Skip to main content
SpringerLink
Log in

Daytime baroreflex sensitivity in patients with primary insomnia

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Insomnia has been linked to cardiovascular disease and among these especially hypertension and changes in autonomic function. One marker for cardiovascular risk is baroreflex sensitivity (BRS). We investigate daytime BRS in patients with primary insomnia in order to assess cardiovascular risk. Twenty-one patients (18 females/3 males) with primary insomnia according to DSM-IV were recruited. Careful investigations excluded confounding sleep disorders such as sleep-disordered breathing and periodic limb movements. An age-matched control group with 21 healthy subjects (18 females/3 males) underwent the same investigations. To assess BRS, an experimental protocol with paced breathing during daytime was performed. ECG and continuous non-invasive blood pressure were recorded to obtain spontaneous BRS by calculating the α index (BRS-α) and also by transfer function analysis (TF-BRS). There were no differences at daytime between insomnia patients and controls neither in BRS-α (8.1 ms/mmHg, range 5.8–14.7 vs. 9.6 ms/mmHg, range 6.9–15.8) nor in TF-BRS (5.8 ms/mmHg, range 2.4–16.8 vs. 5.4 ms/mmHg, range 2.3–11.4). Also there were no differences in absolute, low or high frequency bands of heart rate or blood pressure variability between the two groups. We could show that primary insomnia may be not associated with daytime parameters of autonomic imbalance (e.g., baroreflex sensitivity) which are known as non-classical risk markers of cardiovascular disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bonnet MH, Arand DL (1998) Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med 60:610–615

    PubMed  CAS  Google Scholar 

  2. Bonnet MH, Arand DL (1995) 24-Hour metabolic rate in insomniacs and matched normal sleepers. Sleep 18:581–588

    PubMed  CAS  Google Scholar 

  3. Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161:2126–2128

    Article  PubMed  Google Scholar 

  4. Bonnet MH, Arand DL (1997) Hyperarousal and insomnia. Sleep Med Rev 1:97–108

    Article  PubMed  CAS  Google Scholar 

  5. Schwartz S, McDowell AW, Cole SR, Cornoni-Huntley J, Hays JC, Blazer D (1999) Insomnia and heart disease: a review of epidemiologic studies. J Psychosom Res 47:313–333

    Article  PubMed  CAS  Google Scholar 

  6. Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A (2009) Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 32:491–497

    PubMed  Google Scholar 

  7. Gottlieb DJ, Redline S, Nieto FJ et al (2006) Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep 29:1009–1014

    PubMed  Google Scholar 

  8. Phillips B, Mannino DM (2007) Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med 3:489–494

    PubMed  Google Scholar 

  9. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ (1998) Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (autonomic tone and reflexes after myocardial infarction) investigators. Lancet 351:478–484

    Article  PubMed  CAS  Google Scholar 

  10. Robinson TG, Dawson SL, Eames PJ, Panerai RB, Potter JF (2003) Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 34:705–712

    Article  PubMed  Google Scholar 

  11. Frattola A, Parati G, Gamba P et al (1997) Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus. Diabetologia 40:1470–1475

    Article  PubMed  CAS  Google Scholar 

  12. Dutsch M, Hilz MJ, Devinsky O (2006) Impaired baroreflex function in temporal lobe epilepsy. J Neurol 253:1300–1308

    Article  PubMed  Google Scholar 

  13. Broadley AJ, Frenneaux MP, Moskvina V, Jones CJ, Korszun A (2005) Baroreflex sensitivity is reduced in depression. Psychosom Med 67:648–651

    Article  PubMed  Google Scholar 

  14. Harrington F, Murray A, Ford GA (2000) Relationship of baroreflex sensitivity and blood pressure in an older population. J Hypertens 18:1629–1633

    Article  PubMed  CAS  Google Scholar 

  15. Cortelli P, Parchi P, Contin M et al (1991) Cardiovascular dysautonomia in fatal familial insomnia. Clin Auton Res 1:15–21

    Article  PubMed  CAS  Google Scholar 

  16. Fietze I, Glos M (2003) Baroreceptor sensitivity, sleep and OSAS. Somnologie 7:140–146

    Article  Google Scholar 

  17. Parati G, Di RM, Bonsignore MR et al (1997) Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J Hypertens 15:1621–1626

    Article  PubMed  CAS  Google Scholar 

  18. Cortelli P, Parchi P, Sforza E et al (1994) Cardiovascular autonomic dysfunction in normotensive awake subjects with obstructive sleep apnoea syndrome. Clin Auton Res 4:57–62

