Abstract
Purpose
Heart rate decelerations and accelerations have unequal input to heart rate variability (HRV) and patterns created by consecutive cardiac cycles—this phenomenon is known as heart rate asymmetry (HRA). The analysis of monotonic runs of heart rate decelerations and accelerations provides a detailed insight into the HRA microstructure and thus of HRV.
Aim
To evaluate the relation between the severity of obstructive sleep apnea (OSA) and the HRA microstructure during sleep.
Methods
Seventy-eight patients with suspected OSA underwent overnight polysomnography. The 300-min ECGs from the polysomnography were selected and analyzed. The HRA microstructure was quantified by measuring (1) the contribution of monotonic runs of decelerations or accelerations of different lengths to the number of all sinus beats, and (2) the length of the longest deceleration and acceleration runs.
Results
There were 19 patients with no/mild OSA (Apnea/Hypopnea Index (AHI) 5.1 ± 2.5/h), 18 with moderate OSA (AHI 21.8 ± 4.0/h) and 41 with severe OSA (AHI 42.8 ± 17.4/h). Patients with severe OSA had significantly reduced deceleration and acceleration runs of length 1 compared to the moderate OSA group, and compared to patients with no/mild OSA they had an increased number of longer runs (from 5 to 10 for accelerations and from 5 to 8 for decelerations; p < 0.05 for all comparisons). The longest acceleration runs were significantly longer in severe OSA group (p < 0.05) than in subjects with no/mild OSA.
Conclusions
HRA microstructure is related with OSA severity. An increased number of longer deceleration and acceleration runs is more common in severe OSA patients.
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References
Yasuma F, Hayano J (2004) Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest 125:683–690
Eckberg DL (2003) The human respiratory gate. J Physiol 548:339–352
Jo JA, Blasi A, Valladares E, Juarez R, Baydur A, Khoo MC (2005) Determinants of heart rate variability in obstructive sleep apnea syndrome during wakefulness and sleep. Am J Physiol Heart Circ Physiol 288:H1103–H1112
Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, Nagaraja HN, Porges SW, Saul JP, Stone PH, van der Molen MW (1997) Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 34:623–648
Task Force of the European Society of Cardiology and the American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 93:1043–1065
Guzik P, Piskorski J, Krauze T, Wykretowicz A, Wysocki A (2006) Heart rate asymmetry by Poincaré plots of RR intervals. Biomed Tech (Berl) 51:272–275
Piskorski J, Guzik P (2007) Geometry of the Poincaré plot of RR intervals and its asymmetry in healthy adults. Physiol Meas 28:287–300
Piskorski J, Guzik P (2011) Asymmetric properties of long-term and total heart rate variability. Med Biol Eng Comput 49:1289–1297
Piskorski J, Guzik P (2011) The structure of heart rate asymmetry: deceleration and acceleration runs. Physiol Meas 32:1011–1023
Guzik P, Piskorski J, Contreras P, Migliaro ER (2010) Asymmetrical properties of heart rate variability in type 1 diabetes. Clin Auton Res 20:255–257
Porta A, Casali KR, Casali AG, Gnecchi-Ruscone T, Tobaldini E, Montano N, Lange S, Geue D, Cysarz D, Van Leeuwen P (2008) Temporal asymmetries of short-term heart period variability are linked to autonomic regulation. Am J Physiol Regul Integr Comp Physiol 295:R550–R557
American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689
Cortelli P, Parchi P, Sforza E, Contin M, Pierangeli G, Barletta G, Lugaresi E (1994) Cardiovascular autonomic dysfunction in normotensive awake subjects with obstructive sleep apnoea syndrome. Clin Auton Res 4:57–62
Parati G, Lombardi C, Narkiewicz K (2007) Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Physiol 293:R1671–R1683
Guilleminault C, Connolly S, Winkle R, Melvin K, Tilkian A (1984) Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. Lancet 1:126–131
Baranchuk A, Simpson CS, Redfearn DP, Fitzpatrick M (2008) It’s time to wake up! sleep apnea and cardiac arrhythmias. Europace 10:666–667
Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. US Government Printing Office. US Public Health Service, Washington, DC
Lomb NR (1976) Least-squares frequency analysis of unequally spaced data. Astrophys Space Sci 39:447–462
Moody GB (1993) Spectral analysis of heart rate without resampling. Comput Cardiol 20:715–718. doi:10.1109/CIC.1993.378302
