From the Departments of Internal Medicine (K.N., P.J.H. v. d. B., V.K.S.)
and Neurology (M.E.D.), Cardiovascular Division, University of Iowa, Iowa
City, and Centro L.I.T.A.-Vialba (N.M., C.C.), Centro Ricerche
Cardiovascolari, CNR, Medicina Interna II, Ospedalè "L.
Sacco", Università degli Studi di Milano (Italy).
Correspondence to Virend Somers, MD, PhD, Department of Internal Medicine, Cardiovascular Division, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail virend-somers{at}uiowa.edu
Background—Altered
cardiovascular variability is a prognostic indicator
for cardiovascular events. Patients with obstructive
sleep apnea (OSA) are at an increased risk for
cardiovascular disease. We tested the hypothesis that
OSA is accompanied by alterations in cardiovascular
variability, even in the absence of overt cardiovascular
disease.
Methods and Results—Spectral analysis of variability of
muscle sympathetic nerve activity, RR interval, and blood pressure were
obtained during undisturbed supine rest in 15 patients with
moderate-to-severe OSA, 18 patients with mild OSA, and 16 healthy
control subjects in whom sleep disordered breathing was excluded by
complete overnight polysomnography. Patients with OSA were newly
diagnosed, never treated for OSA, and free of any other known diseases.
Patients with moderate-to-severe OSA had shorter RR intervals (793±27
ms) and increased sympathetic burst frequency (49±4 bursts/min)
compared with control subjects (947±42 ms; 24±3 bursts/min;
P=0.008 and P<0.001, respectively). In
these patients, total variance of RR was reduced
(P=0.01) and spectral analysis of RR variability
showed an increase in low frequency normalized units, a decrease
in high frequency normalized units, and an increase in the ratio of low
to high frequency (all P<0.05). Even though blood
pressure was similar to that of the control subjects, blood pressure
variance in patients with moderate-to-severe OSA was more than double
the variance in control subjects (P=0.01). Patients with
mild OSA also had a reduction in RR variance (P=0.02) in
the absence of any significant difference in absolute RR interval. For
all patients with OSA, linear regression showed a positive correlation
(r=0.40; P=0.02) between sleep apnea
severity and blood pressure variance.
Conclusions—Cardiovascular variability is altered
in patients with OSA. This alteration is evident even in the absence of
hypertension, heart failure, or other disease states and may be linked
to the severity of OSA. Abnormalities in cardiovascular
variability may be implicated in the subsequent development of overt
cardiovascular disease in patients with OSA.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Altered Cardiovascular Variability in Obstructive Sleep Apnea
Key Words: nervous system, autonomic • nervous system, sympathetic • sleep • blood pressure • heart rate
This article has been cited by other articles:
 |
|
 |
|
  V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. 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 In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rey, M. P. Tarvainen, P. A. Karjalainen, and R. Iturriaga Dynamic time-varying analysis of heart rate and blood pressure variability in cats exposed to short-term chronic intermittent hypoxia Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2008; 295(1): R28 - R37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Lopez-Jimenez, F. H. Sert Kuniyoshi, A. Gami, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease Chest, March 1, 2008; 133(3): 793 - 804. [Full Text] [PDF]
|
|
|
|
|
|
R. E. Maser, M. J. Lenhard, A. A. Rizzo, and A. A. Vasile Continuous Positive Airway Pressure Therapy Improves Cardiovascular Autonomic Function for Persons With Sleep-Disordered Breathing Chest, January 1, 2008; 133(1): 86 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Parati, C. Lombardi, and K. Narkiewicz Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1671 - R1683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-C. P. Arai, M. Nakayama, N. Kato, Y. Wakao, H. Ito, and T. Komatsu The Effects of Jaw Thrust and the Lateral Position on Heart Rate Variability in Anesthetized Children with Obstructive Sleep Apnea Syndrome Anesth. Analg., June 1, 2007; 104(6): 1352 - 1355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Coruzzi, M. Gualerzi, E. Bernkopf, L. Brambilla, V. Brambilla, V. Broia, C. Lombardi, and G. Parati Autonomic Cardiac Modulation in Obstructive Sleep Apnea: Effect of an Oral Jaw-Positioning Appliance. Chest, November 1, 2006; 130(5): 1362 - 1368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Jurysta, J.