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Zhou Y, Wang Q, Larkey L, James D, Cui H. Tai Chi Effects on Heart Rate Variability: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:121-132. [PMID: 37695835 DOI: 10.1089/jicm.2022.0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background: Tai Chi, originating in China, is a mind-body exercise that integrates mind training, Qi training, and body training. While Tai Chi practice has demonstrated beneficial physical and psychological health benefits, how it achieves effects has been less studied. In recent years, some researchers have begun to explore the potential of heart rate variability (HRV) changes as balancing the autonomic nervous system (ANS) to achieve results, but only a few studies have directly tested how Tai Chi impacts HRV, and results have been mixed. Objective: This study systematically evaluates the effects of Tai Chi on HRV. Methods: Electronic databases including Web of Science, PubMed, Scopus, Cochrane Library, and EBSCOhost direct from inception until December 2020 were searched to obtain eligible studies. The primary outcomes examined were HRV parameters (time domain and frequency domain), and secondary analysis was whether breathing was emphasized during Tai Chi interventions. Results: Based on the 11 randomized controlled trials included comparing Tai Chi with non-active control condition, meta-analyses showed significantly beneficial effects on HRV parameters (low-frequency power [LF], mean difference [MD] = -200.40, 95% confidence interval [CI]: 365.31 to -35.49, p = 0.02; normalized low-frequency power [nLF], MD = -7.39, 95% CI: -12.48 to -2.29, p = 0.004; total power [TP], MD = -649.82, 95% CI: -1180.54 to -119.11, p = 0.02; very low-frequency power [VLF], MD = -200.55, 95% CI: -349.63 to -51.46, p = 0.008; root mean square of the square sum of the difference between adjacent normal heartbeat intervals [RMSSD], MD = 2.59, 95% CI: -7.23 to 12.41, p < 0.0001; standard deviation of the heartbeat interval [SDNN], MD = 8.33, 95% CI: 0.69 to 15.98, p = 0.03). The effect of Tai Chi on certain HRV parameters compared with active control conditions was less favorable (nLF, MD = 6.42, 95% CI: 3.74 to 9.09, p < 0.00001; normalized high-frequency power [nHF], MD: -6.13, 95% CI: -8.76 to -3.50, p < 0.00001; low-frequency/high-frequency power ratio [LF/HF], MD = 1.00, 95% CI: 0.68 to 1.33, p < 0.00001). In addition, studies describing an emphasis on breathing in the Tai Chi intervention showed positive impact on HRV (nLF, MD = -3.22, 95% CI: -5.32 to -1.12, p = 0.003; nHF, MD = 3.80, 95% CI: 0.80 to 6.81, p = 0.01; SDNN, MD = 5.55, 95% CI: 4.85 to 6.25, p < 0.00001). Conclusions: Meta-analysis results showed that Tai Chi compared with non-active control conditions has a positive impact on key HRV parameters associated with the ANS balance. However, active control condition comparisons showed greater HRV improvements than for Tai Chi. Considering the limited number of studies and their heterogeneity, further robust studies are necessary to verify findings and investigate differential effects of Tai Chi on HRV.
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Affiliation(s)
- Yujiao Zhou
- Department of Wushu, Beijing Sport University, Beijing, China
| | - Qiuyu Wang
- Department of Foreign Languages, Beijing Sport University, Beijing, China
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Dara James
- Center for Health Promotion and Disease Prevention, Edson College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Hua Cui
- Department of Wushu, Beijing Sport University, Beijing, China
- Sport Information Research and Teaching Center, Beijing Sport University, Beijing, China
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2
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Wang Z, Jiang F, Xiao J, Chen L, Zhang Y, Li J, Yi Y, Min W, Su L, Liu X, Zou Z. Heart rate variability changes in patients with obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res 2023; 32:e13708. [PMID: 36070876 DOI: 10.1111/jsr.13708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea is a common sleep breathing disorder related to autonomic nervous function disturbances. Heart rate variability is an important non-invasive indicator of autonomic nervous system function. The PubMed, Embase, Medline and Web of Science databases were systematically searched for English literature comparing patients with obstructive sleep apnea with controls up to May 2021. Heart rate variability outcomes, including integrated indices (parasympathetic function and total variability), time domain indices (the standard deviation of NN intervals and the root mean square of the successive differences between normal heartbeats) and frequency domain indices (high-frequency, low-frequency, very-low-frequency and the ratio of low-frequency to high-frequency) were derived from the studies. Twenty-two studies that included 2565 patients with obstructive sleep apnea and 1089 healthy controls were included. Compared with controls, patients with obstructive sleep apnea exhibited significantly reduced parasympathetic function. For the obstructive sleep apnea severity subgroup meta-analysis, patients with severe obstructive sleep apnea had significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and higher low-frequency and ratios of low-frequency to high-frequency. However, only the ratio of low-frequency to high-frequency was significantly higher in patients with moderate obstructive sleep apnea than in controls. Finally, for the collection time analysis, patients with obstructive sleep apnea had significantly higher low-frequency and ratio of low-frequency to high-frequency at night, significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and a higher ratio of low-frequency to high-frequency during the day than controls. Autonomic function impairment was more serious in patients with severe obstructive sleep apnea. During sleep, low-frequency can well reflect the impairment of autonomic function in obstructive sleep apnea, and the ratio of low-frequency to high-frequency may play an important role in obstructive sleep apnea diagnosis.
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Affiliation(s)
- Zuxing Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fugui Jiang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Lili Chen
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jieying Li
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yang Yi
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Wenjiao Min
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Liuhui Su
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xuemei Liu
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
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3
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Cheng W, Chen H, Tian L, Ma Z, Cui X. Heart rate variability in different sleep stages is associated with metabolic function and glycemic control in type 2 diabetes mellitus. Front Physiol 2023; 14:1157270. [PMID: 37123273 PMCID: PMC10140569 DOI: 10.3389/fphys.2023.1157270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction: Autonomic nervous system (ANS) plays an important role in the exchange of metabolic information between organs and regulation on peripheral metabolism with obvious circadian rhythm in a healthy state. Sleep, a vital brain phenomenon, significantly affects both ANS and metabolic function. Objectives: This study investigated the relationships among sleep, ANS and metabolic function in type 2 diabetes mellitus (T2DM), to support the evaluation of ANS function through heart rate variability (HRV) metrics, and the determination of the correlated underlying autonomic pathways, and help optimize the early prevention, post-diagnosis and management of T2DM and its complications. Materials and methods: A total of 64 volunteered inpatients with T2DM took part in this study. 24-h electrocardiogram (ECG), clinical indicators of metabolic function, sleep quality and sleep staging results of T2DM patients were monitored. Results: The associations between sleep quality, 24-h/awake/sleep/sleep staging HRV and clinical indicators of metabolic function were analyzed. Significant correlations were found between sleep quality and metabolic function (|r| = 0.386 ± 0.062, p < 0.05); HRV derived ANS function showed strengthened correlations with metabolic function during sleep period (|r| = 0.474 ± 0.100, p < 0.05); HRV metrics during sleep stages coupled more tightly with clinical indicators of metabolic function [in unstable sleep: |r| = 0.453 ± 0.095, p < 0.05; in stable sleep: |r| = 0.463 ± 0.100, p < 0.05; in rapid eye movement (REM) sleep: |r| = 0.453 ± 0.082, p < 0.05], and showed significant associations with glycemic control in non-linear analysis [fasting blood glucose within 24 h of admission (admission FBG), |r| = 0.420 ± 0.064, p < 0.05; glycated hemoglobin (HbA1c), |r| = 0.417 ± 0.016, p < 0.05]. Conclusions: HRV metrics during sleep period play more distinct role than during awake period in investigating ANS dysfunction and metabolism in T2DM patients, and sleep rhythm based HRV analysis should perform better in ANS and metabolic function assessment, especially for glycemic control in non-linear analysis among T2DM patients.
