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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(11): s00441791660
DOI: 10.1055/s-0044-1791660
Original Article

Heart rate variability in chronic ischemic stroke: analysis during the sleep-wake cycle

Variabilidade da frequência cardíaca no acidente vascular cerebral isquêmico crônico: análise durante o ciclo sono-vigília
Natalia Buitrago-Ricaurte 
1   Universidade Federal de São Paulo, São Paulo SP, Brazil.
2   Universidad del Rosario, Bogotá, Colombia.
,
Fatima Dumas Cintra 
3   Universidade Federal de São Paulo, Departamento de Cardiologia, São Paulo SP, Brazil.
,
Jean Faber 
4   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Gisele Sampaio Silva 
4   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
5   Hospital Albert Einstein, São Paulo SP, Brazil.
› Author Affiliations Support This study was partly funded by CAPES.
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Abstract

Background Alterations of the autonomic nervous system (ANS) in the chronic stage of ischemic stroke (IS) are not well understood. Heart rate variability (HRV) provides a noninvasive approach to assess autonomic function.

Objective To compare the HRV parameters during the sleep-wake cycle between patients with IS in the chronic stage and healthy subjects.

Methods We conducted a retrospective transversal study based on clinical records and 24-hour electrocardiogram (EKG) monitoring registries of 179 patients with a confirmed IS diagnosis and 184 age- and sex-matched healthy subjects. Circadian variation was calculated according to the variation of the total autonomic activity (VTAI) and the parasympathetic activity (VPAI) indexes. Comparisons were performed using nonparametric tests. Multivariable analyses were performed with canonical discriminant analysis (CDA) and a three-way analysis of variance (ANOVA). Statistical significance was established with a confidence level of 95%.

Results During waking hours, the healthy group exhibited higher variability in the time domain and frequency domain parameters: standard deviation of NN intervals (SDNN, p < 0.001) and of the average NN intervals (SDANN, p < 0.001), as well as low-frequency (LF) band (p < 0.001). During sleep, the difference was higher in the high-frequency (HF) band (p < 0.001), and lower in the low-/high-frequency ratio (LF/HF, p < 0.001). Both VPAI and VTAI showed less significant difference in IS patients (p < 0.001).

Conclusion There was diminished heart vagal activity among IS patients, as measured through HRV. During sleep, this is likely caused by an imbalance in the sympathetic and parasympathetic systems shifting through the sleep phases. These imbalances could persist over time in patients with IS, lasting months after the initial injury.

Resumo

Antecedentes A compreensão das alterações do sistema nervoso autônomo (SNA) na fase crônica do acidente vascular cerebral isquêmico (AVCi) ainda é insuficiente. A variabilidade da frequência cardíaca (VFC) fornece uma abordagem não invasiva para avaliar a função autonômica.

Objetivo Comparar os parâmetros da VFC durante o ciclo sono-vigília entre participantes saudáveis e com AVCi crônico.

Métodos Estudo retrospectivo transversal baseado em registros clínicos e registros de eletrocardiograma de 24 horas de 179 pacientes com AVCi confirmado e 184 controles pareados por idade e sexo. As variações do índice de atividade autonômica total (VTAI) e do índice de atividade parassimpática (VPAI) foram usados para calcular a variação circadiana. As comparações foram feitas usando testes não paramétricos. Análise discriminante canônica (CDA) e análise de variância (ANOVA) de três vias foram usadas para análises multivariadas. Um nível de confiança de 95% foi estabelecido para a significância estatística.

Resultados O grupo controle exibiu maior variabilidade nos parâmetros de domínio do tempo e da frequência durante as horas de vigília: desvio padrão dos intervalos NN (SDNN, p < 0,001) e das médias dos intervalos NN (SDANN, p < 0,001), assim como a banda de baixa frequência (LF, p < 0,001). Durante o sono, a diferença foi maior na banda de alta frequência (HF, p < 0,001) e a razão baixa/alta frequência (LF/HF) foi menor (p < 0,001). O VPAI e VTAI mostraram menor variabilidade nos pacientes com AVC (p < 0,001).

Conclusão Os pacientes com AVCi apresentaram atividade vagal cardíaca diminuída, medida pela VFC. Isto pode resultar de desequilíbrios nos sistemas simpático e parassimpático que mudam durante as fases do sono. Em pacientes com AVCi, esses desequilíbrios podem permanecer meses após a lesão inicial.

Keywords

Ischemic Stroke - Heart Rate Determination - Autonomic Nervous System - Stroke - Circadian Rhythm

Palavras-chave

Acidente Vascular Cerebral Isquêmico - Determinação da Frequência Cardíaca - Sistema Nervoso Autônomo - Acidente Vascular Cerebral - Ritmo Circadiano

Authors' Contributions

NBR: contributed to the conception and design of the work, the acquisition, analysis, and interpretation of the data, the drafting of the article, and the final approval of the version to be published; FDC: contributed to the conception and design of the study, the acquisition of data, and writing of the manuscript; JF: contributed through data interpretation, statistical analysis, and writing of the manuscript; GSS: contributed to the conception and design of the study, the acquisition of data, and writing of the manuscript. The authors complied with the International Committee of Medical Journal Editors Criteria for Authorship.


Editor-in-Chief: Ayrton Roberto Massaro.


Associate Editor: Octávio Marques Pontes-Neto.




Publication History

Received: 04 February 2024

Accepted: 27 July 2024

Article published online:
06 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
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Bibliographical Record
Natalia Buitrago-Ricaurte, Fatima Dumas Cintra, Jean Faber, Gisele Sampaio Silva. Heart rate variability in chronic ischemic stroke: analysis during the sleep-wake cycle. Arq Neuropsiquiatr 2024; 82: s00441791660.
DOI: 10.1055/s-0044-1791660
 

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