1
|
Ziegler MG, Milic M, Dimsdale JE, Mills PJ. Sympathetic overactivity and nocturnal diuresis in obstructive sleep apnea alter the response to hypertension therapy. Clin Hypertens 2024; 30:14. [PMID: 38822391 PMCID: PMC11143623 DOI: 10.1186/s40885-024-00272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/23/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with high blood pressure that responds poorly to usual antihypertensive therapy. METHODS AND RESULTS Forty-one subjects with OSA had 25% higher plasma norepinephrine and 42% higher epinephrine measured every 2 h over 24 h than 20 control subjects. They also excreted more sodium during sleep. This suggested that that a sympatholytic would be a more successful antihypertensive than a diuretic. To test this hypothesis we treated a second group of 23 hypertensive apneics with placebo, 6 weeks of the sympatholytic guanfacine and 6 weeks of hydrochlorothiazide in a crossover study. Guanfacine lowered 24-hour blood pressure by 9.6/6.7 mmHg, more than the 5.4/2.9 mmHg effect of hydrochlorothiazide (P < 0.05). Nighttime systolic blood pressure dipping was poor at 6.6 ± 1.8%. Hydrochlorothiazide did not alter blood pressure dipping but guanfacine improved dipping to 9.1 ± 1.2%, a better result (P = 0.03) than from the diuretic. Central aortic pressure by pulse wave analysis was 120/84 mmHg on hydrochlorothiazide and 109/72 on guanfacine, (P < 0.05). Guanfacine, but not hydrochlorothiazide, improved baroreflex sensitivity, heart rate variability and flow mediated vascular dilation, suggesting that decreasing the elevated sympathetic nerve activity of obstructive sleep apnea returned vascular function toward normal. CONCLUSIONS OSA is the most common condition associated with antihypertensive treatment failure. It increased sympathetic nerve activity day and night. Drugs that block sympathetic nerve function are not among the 4 most commonly recommended classes of antihypertensives but diuretics are. Sympatholytic therapy was superior to diuretic treatment for hypertension associated with sleep apnea. TRIAL REGISTRATION NCT, NCT02699125, Registered 26 February 2016 - Retrospectively registered, https://clinicaltrials.gov/study/NCT02699125 .
Collapse
Affiliation(s)
- Michael G Ziegler
- Department of Medicine, Division of Nephrology and Hypertension, University of California San Diego, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103- 8341, USA
| | - Milos Milic
- Department of Medicine, Division of Nephrology and Hypertension, University of California San Diego, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103- 8341, USA.
| | - Joel E Dimsdale
- Department of Psychiatry, University of California San Diego, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103-8341, USA
| | - Paul J Mills
- Department of Family Medicine and Public Health, University of California San Diego, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103-8341, USA
| |
Collapse
|
2
|
Ma Y, Chang MC, Litrownik D, Wayne PM, Yeh GY. Day-night patterns in heart rate variability and complexity: differences with age and cardiopulmonary disease. J Clin Sleep Med 2023; 19:873-882. [PMID: 36692177 PMCID: PMC10152358 DOI: 10.5664/jcsm.10434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Heart rate variability (HRV) measures provide valuable insights into physiology; however, gaps remain in understanding circadian patterns in heart rate dynamics. We aimed to explore day-night differences in heart rate dynamics in patients with chronic cardiopulmonary disease compared with healthy controls. METHODS Using 24-hour heart rate data from patients with chronic obstructive pulmonary disease (COPD) and/or heart failure (n = 16) and healthy adult controls (older group: ≥50 years, n = 42; younger group: 20-49 years, n = 136), we compared day-night differences in conventional time and frequency domain HRV indices and a multiscale-entropy-based complexity index (CI1-20) of HRV among the 3 groups. RESULTS Twenty-four-hour HRV showed significant day-night differences (marked with "△") among younger healthy (mean age: 34.5 years), older healthy (mean age: 61.6 years), and cardiopulmonary patients (mean age: 68.4 years), including change in percentage of adjacent intervals that differ > 50 ms (△pNN50), high frequency (△HF), normalized low frequency (△nLF), ratio (△LF/HF), and △CI1-20. Among these, △LF/HF (2.13 ± 2.35 vs 1.1 ± 2.47 vs -0.35 ± 1.25; P < .001) and △CI1-20 (0.15 ± 0.24 vs 0.02 ± 0.28 vs -0.21 ± 0.27; P < .001) were significant in each pairwise comparison following analysis of variance tests. Average CI1-20 was highest in younger healthy individuals and lowest in cardiopulmonary patients (1.37 ± 0.12 vs 1.01 ± 0.27; P < .001). Younger healthy patients showed a heart rate complexity dipping pattern (night < day), older healthy patients showed nondipping, and cardiopulmonary patients showed reverse dipping (night > day). CONCLUSIONS As measures of 24-hour variability, traditional and complexity-based metrics of HRV exhibit large day-night differences in healthy individuals; these differences are blunted, or even reversed, in individuals with cardiopulmonary pathology. Measures of diurnal dynamics may be useful indices of reduced adaptive capacity in patients with cardiopulmonary conditions. CITATION Ma Y, Chang M-C, Litrownik D, Wayne PM, Yeh GY. Day-night patterns in heart rate variability and complexity: differences with age and cardiopulmonary disease. J Clin Sleep Med. 2023;19(5):873-882.