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Affiliation(s)
- Wenquan Cheng
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Hongsen Chen
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Leirong Tian
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Zhimin Ma
- Endocrinology Department, Suzhou Science and Technology Town Hospital, Suzhou, China
- *Correspondence: Zhimin Ma, ; Xingran Cui,
| | - Xingran Cui
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Institute of Medical Devices (Suzhou), Southeast University, Suzhou, China
- *Correspondence: Zhimin Ma, ; Xingran Cui,
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Benedetti D, Olcese U, Bruno S, Barsotti M, Maestri Tassoni M, Bonanni E, Siciliano G, Faraguna U. Obstructive Sleep Apnoea Syndrome Screening Through Wrist-Worn Smartbands: A Machine-Learning Approach. Nat Sci Sleep 2022; 14:941-956. [PMID: 35611177 PMCID: PMC9124490 DOI: 10.2147/nss.s352335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose A large portion of the adult population is thought to suffer from obstructive sleep apnoea syndrome (OSAS), a sleep-related breathing disorder associated with increased morbidity and mortality. International guidelines include the polysomnography and the cardiorespiratory monitoring (CRM) as diagnostic tools for OSAS, but they are unfit for a large-scale screening, given their invasiveness, high cost and lengthy process of scoring. Current screening methods are based on self-reported questionnaires that suffer from lack of objectivity. On the contrary, commercial smartbands are wearable devices capable of collecting accelerometric and photoplethysmographic data in a user-friendly and objective way. We questioned whether machine-learning (ML) classifiers trained on data collected through these wearable devices would help predict OSAS severity. Patients and Methods Each of the patients (n = 78, mean age ± SD: 57.2 ± 12.9 years; 30 females) underwent CRM and concurrently wore a commercial wrist smartband. CRM's traces were scored, and OSAS severity was reported as apnoea hypopnoea index (AHI). We trained three pairs of classifiers to make the following prediction: AHI <5 vs AHI ≥5, AHI <15 vs AHI ≥15, and AHI <30 vs AHI ≥30. Results According to the Matthews correlation coefficient (MCC), the proposed algorithms reached an overall good correlation with the ground truth (CRM) for AHI <5 vs AHI ≥5 (MCC: 0.4) and AHI <30 vs AHI ≥30 (MCC: 0.3) classifications. AHI <5 vs AHI ≥5 and AHI <30 vs AHI ≥30 classifiers' sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and diagnostic odds ratio (DOR) are comparable with the STOP-Bang questionnaire, an established OSAS screening tool. Conclusion Machine learning algorithms showed an overall good performance. Unlike questionnaires, these are based on objectively collected data. Furthermore, these commercial devices are widely distributed in the general population. The aforementioned advantages of machine-learning algorithms applied to smartbands' data over questionnaires lead to the conclusion that they could serve a population-scale screening for OSAS.
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Affiliation(s)
- Davide Benedetti
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Umberto Olcese
- Cognitive and Systems Neuroscience Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Marta Barsotti
- Neurological Clinics, University Hospital of Pisa, Pisa, Italy
| | - Michelangelo Maestri Tassoni
- Neurological Clinics, University Hospital of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrica Bonanni
- Neurological Clinics, University Hospital of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Neurological Clinics, University Hospital of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
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5
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Bassi TG, Rohrs EC, Fernandez KC, Ornowska M, Nicholas M, Gani M, Evans D, Reynolds SC. Transvenous Diaphragm Neurostimulation Mitigates Ventilation-associated Brain Injury. Am J Respir Crit Care Med 2021; 204:1391-1402. [PMID: 34491883 PMCID: PMC8865722 DOI: 10.1164/rccm.202101-0076oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Mechanical ventilation (MV) is associated with hippocampal apoptosis and inflammation, and it is important to study strategies to mitigate them. Objectives: To explore whether temporary transvenous diaphragm neurostimulation (TTDN) in association with MV mitigates hippocampal apoptosis and inflammation after 50 hours of MV. Methods: Normal-lung porcine study comparing apoptotic index, inflammatory markers, and neurological-damage serum markers between never-ventilated subjects, subjects undergoing 50 hours of MV plus either TTDN every other breath or every breath, and subjects undergoing 50 hours of MV (MV group). MV settings in volume control were Vt of 8 ml/kg, and positive end-expiratory pressure of 5 cm H2O. Measurements and Main Results: Apoptotic indices, microglia percentages, and reactive astrocyte percentages were greater in the MV group in comparison with the other groups (P < 0.05). Transpulmonary pressure at baseline and at study end were both lower in the group receiving TTDN every breath, but lung injury scores and systemic inflammatory markers were not different between the groups. Serum concentrations of four neurological-damage markers were lower in the group receiving TTDN every breath than in the MV group (P < 0.05). Heart rate variability declined significantly in the MV group and increased significantly in both TTDN groups over the course of the experiments. Conclusions: Our study found that mechanical ventilation is associated with hippocampal apoptosis and inflammation, independent of lung injury and systemic inflammation. Also, in a porcine model, TTDN results in neuroprotection after 50 hours, and the degree of neuroprotection increases with greater exposure to TTDN.
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Affiliation(s)
- Thiago G. Bassi
- Simon Fraser University, Burnaby, British Columbia, Canada
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Elizabeth C. Rohrs
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Karl C. Fernandez
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Michelle Nicholas
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matt Gani
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Doug Evans
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Steven C. Reynolds
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
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6
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Cipriano LHC, Borges YG, Mill JG, Mauad H, Martins de Araújo MT, Gouvea SA. Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients. Psychophysiology 2021; 58:e13771. [PMID: 33483990 DOI: 10.1111/psyp.13771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/08/2020] [Accepted: 12/30/2020] [Indexed: 01/11/2023]
Abstract
We compared the effects of 2-month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty-nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non-hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non-hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non-hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.
