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CC BY-NC-ND 4.0 · Sleep Sci 2020; 13(02): 97-102
DOI: 10.5935/1984-0063.20200003
ORIGINAL ARTICLE

Changes in heart rate variability (HRV) in patients with severe and moderate obstructive sleep apnea before and after acute CPAP therapy during nocturnal polysomnography

Neda Efazati
1   Tehran University of Medical Sciences, Department of Internal Medicine - Tehran - Iran.
,
Besharat Rahimi
2   Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran.
,
Mahsa Mirdamadi
3   Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran - Iran.
,
Maryam Edalatifard
2   Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran.
,
Anahita Tavoosi
4   Tehran University of Medical Sciences, Imam Khomeini Hospital - Tehran - Iran.
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ABSTRACT

Introduction: Obstructive sleep apnea is an important risk factor for cardiovascular disease. Noninvasive positive pressure ventilation is the standard treatment of this disease, and it can reduce mortality in patients. Dysfunction of the autonomic system is one of the reasons for an increased risk of cardiovascular disease in these patients. The purpose of the present study was to investigate the effect of positive airway pressure (PAP) therapy on heart rate variability (HRV) indices.

Methods: The study population was comprised of 55 patients, who underwent nocturnal polysomnography for the diagnosis of obstructive sleep apnea and PAP titration on the same night. The levels of continuous positive airway pressure (CPAP) and bilevel positive airway pressure were adjusted to relieve obstructive sleep apnea, hypopnea, and desaturation. The patients’ heart changes and cardiac characteristics were recorded before and after the start of routine CPAP therapy. Finally, the cases’ sleep and polysomnography tests were analyzed and interpreted in collaboration with a sleep specialist and their cardiac changes with the aid of a cardiologist before and after treatment with CPAP.

Results: The participants were 55 patients at a mean age of 57.04±12.9 years. There were 34 (61.8%) male and 21 (38.2%) female cases. PAP therapy on the same night resulted in a decreased standard deviation of the N-N interval index (p=0.036) and a low-frequency index (p=0.021), as well as increased high-frequency index (p<0.001) and low frequency / high frequency ratios (p=0.008).

Conclusion: Our findings indicate a relative improvement in the activity of the autonomic system in patients with obstructive sleep apnea after 1 night of PAP therapy. Overwhelming evidence suggests that improvement in the sympathetic balance can reduce the risk of cardiovascular disease in patients.

Keywords:

