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Respiratory effort-related arousals contribute to sympathetic modulation of heart rate variability

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Abstract

Purpose

Sympathetic activation induced by sleep-disordered breathing may contribute to cardiovascular morbidity. However, the apnea–hypopnea index (AHI) excludes respiratory effort-related arousals (RERAs) associated with inspiratory flow limitation without oxygen desaturation. We sought to determine whether RERAs are associated with sympathetic activation.

Methods

Twenty-five adults (12 males, 13 females) with AHI < 10/h and RERA index >5/h were included in this study. Power spectral density analysis was performed on two non-contiguous 10-min segments containing inspiratory flow limitation and arrhythmia-free electrocardiogram during N2 sleep. One segment contained RERA; the other did not, NO-RERA. Spectral power was described in a low-frequency domain (LF; 0.04–0.15 Hz), primarily sympathetic modulation, and a high frequency domain (HF; 0.15–0.4 Hz), parasympathetic modulation.

Results

Analyses of LF and HF powers were made using normalized and absolute values. LF power was greater during RERA compared to NO-RERA (50.3 vs. 30.1 %, p < 0.001) whereas HF power was greater during NO-RERA compared to RERA (69.9 vs. 49.7 %, p < 0.001). The LF/HF ratio was greater during RERA than NO-RERA (1.01 vs. 0.43, p < 0.001). Gender differences emerged using absolute values of power: The percentage increase in LF power during RERA relative to NO-RERA was significantly greater for females than males, 247.6 vs. 31.9 %, respectively (p < 0.02).

Conclusions

RERAs are associated with a marked increase in cardiac sympathetic modulation, especially in females. Patients with a high RERA index, even in the setting of a low or normal AHI, may be exposed to elevated sympathetic tone during sleep.

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Conflicts of interest

None of the authors report any conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Subani Chandra

  2. Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, 410 Lakeville Rd., Suite 107, New Hyde Park, NY, 11042, USA

    Anthony L. Sica, Janice Wang, Viera Lakticova & Harly E. Greenberg

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  1. Subani Chandra
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  2. Anthony L. Sica
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  3. Janice Wang
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  4. Viera Lakticova
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  5. Harly E. Greenberg
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Corresponding author

Correspondence to Harly E. Greenberg.

Additional information

Work was performed at North Shore LIJ Sleep Disorders Center, Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.

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Chandra, S., Sica, A.L., Wang, J. et al. Respiratory effort-related arousals contribute to sympathetic modulation of heart rate variability. Sleep Breath 17, 1193–1200 (2013). https://doi.org/10.1007/s11325-013-0823-6

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  • DOI: https://doi.org/10.1007/s11325-013-0823-6

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