Collapse
Affiliation(s)
- Yan Ma
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mei-Chu Chang
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Litrownik
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3
|
Shimizu S, Kawada T, Akiyama T, Turner MJ, Shishido T, Kamiya A, Shirai M, Sugimachi M. Guanfacine enhances cardiac acetylcholine release with little effect on norepinephrine release in anesthetized rabbits. Auton Neurosci 2014; 187:84-7. [PMID: 25498385 DOI: 10.1016/j.autneu.2014.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
An α2A-adrenergic agonist guanfacine improves autonomic imbalance in attention-deficit hyperactivity disorder, suggesting that it may be useful to correct autonomic imbalance in chronic heart failure (CHF) patients. To investigate the effects of guanfacine on cardiac autonomic nerve activities, a microdialysis technique was applied to anesthetized rabbit heart. Acetylcholine (ACh) and norepinephrine (NE) concentrations in atrial dialysates were measured as indices of cardiac autonomic nerve activities. Guanfacine at a dose of 100 μg/kg significantly decreased heart rate and increased dialysate ACh concentration without decreasing sympathetic NE release. Guanfacine may be useful for vagal activation therapy in CHF patients.
Collapse
Affiliation(s)
- Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan.
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Tsuyoshi Akiyama
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Michael James Turner
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Toshiaki Shishido
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Atsunori Kamiya
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Mikiyasu Shirai
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan
| |
Collapse
|
4
|
Effect of Daily Cold Water Immersion on Heart Rate Variability and Subjective Ratings of Well-Being in Highly Trained Swimmers. Int J Sports Physiol Perform 2012; 7:33-8. [DOI: 10.1123/ijspp.7.1.33] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose:We investigated the effect of daily cold water immersion (CWI), during a typical training week, on parasympathetic activity and subjective ratings of well-being.Methods:Over two different weeks, eight highly trained swimmers (4 men; 19.6 ± 3.2 y) performed their usual training load (5 d/wk, approx. 21 h/wk). Last training session of each training day was immediately followed by 5 min of seated recovery, in randomized order, with CWI (15°C) or without (CON). Each morning before the first training session (6:30 AM) during the two experimental weeks, subjective ratings of well-being (eg, quality of sleep) were assessed and the R-R intervals were recorded for 5 min in supine position. A vagal-related index (ie, natural logarithm of the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals; Ln rMSSD) was calculated from the last 3-min segment.Results:Compared with CON, CWI effect on Ln rMSSD was rated as possibly beneficial on day 2 [7.0% (–3; 19)], likely beneficial on day 3 [20.0% (1.5; 43.5)], very likely beneficial on day 4 [30.4% (12.2; 51.6)] and likely beneficial on day 5 [24.1% (–0.4; 54.8)]. Cold water immersion was associated with a likely greater quality of sleep on day 2 [30.0% (2.7; 64.6)], very likely on day 3 [31.0% (5.0; 63.1)] and likely on day 4 [38.6% (11.4; 72.4)] when compared with CON.Conclusion:Five minutes of CWI following training can reduce the usual exercise-induced decrease in parasympathetic activity and is associated with improved rating of perceived sleep quality.
Collapse
|
5
|
Shimizu S, Akiyama T, Kawada T, Sata Y, Mizuno M, Kamiya A, Shishido T, Inagaki M, Shirai M, Sano S, Sugimachi M. Medetomidine, an α(2)-adrenergic agonist, activates cardiac vagal nerve through modulation of baroreflex control. Circ J 2011; 76:152-9. [PMID: 22040937 DOI: 10.1253/circj.cj-11-0574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although α(2)-adrenergic agonists have been reported to induce a vagal-dominant condition through suppression of sympathetic nerve activity, there is little direct evidence that they directly increase cardiac vagal nerve activity. Using a cardiac microdialysis technique, we investigated the effects of medetomidine, an α(2)-adrenergic agonist, on norepinephrine (NE) and acetylcholine (ACh) release from cardiac nerve endings. METHODS AND RESULTS A microdialysis probe was implanted into the right atrial wall near the sinoatrial node in anesthetized rabbits and perfused with Ringer's solution containing eserine. Dialysate NE and ACh concentrations were measured using high-performance liquid chromatography. Both 10 and 100µg/kg of intravenous medetomidine significantly decreased mean blood pressure (BP) and the dialysate NE concentration, but only 100µg/kg of medetomidine enhanced ACh release. Combined administration of medetomidine and phenylephrine maintained mean BP at baseline level, and augmented the medetomidine-induced ACh release. When we varied the mean BP using intravenous administration of phenylephrine, treatment with medetomidine significantly steepened the slope of the regression line between mean BP and log ACh concentration. CONCLUSIONS Medetomidine increased ACh release from cardiac vagal nerve endings and augmented baroreflex control of vagal nerve activity.
