or obstructive sleep apnoea, are characteristically a progressive bradycardia during the apnoeic period followed by an abrupt reversal to tachycardia with resumption of lung inflation. 2. In a subject who had undergone bilateral pulmonary vagotomy with sparing of the cardiac branches on the left side, the bradycardia is still present during the apnoeic period; however, there is no abrupt response to lung inflation. 3. A subject who had undergone unilateral right-sided pulmonary vagotomy demonstrated a normal response, the increase in heart rate coinciding with resumption of airflow. 4. These findings are consistent with the hypothesis that the bradycardia of sleep apnoea is a hypoxia-induced chemoreflex and that reversal to tachycardia with resumption of lung inflation is a reflex with afferent fibres in the pulmonary vagus nerves.

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