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Affiliation(s)
- Luis Henrique Ceia Cipriano
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - Ytalo Gonçalves Borges
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - José Geraldo Mill
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil.,Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - Helder Mauad
- Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Sonia Alves Gouvea
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil.,Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
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7
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Barnett WH, Latash EM, Capps RA, Dick TE, Wehrwein EA, Molkov YI. Traube-Hering waves are formed by interaction of respiratory sinus arrhythmia and pulse pressure modulation in healthy men. J Appl Physiol (1985) 2020; 129:1193-1202. [PMID: 32940558 DOI: 10.1152/japplphysiol.00452.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Excessive blood pressure variation is linked to the development of hypertension and other diseases. This study assesses the relative role of respiratory sinus arrhythmia (RSA) and pulse pressure (PP) on the amplitude and timing of blood pressure variability with respiration [Traube-Hering (TH) waves]. We analyzed respiratory, electrocardiogram, and blood pressure traces from healthy, supine male subjects (n = 10, mean age = 26.7 ± 1.4) during 20-min epochs of resting, slow deep breathing (SDB), and recovery. Across all epochs, blood pressure and heart rate (HR) were modulated with respiration and the magnitude of RSA; TH waves increased during SDB. The data were deconstructed using a simple mathematical model of blood pressure to dissect the relative roles of RSA and PP on TH waves. We constructed the time series of the R-wave peaks and compared the recorded TH waves with that predicted by the model. Given that cardiac output is determined by both heart rate and stroke volume, it was surprising that the magnitude of the TH waves could be captured by only HR modulation. However, RSA alone did not accurately predict the timing of TH waves relative to the respiratory cycle. Adding respiratory modulation of PP to the model corrected the phase shift showing the expected pattern of BP rising during inspiration with the peak of the TH wave during early expiration. We conclude that short-term variability of blood pressure referred to as TH waves has at least two independent mechanisms whose interaction forms their pattern: RSA and respiratory-driven changes in PP.NEW & NOTEWORTHY Variability in blood pressure has become an important metric to consider as more is learned about the link between excessive blood pressure variability and adverse health outcomes. In this study using slow deep breathing in human subjects, we found that heart rate and pulse pressure variations have comparable effects on the amplitude of blood pressure waves, and it is the common action of the two that defines the phase relationship between respiration and blood pressure oscillations.
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Affiliation(s)
- William H Barnett
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia
| | - Elizaveta M Latash
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia
| | - Robert A Capps
- Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio.,Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio
| | - Erica A Wehrwein
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Yaroslav I Molkov
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia.,Neuroscience Institute, Georgia State University, Atlanta, Georgia
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8
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Li X, Covassin N, Zhou J, Zhang Y, Ren R, Yang L, Tan L, Li T, Xue P, Tang X. Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability. J Sleep Res 2019; 28:e12861. [PMID: 31131533 DOI: 10.1111/jsr.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/01/2019] [Accepted: 03/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Xiao Li
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Naima Covassin
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota, USA
| | - Junying Zhou
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Linghui Yang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Lu Tan
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Taomei Li
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Pei Xue
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
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9
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da Silva LSCB, Oliveira FMGS. CRSIDLab: A Toolbox for Multivariate Autonomic Nervous System Analysis Using Cardiorespiratory Identification. IEEE J Biomed Health Inform 2019; 24:728-734. [PMID: 31056529 DOI: 10.1109/jbhi.2019.2914211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents the Cardiorespiratory System Identification Lab (CRSIDLab), a MATLAB-based software tool for multivariate autonomic nervous system (ANS) evaluation through heart rate variability (HRV) analysis and cardiorespiratory system identification. Based on a graphical user interface, CRSIDLab provides a complete set of tools including pre-processing cardiorespiratory data (electrocardiogram, continuous blood pressure, airflow, and instantaneous lung volume), power spectral density estimation, and multivariable cardiorespiratory system model identification. Parametrized multivariate models can assess both HRV and baroreflex sensitivity (BRS) by considering the causal relationship from respiration to heart rate (or its reciprocal, R-to-R interval - RRI) and from systolic blood pressure to RRI, for instance. The impulse response, estimated from the model, is used as a mathematical tool to effectively open the inherently closed-loop nature of the cardiorespiratory system, allowing the investigation of the dynamic response between pairs of cardiorespiratory variables. This system modeling approach provides information on gain and temporal behavior regarding dynamics, such as the baroreflex, complementing traditional HRV, and BRS indices. The toolbox is presented and used to investigate autonomic function in sleep apnea. The results show that, while traditional HRV indices were unable to differentiate between apneic and non-apneic subjects, the autonomic descriptors obtained from the multivariate system identification techniques were able to show vagal impairment in apneic compared to non-apneic subjects. Thus, CRSIDLab can help promote the use of cardiorespiratory system identification as a potentially more sensitive measure of ANS activity than classical HRV analysis.
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10
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Abnormalities in autonomic function in obese boys at-risk for insulin resistance and obstructive sleep apnea. Pediatr Res 2019; 85:790-798. [PMID: 30420708 PMCID: PMC6494692 DOI: 10.1038/s41390-018-0226-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/13/2018] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES Current evidence in adults suggests that, independent of obesity, obstructive sleep apnea (OSA) can lead to autonomic dysfunction and impaired glucose metabolism, but these relationships are less clear in children. The purpose of this study was to investigate the associations among OSA, glucose metabolism, and daytime autonomic function in obese pediatric subjects. METHODS Twenty-three obese boys participated in: overnight polysomnography; a frequently sampled intravenous glucose tolerance test; and recordings of spontaneous cardiorespiratory data in both the supine (baseline) and standing (sympathetic stimulus) postures. RESULTS Baseline systolic blood pressure and reactivity of low-frequency heart rate variability to postural stress correlated with insulin resistance, increased fasting glucose, and reduced beta-cell function, but not OSA severity. Baroreflex sensitivity reactivity was reduced with sleep fragmentation, but only for subjects with low insulin sensitivity and/or low first-phase insulin response to glucose. CONCLUSIONS These findings suggest that vascular sympathetic activity impairment is more strongly affected by metabolic dysfunction than by OSA severity, while blunted vagal autonomic function associated with sleep fragmentation in OSA is enhanced when metabolic dysfunction is also present.
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López-Cano C, Gutiérrez-Carrasquilla L, Sánchez E, González J, Yeramian A, Martí R, Hernández M, Cao G, Ribelles M, Gómez X, Barril S, Barbé F, Hernández C, Simó R, Lecube A. Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes. Front Endocrinol (Lausanne) 2019; 10:752. [PMID: 31736881 PMCID: PMC6839128 DOI: 10.3389/fendo.2019.00752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0-1375.0) vs. 210.0 (92.0-670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.
