Treatment-Related Changes in Heart Rate Variability in Children with Sleep Apnea

Objective Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment-related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity. Study Design Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT). Setting Analysis of database. Subjects and Methods Time- and frequency-domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated. Results In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3-9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter ( P < .001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment-related changes in AHI or ODI. Conclusions The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment-related changes in AHI or ODI.

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Heart Rate Dynamics in Patients with Obstructive Sleep Apnea: Heart Rate Variability and Entropy

Entropy ◽

10.3390/e21100927 ◽

2019 ◽

Vol 21 (10) ◽

pp. 927

Author(s):

Lulu Zhang ◽

Mingyu Fu ◽

Fengguo Xu ◽

Fengzhen Hou ◽

Yan Ma

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Sleep Study ◽

Ecg Signals ◽

Potential Association ◽

Obstructive Sleep

Background: Obstructive sleep apnea (OSA), a highly prevalent sleep disorder, is closely related to cardiovascular disease (CVD). Our previous work demonstrated that Shannon entropy of the degree distribution (EDD), obtained from the network domain of heart rate variability (HRV), might be a potential indicator for CVD. Method: To investigate the potential association between OSA and EDD, OSA patients and healthy controls (HCs) were identified from a sleep study database. Then EDD was calculated from electrocardiogram (ECG) signals during sleep, followed by cross-sectional comparisons between OSA patients and HCs, and longitudinal comparisons from baseline to follow-up visits. Furthermore, for OSA patients, the association between EDD and OSA severity, measured by apnea-hypopnea index (AHI), was also analyzed. Results: Compared with HCs, OSA patients had significantly increased EDD during sleep. A positive correlation between EDD and the severity of OSA was also observed. Although the value of EDD became larger with aging, it was not OSA-specified. Conclusion: Increased EDD derived from ECG signals during sleep might be a potential dynamic biomarker to identify OSA patients from HCs, which may be used in screening OSA with high risk before polysomnography is considered.

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P.2.35 Heart rate variability and sleep-related breathing disorders in commercial drivers

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.262 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A96.1-A96

Author(s):

Wei-te Wu ◽

Yu-Jen Lin ◽

Saou-Hsing Liou

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Fasting Blood Glucose ◽

Apnea Hypopnea Index ◽

Sleep Related Breathing Disorders ◽

Cross Sectional ◽

Breathing Disorders ◽

Obstructive Sleep ◽

Commercial Drivers

BackgroundSleep-related breathing disorders, such as obstructive sleep apnea (OSA), seems to have an important influence on the autonomic nervous function on the heart, and associated with cardiovascular mortality. Therefore, we assessed the relations of sleep apnea-related parameters with 5 min heart rate variability (HRV) in a large cohort of male commercial drivers.MethodsThis cross-sectional study recruited 245 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test and by blood lipids examination. Severity of OSA was categorized according to the apnea-hypopnea index (AHI). In addition, short-term HRV was tested.ResultsSubjects were categorized into severe OSA group (n=44; 17.9%), moderate and mild OSA group (n=117; 47.8%), and non-OSA group (n=84; 34.3%). AHI had negative correlations with SDNN (β=−0.075, p=0.007) and RMSSD (β=−0.121, p<0.001), adjusting for age, body mass index, smoking, drinking, systolic blood pressure, HDL, and fasting blood glucose. RMSSD level was decreased with severe OSA (β=−0.266, p=0.042) even adjusting for confounders.ConclusionsThe findings showed a low level of RMSSD in OSA among commercial drivers, especially in the severe group category. Decreased SDNN and RMSSD levels are associated with AHI level in commercial drivers, suggesting that they are tightly linked with autonomic dysfunction.

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Clinical Usefulness of New R-R Interval Analysis Using the Wearable Heart Rate Sensor WHS-1 to Identify Obstructive Sleep Apnea: OSA and RRI Analysis Using a Wearable Heartbeat Sensor

Journal of Clinical Medicine ◽

10.3390/jcm9103359 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3359

Author(s):

Takuo Arikawa ◽

Toshiaki Nakajima ◽

Hiroko Yazawa ◽

Hiroyuki Kaneda ◽

Akiko Haruyama ◽

...

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Saturation Index ◽

Cost Effective ◽

Sleep Time ◽

Apnea Hypopnea Index ◽

Oxygen Desaturation Index ◽

Obstructive Sleep ◽

Rate Sensor

Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for OSA. We investigated the usefulness of RRI analysis to identify OSA using the wearable heart rate sensor WHS-1 and newly developed algorithm. WHS-1 and polysomnography simultaneously applied to 30 cases of OSA. By using the RRI averages calculated for each time series, tachycardia with CVHR was identified. The ratio of integrated RRIs determined by integrated RRIs during CVHR and over all sleep time were calculated by our newly developed method. The patient was diagnosed as OSA according to the predetermined criteria. It correlated with the apnea hypopnea index and 3% oxygen desaturation index. In the multivariate analysis, it was extracted as a factor defining the apnea hypopnea index (r = 0.663, p = 0.003) and 3% oxygen saturation index (r = 0.637, p = 0.008). Twenty-five patients could be identified as OSA. We developed the RRI analysis using the wearable heart rate sensor WHS-1 and a new algorithm, which may become an expeditious and cost-effective screening tool for identifying OSA.

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Benefits of oxytocin administration in obstructive sleep apnea

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00206.2017 ◽

2017 ◽

Vol 313 (5) ◽

pp. L825-L833 ◽

Cited By ~ 11

Author(s):

Vivek Jain ◽

Joseph Marbach ◽

Shawn Kimbro ◽

David C. Andrade ◽

Arad Jain ◽

...

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Sleep Time ◽

Apnea Hypopnea Index ◽

Beneficial Effects ◽

Oxytocin Receptors ◽

Obstructive Sleep ◽

Patient Reported

Activation of oxytocin receptors has shown benefits in animal models of obstructive sleep apnea (OSA). We tested if nocturnal oxytocin administration could have beneficial effects in OSA patients. Eight patients diagnosed with OSA were administered intranasal oxytocin (40 IU). Changes in cardiorespiratory events during sleep, including apnea and hypopnea durations and frequency, risk of event-associated arousals, and heart rate variability, were assessed. Oxytocin significantly increased indexes of parasympathetic activity, including heart rate variability, total sleep time, and the postpolysommogram sleep assessment score, an index of self-reported sleep satisfaction. Although the apnea-hypopnea index was not significantly changed with oxytocin administration, when apnea and hypopnea events were compared independently, the frequency of hypopneas, but not apneas, was significantly ( P ≤ 0.005) decreased with oxytocin treatment. Both apneas and hypopneas were significantly shortened in duration with oxytocin treatment. Oxytocin treatment significantly decreased the percent of apnea and hypopnea events that were accompanied with an arousal. Oxytocin administration has the potential to restore cardiorespiratory homeostasis and reduce some clinically important (objective and patient-reported) adverse events that occur with OSA. Additional studies are needed to further understand the mechanisms by which oxytocin promotes these changes in cardiorespiratory and autonomic function in OSA patients.

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