    Article  PubMed  CAS  Google Scholar 

  19. Parati G, Di RM, Mancia G (2000) How to measure baroreflex sensitivity: from the cardiovascular laboratory to daily life. J Hypertens 18:7–19

    PubMed  CAS  Google Scholar 

  20. Pitzalis MV, Mastropasqua F, Passantino A et al (1998) Comparison between non-invasive indices of baroreceptor sensitivity and the phenylephrine method in post-myocardial infarction patients. Circulation 97:1362–1367

    PubMed  CAS  Google Scholar 

  21. Pagani M, Somers V, Furlan R et al (1988) Changes in autonomic regulation induced by physical training in mild hypertension. Hypertension 12:600–610

    PubMed  CAS  Google Scholar 

  22. Pinna GD, Maestri R (2002) New criteria for estimating baroreflex sensitivity using the transfer function method. Med Biol Eng Comput 40:79–84

    Article  PubMed  CAS  Google Scholar 

  23. Pinna GD, Maestri R, Raczak G, La Rovere MT (2002) Measuring baroreflex sensitivity from the gain function between arterial pressure and heart period. Clin Sci (Lond) 103:81–88

    Article  Google Scholar 

  24. Laude D, Elghozi JL, Girard A et al (2004) Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study). Am J Physiol Regul Integr Comp Physiol 286:R226–R231

    Article  PubMed  CAS  Google Scholar 

  25. La Rovere MT, Pinna GD, Raczak G (2008) Baroreflex sensitivity: measurement and clinical implications. Ann Noninvasive Electrocardiol 13:191–207

    Article  PubMed  Google Scholar 

  26. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Washington DC: APA, 1994

  27. Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33

    PubMed  Google Scholar 

  28. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  PubMed  CAS  Google Scholar 

  29. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740

    Article  PubMed  Google Scholar 

  30. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  31. Fietze I, Diefenbach K (2003) Healthy sleepers are rare: problems and success rates in establishing a control group for sleep studies. Neuropsychopharmacology 28:558–561

    Article  PubMed  Google Scholar 

  32. Fietze I, Romberg D, Glos M et al (2004) Effects of positive-pressure ventilation on the spontaneous baroreflex in healthy subjects. J Appl Physiol 96:1155–1160

    Article  PubMed  Google Scholar 

  33. Penaz J (1973) Photoelectric measurement of blood pressure, volume and flow in the finger. Dresden, p 104

  34. Wesseling KH, De Wit B, van der Hoeven GM, van Goudoever J, Settels JJ (1995) Physiocal, calibrating finger vascular physiology for FINAPRES. Homeostasis 36:67–82

    Google Scholar 

  35. Parati G, Casadei R, Groppelli A, Di RM, Mancia G (1989) Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension 13:647–655

    PubMed  CAS  Google Scholar 

  36. Gizdulich P, Imholz BP, van den Meiracker AH, Parati G, Wesseling KH (1996) Finapres tracking of systolic pressure and baroreflex sensitivity improved by waveform filtering. J Hypertens 14:243–250

    Article  PubMed  CAS  Google Scholar 

  37. Glos M, Romberg D, Endres S, Fietze I (2007) Estimation of spontaneous baroreflex sensitivity using transfer function analysis: effects of positive pressure ventilation. Biomed Tech (Berl) 52:66–72

    Article  Google Scholar 

  38. Welch PD (1967) The use of fast fourier transform for the estimation of power spectra: a method based on time averaging over short, modified periodograms. IEEE Trans Audio Electroacoust AU- 15:70–73

    Article  Google Scholar 

  39. Task Force NASPE of the ESC (1996) 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. Eur Heart J 17:354–381

    Google Scholar 

  40. de Boer RW, Karemaker JM, Strackee J (1987) Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. Am J Physiol 253:H680–H689

    Google Scholar 

  41. Pitzalis MV, Mastropasqua F, Massari F et al (1998) Effect of respiratory rate on the relationships between RR-interval and systolic blood pressure fluctuations: a frequency-dependent phenomenon. Cardiovasc Res 38:332–339

    Article  PubMed  CAS  Google Scholar 

  42. Lucini D, Porta A, Milani O, Baselli G, Pagani M (2000) Assessment of arterial and cardiopulmonary baroreflex gains from simultaneous recordings of spontaneous cardiovascular and respiratory variability. J Hypertens 18:281–286

    Article  PubMed  CAS  Google Scholar 

  43. Lucini D, Guzzetti S, Casiraghi S, Pagani M (2002) Correlation between baroreflex gain and 24-h indices of heart rate variability. J Hypertens 20:1625–1631