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Affiliation(s)
- Carolina López-Cano
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Jessica González
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Andree Yeramian
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Raquel Martí
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Gonzalo Cao
- Section of Hormones, Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Mercè Ribelles
- Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Xavier Gómez
- Clinic Laboratory, Department of Laboratory Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Silvia Barril
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ferran Barbé
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Albert Lecube
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Abstract
Obstructive sleep apnea (OSA) is common among patients with cardiac rhythm disorders. OSA may contribute to arrhythmias due to acute mechanisms, such as generation of negative intrathoracic pressure during futile efforts to breath, intermittent hypoxia, and surges in sympathetic activity. In addition, OSA may lead to heart remodeling and increases arrhythmia susceptibility. Atrial distension and remodeling, that has been shown to be associated with OSA, is a well-known anatomical substrate for atrial fibrillation (AF). AF is the arrhythmia most commonly described in patients with OSA. Several observational studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) reduces recurrence of AF after electrical cardioversion and catheter ablation. There is also evidence that nocturnal hypoxemia, a hallmark of OSA, predicts sudden cardiac death (SCD) independently of well-established cardiovascular risk factors. Among patients with an implantable cardiac defibrillator, those with OSA have a higher risk of receiving treatment for life-threatening arrhythmias. Nocturnal hypoxemia may also increase vagal tone, which increases susceptibility to bradycardic and conduction rhythm disorders that have also been described in patients with OSA. In conclusion, there are several biological pathways linking OSA and increased cardiac arrhythmogenesis propensity. However, the independent association is derived from observational studies and the direction of the association still needs clarification due to the lack of large clinical trials. This review focuses on the current scientific evidence linking OSA to cardiac rhythm disorders and point out future directions.
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Affiliation(s)
- Glaucylara Reis Geovanini
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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13
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Liang J, Zhang X, He X, Ling L, Zeng C, Luo Y. The independent and combined effects of respiratory events and cortical arousals on the autonomic nervous system across sleep stages. Sleep Breath 2018; 22:1161-1168. [DOI: 10.1007/s11325-018-1669-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 01/24/2023]
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14
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Zangrando KTL, Trimer R, de Carvalho LCS, Arêas GPT, Caruso FCR, Cabiddu R, Roscani MG, Rizzatti FPG, Borghi-Silva A. Chronic obstructive pulmonary disease severity and its association with obstructive sleep apnea syndrome: impact on cardiac autonomic modulation and functional capacity. Int J Chron Obstruct Pulmon Dis 2018; 13:1343-1351. [PMID: 29731622 PMCID: PMC5927062 DOI: 10.2147/copd.s156168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The study was conducted to determine the impact of chronic obstructive pulmonary disease (COPD) in association with obstructive sleep apnea syndrome (OSAS) on cardiac autonomic control and functional capacity. Subjects and methods The study was a cross-sectional prospective controlled clinical study. Heart rate variability indices of 24 COPD (n = 12) and COPD+OSAS (n = 12) patients were evaluated and compared by electrocardiographic recordings acquired during rest, active postural maneuver (APM), respiratory sinus arrhythmia maneuver (RSA-m), and the 6-minute walk test (6MWT). Results The COPD group presented higher parasympathetic modulation during APM when compared to the COPD+OSAS group (P = 0.02). The COPD+OSAS group presented higher sympathetic modulation during RSA-m when compared to the COPD group (P = 0.00). The performance during 6MWT was similarly impaired in both groups, despite the greater severity of the COPD group. Conclusion Subjects with COPD+OSAS present marked sympathetic modulation, and the presence of OSAS in COPD subjects has a negative impact on functional capacity regardless of the severity of lung disease.
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Affiliation(s)
- Katiany Thays Lopes Zangrando
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Renata Trimer
- Physical Education and Health Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Luiz Carlos Soares de Carvalho
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Guilherme Peixoto Tinoco Arêas
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Flávia Cristina Rossi Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ramona Cabiddu
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Meliza Goi Roscani
- Medicine Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Fujimoto K, Ura M, Yamazaki H, Uematsu A. Instability of parasympathetic nerve function evaluated by instantaneous time–frequency analysis in patients with obstructive sleep apnea. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0153-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Liang J, Zhang X, Luo Y, Wang T, Sun L, Huang S. The Impact of Respiratory Events on the Autonomic Nervous System during Sleep. Int Heart J 2018. [DOI: 10.1536/ihj.16-429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Xiangmin Zhang
- Sleep-Disordered Breathing Center of the 6th Affiliated Hospital of Sun Yat-Sen University
| | - Yuxi Luo
- School of Engineering, Sun Yat-Sen University
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, Sun Yat-Sen University
| | | | - Lin Sun
- School of Engineering, Sun Yat-Sen University
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17
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Galal IH. Nocturnal heart rate variability in obstructive sleep apnea syndrome: effect of automatic positive airway pressure. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_36_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Amra B, Behjati M, Penzel T, Fietze I, Schoebel C, Sarrafzadegan N. Nocturnal heart rate variation in diabetic and non-diabetic patients with sleep apnea syndrome. Sleep Med 2016; 29:57-60. [PMID: 28153217 DOI: 10.1016/j.sleep.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Heart rate variability (HRV) analysis is used for the evaluation of autonomic function in the cardiovascular system. Decreased HRV is associated with disorders affecting the autonomous system such as diabetes mellitus (DM) and obstructive sleep apnea (OSA). Previous studies have shown an association between OSA and DM. However, the interrelationships of HRV with OSA and DM are not well known. The aim of this study was to assess nocturnal HRV in patients who suffered from OSA with and without DM. METHODS Sixty patients with OSA (27 with DM and 33 non-DM) underwent polysomnography for eight hours starting at midnight. From electrocardiogram (ECG) recordings taken as a part of polysomnography, time-domain and frequency-domain HRV parameters were evaluated to compare patients with regard to nocturnal HRV components such as low frequency (LF) and high frequency (HF), apnea-hypopnea index (AHI) and sleep parameters. RESULTS In the non-DM group, a direct relationship was observed between AHI and HRV rather than very low frequency (VLF) and LF/HF variables. This relationship was just significant between AHI and standard deviation of five-min average of normal R-R intervals and adjacent R-R intervals differing by 0.50 ms over 24 h (p < 0.05). In the DM group, the correlation between AHI and HRV parameters except HF and waking frequency was direct and non-significant. Intergroup comparison showed a significant difference between groups regarding AHI and HRV-index, LF and VLF (p < 0.05). CONCLUSIONS DM can affect HRV; however, this is not the case in OSA patients. This means that in the presence of OSA, the DM effect on HRV disappears.