Guzik P, Piskorski J, Barthel P, Bauer A, Müller A, Junk N, Ulm K, Malik M, Schmidt G (2012) Heart rate deceleration runs for post-infarction risk prediction. J Electrocardiol 45:70–76
Billois R, Poree F, Beuchee A, Carrault G (2012) Interest of RR deceleration for diagnosis of late onset sepsis. Comput Cardiol 39:633–636
Casali KR, Casali AG, Montano N, Irigoyen MC, Macagnan F, Guzzetti S, Porta A (2008) Multiple testing strategy for the detection of temporal irreversibility in stationary time series. Phys Rev E: Stat, Nonlin, Soft Matter Phys 77:066204
Voss A, Kurths J, Kleiner HJ, Witt A, Wessel N, Saparin P, Osterziel KJ, Schurath R, Dietz R (1996) The application of methods of non-linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. Cardiovasc Res 31:419–433
Narkiewicz K, Pesek CA, Kato M, Phillips BG, Davison DE, Somers VK (1998) Baroreflex control of sympathetic nerve activity and heart rate in obstructive sleep apnea. Hypertension 32:1039–1043
Narkiewicz K, van de Borne PJ, Pesek CA, Dyken ME, Montano N, Somers VK (1999) Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation 99:1183–1189
Stein PK, Pu Y (2012) Heart rate variability, sleep and sleep disorders. Sleep Med Rev 16:47–66
Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R (1982) Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest 69:1286–1292
Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T, American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology; American Heart Association Stroke Council; American Heart Association Council on Cardiovascular Nursing; American College of Cardiology Foundation (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 52:686–717
Porta A, D’addio G, Bassani T, Maestri R, Pinna GD (2009) Assessment of cardiovascular regulation through irreversibility analysis of heart period variability: a 24 hours Holter study in healthy and chronic heart failure populations. Philos Transact A Math Phys Eng Sci 367:1359–1375
Lorenzi-Filho G, Dajani HR, Leung RS, Floras JS, Bradley TD (1999) Entrainment of blood pressure and heart rate oscillations by periodic breathing. Am J Respir Crit Care Med 159:1147–1154
Klintworth A, Ajtay Z, Paljunite A, Szabados S, Hejjel L (2012) Heart rate asymmetry follows the inspiration/expiration ratio in healthy volunteers. Physiol Meas 33:1717–1731
Castiglioni P, Parati G (2011) Present trends and future directions in the analysis of cardiovascular variability. J Hypertens 29:1285–1288
Aydin M, Altin R, Ozeren A, Kart L, Bilge M, Unalacak M (2004) Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms. Tex Heart Inst J 31:132–136
Roche F, Gaspoz JM, Court-Fortune I, Minini P, Pichot V, Duverney D, Costes F, Lacour JR, Barthélémy JC (1999) Screening of obstructive sleep apnea syndrome by heart rate variability analysis. Circulation 100:1411–1415
Dingli K, Assimakopoulos T, Wraith PK, Fietze I, Witt C, Douglas NJ (2003) Spectral oscillations of RR intervals in sleep apnoea/hypopnoea syndrome patients. Eur Respir J 22:943–950
Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK (1998) Altered cardiovascular variability in obstructive sleep apnea. Circulation 98:1071–1077
Jo JA, Blasi A, Valladares E, Juarez R, Baydur A, Khoo MC (2003) Model-based assessment of autonomic control in obstructive sleep apnea syndrome during sleep. Am J Respir Crit Care Med 167:128–136
Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, Guzik P, Lombardi F, Müller A, Oto A, Schneider R, Watanabe M, Wichterle D, Zareba W (2008) Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: international Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol 52:1353–1365
Acknowledgments
This study has been supported by an Unrestricted Grant from the Queen’s University Garfield Kelly Cardiovascular Development Fund for the project “Heart rate asymmetry in patients with severe obstructive sleep apnea”.
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There is no conflict of interest for any of the authors.
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Guzik, P., Piskorski, J., Awan, K. et al. Obstructive sleep apnea and heart rate asymmetry microstructure during sleep. Clin Auton Res 23, 91–100 (2013). https://doi.org/10.1007/s10286-013-0188-8
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DOI: https://doi.org/10.1007/s10286-013-0188-8