Obstructive Sleep Apnea - Heart Rate - Positive-Pressure - Ventilation


Publication History

Received: 26 February 2019

Accepted: 22 October 2019

Article published online:
09 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.
  • 2 Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13(5):665-6.
  • 3 Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352-60.
  • 4 Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378-84.
  • 5 Molnar MZ, Mucsi I, Novak M, Szabo Z, Freire AX, Huch KM, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-95.
  • 6 Kufoy E, Palma JA, Lopez J, Alegre M, Urrestarazu E, Artieda J, et al. Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment. PLoS One. 2012;7(3):e33769.
  • 7 Kim YS, Kim SY, Park DY, Wu HW, Hwang GS, Kim HJ. Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients. J Craniofac Surg. 2015;26(5):1592-5.
  • 8 Roche F, Gaspoz JM, Court-Fortune I, Minini P, Pichot V, Duverney D, et al. Screening of obstructive sleep apnea syndrome by heart rate variability analysis. Circulation. 1999;100(13):1411-5.
  • 9 Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65.
  • 10 Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258.
  • 11 Gong X, Huang L, Liu X, Li C, Mao X, Liu W, et al. Correlation Analysis between Polysomnography Diagnostic Indices and Heart Rate Variability Parameters among Patients with Obstructive Sleep Apnea Hypopnea Syndrome. PLoS One. 2016;11(6):e0156628.
  • 12 Park DH, Shin CJ, Hong SC, Yu J, Ryu SH, Kim EJ, et al. Correlation between the severity of obstructive sleep apnea and heart rate variability indices. J Korean Med Sci. 2008;23(2):226-31.
  • 13 Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014;5:1040.
  • 14 Almeida-Santos MA, Barreto-Filho JA, Oliveira JL, Reis FP, da Cunha Oliveira CC, Sousa AC. Aging, heart rate variability and patterns of autonomic regulation of the heart. Arch Gerontol Geriatr. 2016;63:1-8.
  • 15 Yoo HJ, Hwang SY, Choi KM, Baik SH, Lee EM, Kim EJ, et al. Clinical implication of body size phenotype on heart rate variability. Metabolism. 2016;65(11):1589-96.
  • 16 Song MK, Ha JH, Ryu SH, Yu J, Park DH. The effect of aging and severity of sleep apnea on heart rate variability indices in obstructive sleep apnea syndrome. Psychiatry Investig. 2012;9(1):65-72.
  • 17 Aminian O, Shams-Hosseini NS, Sadeghniiat-Haghighi K. The Relationship between Severity of Obstructive Sleep Apnea and Heart Rate Variability. J Sleep Sci. 2016;1(4):156-63.
  • 18 Xie J, Yu W, Wan Z, Han F, Wang Q, Chen R. Correlation Analysis between Obstructive Sleep Apnea Syndrome (OSAS) and Heart Rate Variability. Iran J Public Health. 2017;46(11):1502-11.
  • 19 Santamit S, Khrisanapant W, Ishida W, Pasurivong O, Boonsawat W, Intarapoka B, et al. Heart Rate Variability in Thai Patients with Obstructive Sleep Apnea. Srinagarind Med J. 2015;30(4):518-26.
  • 20 Gammoudi N, Cheikh RB, Saafi MA, Sakly G, Dogui M. Cardiac autonomic control in the obstructive sleep apnea. Libyan J Med. 2015;10(1):26989.
  • 21 Ozkececi G, Ulasli SS, Akci O, Avsar A, Unlu M, Onrat E. The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients. Sao Paulo Med J. 2016;134(5):430-6.
  • 22 Gharabaghi MA, Ehtesham M, Mollazadeh R, Firouzbakhsh S, Safavi E. Comparative Study of HRV Indexes Between Severe and Non-Severe Obstructive Sleep Apnea Patients. Biomed Pharm J. 2016;9(3):927-32.
  • 23 Sun J, Li X, Guo J, Han F, Zhang H. Identification of obstructive sleep apnea syndrome by ambulatory electrocardiography: clinical evaluation of time-domain and frequency-domain analyses of heart rate variability in Chinese patients. Cell Biochem Biophys. 2011;59(3):165-70.
  • 24 Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992;85(1):164-71.
  • 25 Evrengul H, Tanriverdi H, Kose S, Amasyali B, Kilic A, Celik T, et al. The relationship between heart rate recovery and heart rate variability in coronary artery disease. Ann Noninvasive Electrocardiol. 2006;11(2):154-62.
  • 26 Aeschbacher S, Bossard M, Schoen T, Schmidlin D, Muff C, Maseli A, et al. Heart Rate Variability and Sleep-Related Breathing Disorders in the General Population. Am J Cardiol. 2016;118(6):912-7.
  • 27 Molfino A, Fiorentini A, Tubani L, Martuscelli M, Rossi Fanelli F, Laviano A. Body mass index is related to autonomic nervous system activity as measured by heart rate variability. Eur J Clin Nutr. 2009;63(10):1263-5.
  • 28 Lado MJ, Méndez AJ, Rodríguez-Liñares L, Otero A, Vila XA. Nocturnal evolution of heart rate variability indices in sleep apnea. Comput Biol Med. 2012;42(12):1179-85.
  • 29 Kuramoto E, Kinami S, Ishida Y, Shiotani H, Nishimura Y. Continuous positive nasal airway pressure decreases levels of serum amyloid A and improves autonomic function in obstructive sleep apnea syndrome. Int J Cardiol. 2009;135(3):338-45.
  • 30 Karasulu L, Epöztürk PO, Sökücü SN, Dalar L, Altin S. Improving Heart rate variability in sleep apnea patients: differences in treatment with auto-titrating positive airway pressure (APAP) versus conventional CPAP. Lung. 2010;188(4):315-20.
  • 31 Gilman MP, Floras JS, Usui K, Kaneko Y, Leung RS, Bradley TD. Continuous positive airway pressure increases heart rate variability in heart failure patients with obstructive sleep apnoea. Clin Sci (Lond). 2008;114(3):243-9.
  • 32 Grau N, Bazan V, Kallouchi M, Rodriguez D, Estirado C, Corral MI, et al. Long-term Impact of Continuous Positive Airway Pressure Therapy on Arrhythmia and Heart Rate Variability in Patients With Sleep Apnea. Arch Bronconeumol. 2016;52(1):17-23.
  • 33 Chrysostomakis SI, Simantirakis EN, Schiza SE, Karalis IK, Klapsinos NC, Siafakas NM, et al. Continuous positive airway pressure therapy lowers vagal tone in patients with obstructive sleep apnoea-hypopnoea syndrome. Hellenic J Cardiol. 2006;47(1):13-20.
  • 34 Glos M, Penzel T, Schoebel C, Nitzsche GR, Zimmermann S, Rudolph C, et al. Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. Sleep Breath. 2016;20(2):635-46.