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Influence of obstructive sleep apnea on heart rate turbulence

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Abstract

Background

Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both heart rate turbulence (HRT) and heart rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep–disordered breathing (SDB) on HRT and HRV in patients with OSA.

Methods

Sixty–five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.–6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta–blockers or theophylline were excluded. According to the apnea–hypopnea index (AHI), the patients were assigned to group A (AHI <20, n = 31) or group B (AHI ≥20, n = 34). HRV (time domain, frequency domain) and HRT (onset, slope) were then related to the severity of SDB.

Results

Nighttime turbulence slope (TS) correlated inversely with the AHI (r = –0.45, p = 0.01) and was significantly lower in group B (8.9 ± 1.6 ms/R–R interval) compared with that in group A (19.8 ± 4.0 ms/R–R interval, P = 0.01). This relationship remained stable after adjusting TS for the number of ventricular premature contractions. No significant differences in turbulence onset or parameters of nighttime HRV were observed.

Conclusions

Alterations in nighttime HRT correlate with the severity of SDB, indicating abnormalities in cardiac autonomic activity in moderate–to–severe OSA even in the absence of overt cardiac disease. These changes may be associated with the subsequent development of cardiovascular disease.

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Abbreviations

AHI :

= apnea–hypopnea index

HF:

= high frequency

HRT:

= heart rate turbulence

HRV:

= heart rate variability

LF:

= low frequency

OSA:

= obstructive sleep apnea

pNN 50:

= number of pairs of adjacent R–R intervals differing by more than 50 ms, divided by the total number of all NN intervals

rMSSD:

= square root of the mean of the sum of squared differences of successive R–R intervals

SDANN:

= standard deviation of the averages of R–R intervals in all 5–minute segments of the entire recording

SDB:

= sleep–disordered breathing

SDNN:

= standard deviation of all R–R intervals

TO:

= turbulence onset

TP:

= total power

TS s:

= turbulence slope

VLF:

= very low frequency

VPC:

= ventricular premature contraction

vTS:

= turbulence slope adjusted for the number of VPC

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Authors and Affiliations

  1. Dept. of Medicine II, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    A. Yang MD, R. Manka MD, R. Andrié MD, J. O. Schwab MD, T. Lewalter MD, FESC, B. Lüderitz MD, FACC, FESC, FAHA & S. Tasci MD

  2. Dept. of Pneumology, Klinikum Saarbrücken, Saarbrücken, Germany

    H. Schäfer MD

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  1. A. Yang MD
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  2. H. Schäfer MD
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Yang, A., Schäfer, H., Manka, R. et al. Influence of obstructive sleep apnea on heart rate turbulence. Basic Res Cardiol 100, 439–445 (2005). https://doi.org/10.1007/s00395-005-0536-5

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  • DOI: https://doi.org/10.1007/s00395-005-0536-5

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