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Affiliation(s)
- Babak Amra
- Pulmonary Unit, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Bamdad Respiratory Research Center, Isfahan, Iran.
| | - Mohaddeseh Behjati
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, PO Box 81465-1148 Isfahan, Iran.
| | - Thomas Penzel
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, DE-10117 Berlin, Germany.
| | - Ingo Fietze
- Charité - Universitätsmedizin Berlin, Dept. of Cardiology and Pulmonology, Center of Sleep Medicine, Luisenstr. 13a, D-10117 Berlin, Germany.
| | - Christoph Schoebel
- Charité - Universitätsmedizin Berlin, Dept. of Cardiology and Pulmonology, Center of Sleep Medicine, Luisenstr. 13a, D-10117 Berlin, Germany.
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, PO Box 81465-1148 Isfahan, Iran.
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Chen X, Zhou T, Li D, Zhang C, Jia P, Ma J, Zhang J, Wang G, Fang J. Evaluating the clinical value of oscillatory cardiopulmonary coupling in patients with obstructive sleep apnea hypopnea syndrome by impedance cardiogram. Sleep Med 2015; 19:75-84. [PMID: 27198951 DOI: 10.1016/j.sleep.2015.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES For patients with obstructive sleep apnea hypopnea syndrome (OSAHS), chronic inflammation and hemodynamic oscillations caused by respiratory events contribute to cardiovascular disease (CVD). In this study, a physiological marker named oscillatory coupling factor (OCF) exacted from cardiac output (CO) was introduced. This study aimed to evaluate the clinical value of OCF and tentatively explore its predictive value of cardiovascular prognosis in OSAHS patients. METHODS An impedance cardiogram (ICG) was used to continuously obtain the participants' CO with simultaneous polysomnography. Participants were divided into three groups: an OSAHS-CVD- group (n = 19); an OSAHS + CVD- group (n = 34); and an OSAHS + CVD + group (n = 36). The OCF was exacted from the CO by using empirical mode decompensation-based detrended fluctuation analysis (EMD-DFA). RESULTS The OCF values were: OSAHS + CVD + group [1.20 (0.98-1.78)] > OSAHS + CVD- group [1.14 (1.02-1.94)] > OSAHS-CVD- group [0.95 (0.56-1.16)], (p = 0.001). A Spearman test showed that OCF was positively correlated with age, apnea/hypopnea index (AHI), microarousal index (MAI), oxygen desaturation index (ODI), and negatively correlated with the lowest SpO2. Ten participants were treated by one-night continuous positive airway pressure (CPAP): their AHI decreased from 44.9 (18.0-72.9)/hour to 1.25 (0.0-7.5)/hour, and their OCF fell from 1.17 (1.10-1.69) to 1.08 (0.96-1.23) (p = 0.038). Seventy-seven participants were effectively followed up. Seven participants developed CVD events or newly diagnosed CVD; their OCFs were distributed on a relatively high level [1.18 (1.01-1.56)]. CONCLUSION The OSAHS participants had higher OCFs than those without OSAHS, while CVD made the OCFs even higher; CPAP could rectify this change. Oscillatory coupling factor may be a physiological marker of cardiopulmonary coupling and have potential cardiovascular prognostic value for people with OSAHS.
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Affiliation(s)
- Xue Chen
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Ting Zhou
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Dongfang Li
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Peng Jia
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
| | - Jue Zhang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; College of Engineering, Peking University, Beijing 100871, China.
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Jing Fang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; College of Engineering, Peking University, Beijing 100871, China
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20
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Obstructive sleep apnea and increased QT dispersion. SOMNOLOGIE 2015. [DOI: 10.1007/s11818-015-0013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Qaddoura A, Kabali C, Drew D, van Oosten EM, Michael KA, Redfearn DP, Simpson CS, Baranchuk A. Obstructive sleep apnea as a predictor of atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. Can J Cardiol 2014; 30:1516-22. [PMID: 25475456 DOI: 10.1016/j.cjca.2014.10.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-coronary artery bypass grafting atrial fibrillation (PCAF) is associated with increased morbidity, mortality, and system costs. Few studies have explored obstructive sleep apnea (OSA) as a risk factor for PCAF. We aimed to systematically review and synthesize the evidence associating OSA with PCAF. METHODS We conducted a search of MEDLINE, EMBASE, Google Scholar, and Web of Science, as well as abstracts, conference proceedings, and reference lists until June 2014. Eligible studies were in English, were conducted in humans, and assessed OSA with polysomnography (PSG) or a validated questionnaire. Two reviewers independently selected studies, with disagreement resolved by consensus. Piloted forms were used to extract data and assess risk of bias. RESULTS Five prospective cohort studies were included (n = 642). There was agreement in study selection (κ statistic, 0.89; 95% confidence interval [CI], 0.75-1.00). OSA was associated with a higher risk of PCAF (odds ratio [OR], 1.86; 95% CI 1.24-2.80; P = 0.003; I(2) = 35%). We conducted 3 subgroup analyses. The associations increased for data that used PSG to assess OSA (OR, 2.34; 95% CI, 1.48-3.70), when severe OSA was included from 1 study (OR, 2.59; 95% CI, 1.63-4.11), and when adjusted analyses were pooled (OR, 2.38; 95% CI, 1.57-3.62; P < 0.001 in all), with no heterogeneity detected in any subgroup analysis (I(2) < 0.01% in all). CONCLUSIONS OSA was shown to be a strong predictor of PCAF.
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Affiliation(s)
- Amro Qaddoura
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Conrad Kabali
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Doran Drew
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Kevin A Michael
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Christopher S Simpson
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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22
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Kelmanson I. Signs of sympathetic dominance in sleep and wake based on spectral analysis of heart rate variability in children with obstructive sleep apnea. SOMNOLOGIE 2014. [DOI: 10.1007/s11818-014-0672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Characterizing the phenotypes of obstructive sleep apnea: Clinical, sleep, and autonomic features of obstructive sleep apnea with and without hypoxia. Clin Neurophysiol 2014; 125:1783-91. [DOI: 10.1016/j.clinph.2014.01.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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Véber O, Lendvai Z, Ronai KZ, Dunai A, Zoller R, Lindner AV, Turányi CZ, Szocs JL, Keresztes K, Tabák AG, Novak M, Molnar MZ, Mucsi I. Obstructive Sleep Apnea and Heart Rate Variability in Male Patients with Metabolic Syndrome: Cross-Sectional Study. Metab Syndr Relat Disord 2014; 12:117-24. [DOI: 10.1089/met.2013.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Orsolya Véber
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Institute of Pathophysiology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Zsofia Lendvai
- First Department of Pediatrics,Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Katalin Zsuzsanna Ronai
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Andrea Dunai
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Rezso Zoller
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Anett Virag Lindner
- Department of Neurology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Csilla Zita Turányi
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Julia Luca Szocs
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Adam Gyula Tabák
- First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Marta Novak
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Miklos Z. Molnar
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Institute of Pathophysiology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Medicine, Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
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Brzecka A, Pawelec-Winiarz M, Teplicki A, Piesiak P, Jankowska R. Nocturnal parasympathetic modulation of heart rate in obesity-hypoventilation patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 832:51-7. [PMID: 25248346 DOI: 10.1007/5584_2014_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart rate variation (HRV) reflects the activity of the autonomic nervous system. The aim of the study was to analyze HRV in obstructive sleep apnea (OSA) and obesity hypoventilation (OH) patients to answer the question of whether chronic alveolar hypoventilation influences autonomic heart rate regulation. In 41 patients, diagnosed with either 'pure' OSA (n=23, apnea/hypopnea index--AHI: 43.8±18.0 PaCO2≤45 mmHg) or OH syndrome (n=18, AHI 58.7±38.0 PaCO2>46 mmHg), the HRV was analyzed, based on an 8 h ECG recording during sleep. In the OH patients, compared with the OSA patients, there was a globally decreased HRV, with a corresponding decrease in high frequency power in the spectral analysis of HRV and increased low frequency/high frequency ratio (p<0.05), indicating a reduced parasympathetic and increased sympathetic heart rate modulation. We conclude that hypoxemia and hypercapnia of the sleep disordered breathing have an impact on the autonomic heart rate regulation. HRV indices have a potential to become prognostic factors for the development of cardiovascular complications in patients with sleep disordered breathing.