Collapse
Affiliation(s)
- Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Jurysta F, Lanquart JP, Sputaels V, Dumont M, Migeotte PF, Leistedt S, Linkowski P, van de Borne P. The impact of chronic primary insomnia on the heart rate--EEG variability link. Clin Neurophysiol 2009; 120:1054-60. [PMID: 19403330 DOI: 10.1016/j.clinph.2009.03.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 01/21/2009] [Accepted: 03/30/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if chronic insomnia alters the relationship between heart rate variability and delta sleep determined at the EEG. METHODS After one night of accommodation, polysomnography was performed in 14 male patients with chronic primary insomnia matched with 14 healthy men. ECG and EEG recordings allowed the determination of High Frequency (HF) power of RR-interval and delta sleep EEG power across the first three Non Rapid Eye Movement (NREM)-REM cycles. Interaction between normalized HF RR-interval variability and normalized delta sleep EEG power was studied by coherency analysis. RESULTS Patients showed increased total number of awakenings, longer sleep latency and wake durations and shorter sleep efficiency and REM duration than controls (p<.01). Heart rate variability across first three NREM-REM cycles and sleep stages (NREM, REM and awake) were similar between both groups. In each group, normalized HF variability of RR-interval decreased from NREM to both REM and awake. Patients showed decreased linear relationship between normalized HF RR-interval variability and delta EEG power, expressed by decreased coherence, in comparison to controls (p<.05). Gain and phase shift between these signals were similar between both groups. CONCLUSIONS Interaction between changes in cardiac autonomic activity and delta power is altered in chronic primary insomniac patients, even in the absence of modifications in heart rate variability and cardiovascular diseases. SIGNIFICANCE This altered interaction could reflect the first step to cardiovascular disorders.
Collapse
Affiliation(s)
- F Jurysta
- Sleep Laboratory, Department of Psychiatry, Erasmus Academic Hospital, Free University of Brussels, 1070 Brussels, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Biphasic Dose-dependent Modulation of Cardiac Parasympathetic Activity by Moxonidine, an Imidazoline I1-receptor Agonist. J Cardiovasc Pharmacol 2008; 52:524-35. [DOI: 10.1097/fjc.0b013e3181907146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
|
9
|
Tasaki H, Serita T, Ueyama C, Kitano K, Seto S, Yano K. Long-Term follow-up of the circadian rhythm of heart rate and heart rate variability in healthy elderly patients. Circ J 2006; 70:889-95. [PMID: 16799244 DOI: 10.1253/circj.70.889] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term age-related changes in circadian rhythm of heart rate variability (HRV), that is, autonomic nervous activity, remain unknown in elderly people. METHODS AND RESULTS Holter monitoring was conducted twice at an interval of 15 years in 15 healthy elderly patients (age: 70.0 +/- 4.1 years, at first monitoring, female: 10) and assessed the age-related changes in 24-h mean and hourly mean normal sinus R-R interval (mean NN), HRV (high frequency (HF) component, low frequency (LF) component and LF/HF) and the circadian rhythms. As a result, 24-h mean mean NN (0.976 +/- 0.115 vs 0.903 +/- 0.117 (s), p = 0.0019), LF/HF (1.681 +/- 0.731 vs 0.962 +/- 0.442, p = 0.0022), and LF (278.88 +/- 176.43 vs 179.19 +/- 132.33 (ms2), p = 0.0039) significantly decreased 15 years later, although 24-h mean HF (221.20+/-138.89 vs 310.78+/-296.73 (ms2), p = 0.1102) increased slightly. The hourly mean NN closely correlated with hourly HF and LF/HF throughout circadian rhythms both at first and second monitoring. In the morning hours, amplitude rates of all HRV indices increased significantly 15 years later. CONCLUSION In elderly people, age-related changes in the 24-h mean heart rate (HR) were conversely dissociated from those of the 24-h mean HRV. However, the close correlation between hourly HR and HRV was preserved, even in very elderly patients. Additionally, the amplitude rates in HRV in the morning increased with age. These age-related changes of HR and HRV might be characteristic of elderly people.
Collapse
Affiliation(s)
- Hirofumi Tasaki
- Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | | | | | | | | | | |
Collapse
|