    Article  PubMed  CAS  Google Scholar 

  44. Schary I, Glos M, Blau A, Fietze I (2005) Barorezeptorsensitivität bei Patienten mit primärem Schnarchen. Pneumologie 59[S1]

  45. Akerstedt T, Kecklund G, Axelsson J (2008) Subjective and objective quality of sleep. Somnologie 12:104–109

    Article  Google Scholar 

  46. Suka M, Yoshida K, Sugimori H (2003) Persistent insomnia is a predictor of hypertension in Japanese male workers. J Occup Health 45:344–350

    Article  PubMed  Google Scholar 

  47. Bonnet MH (2005) Hyperarousal as the basis for insomnia: effect size and significance. Sleep 28:1500–1501

    PubMed  Google Scholar 

  48. Varkevisser M, Van Dongen HP, Kerkhof GA (2005) Physiologic indexes in chronic insomnia during a constant routine: evidence for general hyperarousal? Sleep 28:1588–1596

    PubMed  Google Scholar 

  49. Varkevisser M, Van Dongen HP, Kerkhof GA (2006) Hyperarousal as a basis for chronic insomnia: statistical misconceptions and individual differences. Sleep 29:719

    PubMed  Google Scholar 

  50. Simon T, Becker R, Voss F et al (2008) Elevated B-type natriuretic peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res Cardiol 97:306–309

    Article  PubMed  CAS  Google Scholar 

  51. Smilde TD, van Veldhuisen DJ, van den Berg MP (2009) Prognostic value of heart rate variability and ventricular arrhythmias during 13-year follow-up in patients with mild to moderate heart failure. Clin Res Cardiol 98:233–239

    Article  PubMed  CAS  Google Scholar 

  52. Robbe HW, Mulder LJ, Ruddel H, Langewitz WA, Veldman JB, Mulder G (1987) Assessment of baroreceptor reflex sensitivity by means of spectral analysis. Hypertension 10:538–543

    PubMed  CAS  Google Scholar 

  53. Watkins LL, Grossman P, Sherwood A (1996) Non-invasive assessment of baroreflex control in borderline hypertension. Comparison with the phenylephrine method. Hypertension 28:238–243

    PubMed  CAS  Google Scholar 

  54. Persson PB, DiRienzo M, Castiglioni P et al (2001) Time versus frequency domain techniques for assessing baroreflex sensitivity. J Hypertens 19:1699–1705

    Article  PubMed  CAS  Google Scholar 

  55. Pinna GD, Maestri R, Capomolla S et al (2005) Applicability and clinical relevance of the transfer function method in the assessment of baroreflex sensitivity in heart failure patients. J Am Coll Cardiol 46:1314–1321

    Article  PubMed  Google Scholar 

  56. Wang W, Tretriluxana S, Redline S, Surovec S, Gottlieb DJ, Khoo MC (2008) Association of cardiac autonomic function measures with severity of sleep-disordered breathing in a community-based sample. J Sleep Res 17:251–262

    Article  PubMed  Google Scholar 

  57. Buob A, Winter H, Kindermann M et al (2010) Parasympathetic but not sympathetic cardiac dysfunction at early stages of Parkinson’s disease. Clin Res Cardiol 99:701–706

    Article  PubMed  Google Scholar 

  58. Kardos A, Watterich G, de MR, Csanady M, Casadei B, Rudas L (2001) Determinants of spontaneous baroreflex sensitivity in a healthy working population. Hypertension 37:911–916

    PubMed  CAS  Google Scholar 

  59. Moul DE, Nofzinger EA, Pilkonis PA, Houck PR, Miewald JM, Buysse DJ (2002) Symptom reports in severe chronic insomnia. Sleep 25:553–563

    PubMed  Google Scholar 

Download references

Acknowledgments

This study has been funded by Charite university resources.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Sleep Medicine Center, CCM-CC13, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Jan Giso Peter, Martin Glos, Alexander Blau, Thomas Penzel & Ingo Fietze

  2. Clinic of Cardiology and Angiology, CCM-CC13, Charité Universitätsmedizin Berlin, Berlin, Germany

    Gert Baumann

Authors
  1. Jan Giso Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Glos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Blau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Penzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gert Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingo Fietze
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Glos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Peter, J.G., Glos, M., Blau, A. et al. Daytime baroreflex sensitivity in patients with primary insomnia. Clin Res Cardiol 100, 351–358 (2011). https://doi.org/10.1007/s00392-010-0253-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-010-0253-4

Keywords

Search

Navigation