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Affiliation(s)
- A Brzecka
- Department of Pneumology and Lung Cancer, Wroclaw Medical University, 105 Grabiszynska St., 53-439, Wroclaw, Poland,
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Palma JA, Urrestarazu E, Lopez-Azcarate J, Alegre M, Fernandez S, Artieda J, Iriarte J. Increased sympathetic and decreased parasympathetic cardiac tone in patients with sleep related alveolar hypoventilation. Sleep 2013; 36:933-40. [PMID: 23729937 DOI: 10.5665/sleep.2728] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess autonomic function by heart rate variability (HRV) during sleep in patients with sleep related alveolar hypoventilation (SRAH) and to compare it with that of patients with obstructive sleep apnea (OSA) and control patients. DESIGN Cross-sectional study. SETTING Sleep Unit, University Hospital of University of Navarra. PATIENTS Fifteen idiopathic and obesity related-SRAH patients were studied. For each patient with SRAH, a patient with OSA, matched in age, sex, body mass index (BMI), minimal oxygen saturation (SatO2), and mean SatO2 was selected. Control patients were also matched in age, sex, and BMI with patients with OSA and those with SRAH, and in apnea/hypopnea index (AHI) with patients with SRAH. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Time- and frequency-domain HRV measures (R-R, standard deviation of normal-to-normal RR interval [SDNN], very low frequency [VLF], low frequency [LF], high frequency [HF], LF/HF ratio) were calculated across all sleep stages as well as during wakefulness just before and after sleep during a 1-night polysomnography. In patients with SRAH and OSA, LF was increased during rapid eye movement (REM) when compared with control patients, whereas HF was decreased during REM and N1-N2 sleep stages. The LF/HF ratio was equally increased in patients with SRAH and OSA during REM and N1-N2. Correlation analysis showed that LF and HF values during REM sleep were correlated with minimal SatO2 and mean SatO2. CONCLUSIONS Patients with SRAH exhibited an abnormal cardiac tone during sleep. This fact appears to be related to the severity of nocturnal oxygen desaturation. Moreover, there were no differences between OSA and SRAH, supporting the hypothesis that autonomic changes in OSA are primarily related to a reduced nocturnal oxygen saturation, rather than a consequence of other factors such as nocturnal respiratory events.
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Affiliation(s)
- Jose-Alberto Palma
- Sleep Unit and Clinical Neurophysiology Section, University Clinic of Navarra, Pamplona, Spain
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Sleep-related changes in autonomic control in obstructive sleep apnea: a model-based perspective. Respir Physiol Neurobiol 2013; 188:267-76. [PMID: 23707878 DOI: 10.1016/j.resp.2013.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/23/2022]
Abstract
This paper reviews our current understanding of the long-term effects of obstructive sleep apnea (OSA) on cardiovascular autonomic function in humans, focusing directly on the knowledge derived from noninvasive measurements of heart rate, beat-to-beat blood pressure (BP), and respiration during wakefulness and sleep. While heart rate variability (HRV) as a means of autonomic assessment has become ubiquitous, there are serious limitations with the conventional time-domain and spectral methods of analysis. These shortcomings can be overcome with the application of a multivariate mathematical model that incorporates BP, respiration and other external factors as physiological sources of HRV. Using this approach, we have found that: (a) both respiratory-cardiac coupling and baroreflex dynamics are impaired in OSA; (b) continuous positive airway pressure therapy partially restores autonomic function; (c) baroreflex gain, which increases during sleep in normals, remains unchanged or decreases in OSA subjects; and (d) the autonomic changes that accompany transient arousal from NREM sleep in normals are largely absent in patients with OSA.
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Guzik P, Piskorski J, Awan K, Krauze T, Fitzpatrick M, Baranchuk A. Obstructive sleep apnea and heart rate asymmetry microstructure during sleep. Clin Auton Res 2013; 23:91-100. [DOI: 10.1007/s10286-013-0188-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 01/08/2013] [Indexed: 01/29/2023]
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Jo J, K Khoo M, Blasi A, Baydur A, Juarez R. Elucidating nonlinear baroreflex and respiratory contributions to heart rate variability in obstructive sleep apnea syndrome. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2012; 2005:4430-3. [PMID: 17281219 DOI: 10.1109/iembs.2005.1615449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Using a Volterra-Wiener model and the Laguerre expansion technique, we estimated in a previous study the parameters that characterize linear and the second order effects of respiration ("RSA") and arterial blood pressure ("ABR") on heart rate. RSA and ABR gains were significantly lower in Obstructive Sleep Apnea (OSA) patients than in normal subjects. During sleep, ABR gain increased in normals but remained unchanged in OSA. In the present work, we investigated the physiological interpretation of the nonlinear components of the described model of heart rate variability, by means of simulation on the computed linear and nonlinear kernels. Our results indicate that the 2<sup>nd</sup>order kernels reflect specific characteristics of the RSA and ABR mechanisms, such as a RSA frequency response dependence upon tidal volume, saturation in the ABR-Blood Pressure relation, and respiratory modulation of ABR.
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Affiliation(s)
- J Jo
- Departments of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
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Wang W, Redline S, Khoo MCK. Autonomic markers of impaired glucose metabolism: effects of sleep-disordered breathing. J Diabetes Sci Technol 2012; 6:1159-71. [PMID: 23063043 PMCID: PMC3570851 DOI: 10.1177/193229681200600521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The association between diabetes and abnormalities in autonomic function is well-known, but it is not clear if this association can be extended to subjects with prediabetic impaired glucose metabolism (IGM). Sleep-disordered breathing (SDB), which commonly occurs in this population, is often overlooked. We sought to determine how autonomic function, monitored in an overnight sleep study setting, may be impaired in subjects with IGM and/or SDB. METHODS Polysomnograms (PSGs) selected from the Cleveland Family Study database were categorized into four groups: normal, SDB (respiratory disturbance index > 5/h), IGM, and both SDB and IGM. Impaired glucose metabolism was defined as an oral glucose tolerance test (OGTT) level > 140 mg/dl. Time-domain and frequency-domain indices of heart rate variability were used to quantify autonomic impairment. Baroreflex sensitivity determined using pulse transit time (BRS(PTT)), an indirect measure of baroreflex sensitivity based on spontaneous pulse transit time fluctuations, was used as a surrogate measure of baroreflex sensitivity. RESULTS Based on 31 PSGs from subjects (16 males, 15 females) ages 20.8-61.2 years, both SDNN and BRS(PTT) were found to be 20-25% lower in SDB and ~40% lower in IGM and SDB + IGM as compared to subjects without either condition. In analyses of continuous measures, mean standard deviation of 5 min R-R intervals (SDNN) and BRS(PTT) were found to be negatively correlated with OGTT following adjustment for age and body mass index. Oral glucose tolerance test and age were the two most significant factors for predicting SDNN and BRS(PTT). CONCLUSIONS Our analyses suggest that cardiac autonomic control is impaired in IGM, regardless of whether SDB is present. The abnormal autonomic function involves degradation of baroreflex regulation.
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Affiliation(s)
- Wenli Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michael C. K. Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
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Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol 2012; 45:508-12. [PMID: 22520295 DOI: 10.1016/j.jelectrocard.2012.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Indexed: 01/11/2023]
Abstract
Sleep apnea (SA) is a common breathing disorder. It is associated with a myriad of medical conditions including increased cardiovascular morbidity and mortality. Recent studies have shown that cardiac arrhythmias and conduction disorders are common in patients with SA. Sleep apnea has also been also linked to heart failure, hypertension, coronary artery disease, and stroke. The purpose of this brief review is to analyze the available information that links SA with different cardiac arrhythmias and conduction disorders and the role of intracardiac devices for the diagnosis and management of this condition.
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Affiliation(s)
- Adrian Baranchuk
- Cardiology Division, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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Kodituwakku S, Lazar SW, Indic P, Chen Z, Brown EN, Barbieri R. Point process time-frequency analysis of dynamic respiratory patterns during meditation practice. Med Biol Eng Comput 2012; 50:261-75. [PMID: 22350435 PMCID: PMC3341131 DOI: 10.1007/s11517-012-0866-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/17/2011] [Indexed: 12/11/2022]
Abstract
Respiratory sinus arrhythmia (RSA) is largely mediated by the autonomic nervous system through its modulating influence on the heart beats. We propose a robust algorithm for quantifying instantaneous RSA as applied to heart beat intervals and respiratory recordings under dynamic breathing patterns. The blood volume pressure-derived heart beat series (pulse intervals, PIs) are modeled as an inverse Gaussian point process, with the instantaneous mean PI modeled as a bivariate regression incorporating both past PIs and respiration values observed at the beats. A point process maximum likelihood algorithm is used to estimate the model parameters, and instantaneous RSA is estimated via a frequency domain transfer function evaluated at instantaneous respiratory frequency where high coherence between respiration and PIs is observed. The model is statistically validated using Kolmogorov-Smirnov goodness-of-fit analysis, as well as independence tests. The algorithm is applied to subjects engaged in meditative practice, with distinctive dynamics in the respiration patterns elicited as a result. The presented analysis confirms the ability of the algorithm to track important changes in cardiorespiratory interactions elicited during meditation, otherwise not evidenced in control resting states, reporting statistically significant increase in RSA gain as measured by our paradigm.
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Affiliation(s)
- Sandun Kodituwakku
- Applied Signal Processing Group, School of Engineering, The Australian National University, Canberra, Australia
- Neuroscience Statistics Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA, , Tel.: + 61-2-612-58689
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA, , Tel.: + 1-617-724-7108
| | - Premananda Indic
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655 USA, , Tel.: + 1-617 287 6050
| | - Zhe Chen
- Neuroscience Statistics Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139 USA, , Tel.: + 1-617-324-1882
| | - Emery N Brown
- Neuroscience Statistics Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139 USA. , Tel.: + 1-617-726-7487
| | - Riccardo Barbieri
- Neuroscience Statistics Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139 USA, , Tel.: + 1-617-724-1061
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Piskorski J, Guzik P. Asymmetric properties of long-term and total heart rate variability. Med Biol Eng Comput 2011; 49:1289-97. [PMID: 21953298 PMCID: PMC3208812 DOI: 10.1007/s11517-011-0834-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/08/2011] [Indexed: 10/27/2022]
Abstract
We report on two new physiological phenomena: the long-term and total heart rate asymmetry, which describe a significantly larger contribution of heart rate accelerations to long-term and total heart rate variability. In addition to the existing pair of indices, SD1(d); SD1(a); which are based on partitioning short-term variance, we introduce two other pairs of descriptors based on partitioning longterm (SD2(d); SD2(a)) and total (SDNN(d); SDNN(a)) heart rate variability. The new asymmetric descriptors are used to analyze RR intervals time series derived from the 30-min ECG recordings of 241 healthy subjects resting in supine position. It is shown that both new types of asymmetry are present in 76% of the subjects. The new phenomena reported here are real physiological findings rather than artifacts of the method since they vanish after data shuffling.
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Affiliation(s)
- Jaroslaw Piskorski
- Institute of Physics, University of Zielona Gora, Szafrana 4a, Zielona Gora, Poland.
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35
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Montesano M, Miano S, Paolino MC, Massolo AC, Ianniello F, Forlani M, Villa MP. Autonomic cardiovascular tests in children with obstructive sleep apnea syndrome. Sleep 2010; 33:1349-55. [PMID: 21061857 PMCID: PMC2941421 DOI: 10.1093/sleep/33.10.1349] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The aim of our study was to investigate cardiovascular autonomic activity during wakefulness, using cardiovascular tests, in a population of children with OSAS. DESIGN Prospective study. SETTING Sleep unit of an academic center. PARTICIPANTS We included 25 children (mean age 10.2 +/- 2.3 years) undergoing a diagnostic assessment for OSAS, and 25 age-matched healthy control subjects. All subjects underwent an overnight polysomnography and autonomic cardiovascular tests using parts of the Ewing test battery, which is a physiological test used for the assessment of autonomic function (head-up tilt test, Valsalva maneuver, deep breathing test). MEASUREMENTS AND RESULTS Eighteen of 25 children with OSAS (11 males, mean age 9.4 +/- 1.7 years) concluded the study. OSAS patients had higher systolic blood pressure, diastolic blood pressure, baseline heart rate, the 30:15 index (which represents the RR interval at the 15th and 30th beats during the head up tilt test), and delta diastolic and systolic blood pressure during the head-up tilt test, while the heart rate variability during the deep breathing test was lower, compared with controls. A positive correlation between systolic and diastolic blood pressure and the apnea-hypopnea index (AHI), and negative between AHI and both the 30:15 index and Valsalva ratio, were found. Stepwise linear regression analysis detected a negative correlation between AHI and the 30:15 index and Valsalva ratio, a positive correlation between overnight mean oxygen saturation and delta heart rate, and between AHI and delta systolic blood pressure. CONCLUSIONS Our data point to an increase in basal sympathetic activity during wakefulness and to an impaired reaction to several physiological stimuli, which is dependent on the severity of OSAS.
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Affiliation(s)
- Marilisa Montesano
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Silvia Miano
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Maria Chiara Paolino
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Anna Claudia Massolo
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Filomena Ianniello
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Martina Forlani
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
| | - Maria Pia Villa
- Pediatric Department, “La Sapienza” University, II Faculty, Medicine, Rome, Italy
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Kesek M, Franklin KA, Sahlin C, Lindberg E. Heart rate variability during sleep and sleep apnoea in a population based study of 387 women. Clin Physiol Funct Imaging 2009; 29:309-15. [DOI: 10.1111/j.1475-097x.2009.00873.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bresler M, Sheffy K, Pillar G, Preiszler M, Herscovici S. Differentiating between light and deep sleep stages using an ambulatory device based on peripheral arterial tonometry. Physiol Meas 2008; 29:571-84. [PMID: 18460762 DOI: 10.1088/0967-3334/29/5/004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study is to develop and assess an automatic algorithm based on the peripheral arterial tone (PAT) signal to differentiate between light and deep sleep stages. The PAT signal is a measure of the pulsatile arterial volume changes at the finger tip reflecting sympathetic tone variations and is recorded by an ambulatory unattended device, the Watch-PAT100, which has been shown to be capable of detecting wake, NREM and REM sleep. An algorithm to differentiate light from deep sleep was developed using a training set of 49 patients and was validated using a separate set of 44 patients. In both patient sets, Watch-PAT100 data were recorded simultaneously with polysomnography during a full night sleep study. The algorithm is based on 14 features extracted from two time series of PAT amplitudes and inter-pulse periods (IPP). Those features were then further processed to yield a prediction function that determines the likelihood of detecting a deep sleep stage epoch during NREM sleep periods. Overall sensitivity, specificity and agreement of the automatic algorithm to identify standard 30 s epochs of light and deep sleep stages were 66%, 89%, 82% and 65%, 87%, 80% for the training and validation sets, respectively. Together with the already existing algorithms for REM and wake detection we propose a close to full stage detection method based solely on the PAT and actigraphy signals. The automatic sleep stages detection algorithm could be very useful for unattended ambulatory sleep monitoring assessing sleep stages when EEG recordings are not available.
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Khoo MCK. Modeling of autonomic control in sleep-disordered breathing. CARDIOVASCULAR ENGINEERING (DORDRECHT, NETHERLANDS) 2008; 8:30-41. [PMID: 18060581 PMCID: PMC3339254 DOI: 10.1007/s10558-007-9041-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is ample evidence to support the notion that chronic exposure to repetitive episodes of interrupted breathing during sleep can lead to systemic hypertension, heart failure, myocardial infarction and stroke. Recent studies have suggested that abnormal autonomic control may be the common factor linking sleep-disordered breathing (SDB) to these cardiovascular diseases. We have developed a closed-loop minimal model that enables the delineation of the major physiological mechanisms responsible for changes in autonomic system function in SDB, and also forms the basis for a noninvasive technique that enables the early detection of cardiovascular control abnormalities. The model is "minimal" in the sense that all its parameters can be estimated through analysis of the data measured noninvasively from a single experimental procedure. Parameter estimation is enhanced by broadening the frequency content of the subject's ventilatory pattern, either through voluntary control of breathing or involuntary control using ventilator assistance. Although the original form of the model is linear and time-invariant, extensions of the model include the incorporation of nonlinear dynamics in the autonomic control of heart rate, and allowing the transfer functions of the model components to assume time-varying characteristics. The various versions of the model have been applied to different populations of subjects with SDB under different conditions (e.g. supine wakefulness, orthostatic stress, sleep). Our cumulative findings suggest that the minimal model approach provides a more sensitive means of detecting abnormalities in autonomic cardiovascular control in SDB, compared to univariate analysis of heart rate variability or blood pressure variability.
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Affiliation(s)
- Michael C K Khoo
- Biomedical Engineering Department, University of Southern California, DRB-140, University Park, Los Angeles, CA 90089-1111, USA.
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Jo JA, Blasi A, Valladares EM, Juarez R, Baydur A, Khoo MCK. A nonlinear model of cardiac autonomic control in obstructive sleep apnea syndrome. Ann Biomed Eng 2007; 35:1425-43. [PMID: 17415661 DOI: 10.1007/s10439-007-9299-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
Using the Volterra-Wiener approach, we employed a minimal model to quantitatively characterize the linear and nonlinear effects of respiration (RCC) and arterial blood pressure (ABR) on heart rate variability (HRV) in normal controls and subjects with moderate-to-severe obstructive sleep apnea syndrome (OSAS). Respiration, R-R interval (RRI), blood pressure (BP) and other polysomnographic variables were recorded in eight normal controls and nine OSAS subjects in wakefulness, Stage 2 and rapid eye-movement sleep. To increase respiratory and cardiovascular variability, a preprogrammed ventilator delivered randomly timed inspiratory pressures that were superimposed on a baseline continuous positive airway pressure. Except for lower resting RRI in OSAS subjects, summary statistical measures of RRI and BP and their variabilities were similar in controls and OSAS. In contrast, RCC and ABR gains were significantly lower in OSAS. Nonlinear ABR gain and the interaction between respiration and blood pressure in modulating RRI were substantially reduced in OSAS. ABR gain increased during sleep in controls but remained unchanged in OSAS. These findings suggest that normotensive OSAS subjects have impaired daytime parasympathetic and sympathetic function. Nonlinear minimal modeling of HRV provides a useful, insightful, and comprehensive approach for the detection and assessment of abnormal autonomic function in OSAS.
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Affiliation(s)
- Javier A Jo
- Department of Biomedical Engineering, OHE-500, University of Southern California, Los Angeles, CA 90080-1451, USA
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Urabe T, Takase B, Tomiyama Y, Maeda Y, Ishikawa Y, Hattori H, Uehata A, Ishihara M. Effect of Lateral Body Position on Heart Rate Variability in Patients with Sleep Apnea Syndrome. J Arrhythm 2007. [DOI: 10.1016/s1880-4276(07)80025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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