-P. Lanquart, P. van de Borne, P.-F. Migeotte, M. Dumont, J.-P. Degaute, and P. Linkowski The link between cardiac autonomic activity and sleep delta power is altered in men with sleep apnea-hypopnea syndrome Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2006; 291(4): R1165 - R1171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Sumi, K. Chin, K. Takahashi, T. Nakamura, H. Matsumoto, A. Niimi, and M. Mishima Effect of nCPAP therapy on heart rate in patients with obstructive sleep apnoea-hypopnoea QJM, August 1, 2006; 99(8): 545 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Arzt and T. D. Bradley Treatment of Sleep Apnea in Heart Failure Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1300 - 1308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Campos-Rodriguez, A. Grilo-Reina, J. Perez-Ronchel, M. Merino-Sanchez, M. A. Gonzalez-Benitez, M. Beltran-Robles, and C. Almeida-Gonzalez Effect of Continuous Positive Airway Pressure on Ambulatory BP in Patients With Sleep Apnea and Hypertension: A Placebo-Controlled Trial Chest, June 1, 2006; 129(6): 1459 - 1467. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. K. Soukhova-O'Hare, Z. Cheng, A. M. Roberts, and D. Gozal Postnatal intermittent hypoxia alters baroreflex function in adult rats Am J Physiol Heart Circ Physiol, March 1, 2006; 290(3): H1157 - H1164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Selic, M. M. Siccoli, D. M. Hermann, and C. L. Bassetti Blood Pressure Evolution After Acute Ischemic Stroke in Patients With and Without Sleep Apnea Stroke, December 1, 2005; 36(12): 2614 - 2618. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Focus, October 1, 2005; 3(4): 557 - 567. [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Gami, D. E. Howard, E. J. Olson, and V. K. Somers Day-Night Pattern of Sudden Death in Obstructive Sleep Apnea N. Engl. J. Med., March 24, 2005; 352(12): 1206 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Jo, A. Blasi, E. Valladares, R. Juarez, A. Baydur, and M. C. K. Khoo Determinants of heart rate variability in obstructive sleep apnea syndrome during wakefulness and sleep Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1103 - H1112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Ann Intern Med, February 1, 2005; 142(3): 187 - 197. [Full Text] [PDF]
|
|
|
|
|
|
C. Cogliati, S. Colombo, T. G. Ruscone, D. Gruosso, A. Porta, N. Montano, A. Malliani, and R. Furlan Acute {beta}-Blockade Increases Muscle Sympathetic Activity and Modifies Its Frequency Distribution Circulation, November 2, 2004; 110(18): 2786 - 2791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rey, R. Del Rio, J. Alcayaga, and R. Iturriaga Chronic intermittent hypoxia enhances cat chemosensory and ventilatory responses to hypoxia J. Physiol., October 15, 2004; 560(2): 577 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Iellamo, F. Placidi, M. G. Marciani, A. Romigi, M. Tombini, S. Aquilani, M. Massaro, A. Galante, and J. M. Legramante Baroreflex Buffering of Sympathetic Activation During Sleep: Evidence From Autonomic Assessment of Sleep Macroarchitecture and Microarchitecture Hypertension, April 1, 2004; 43(4): 814 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Dingli, T. Assimakopoulos, P.K. Wraith, I. Fietze, C. Witt, and N.J. Douglas Spectral oscillations of RR intervals in sleep apnoea/hypopnoea syndrome patients Eur. Respir. J., December 1, 2003; 22(6): 943 - 950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wolk, A. S.M. Shamsuzzaman, and V. K. Somers Obesity, Sleep Apnea, and Hypertension Hypertension, December 1, 2003; 42(6): 1067 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. M. Shamsuzzaman, B. J. Gersh, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease JAMA, October 8, 2003; 290(14): 1906 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Harrington, T. Kirjavainen, A. Teng, and C. E. Sullivan nCPAP improves abnormal autonomic function in at-risk-for-SIDS infants with OSA J Appl Physiol, October 1, 2003; 95(4): 1591 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part II: Central Sleep Apnea Circulation, April 8, 2003; 107(13): 1822 - 1826. [Full Text] [PDF]
|
|
|
|
|
|
T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part I: Obstructive Sleep Apnea Circulation, April 1, 2003; 107(12): 1671 - 1678. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Jo, A. Blasi, E. Valladares, R. Juarez, A. Baydur, and M. C. K. Khoo Model-based Assessment of Autonomic Control in Obstructive Sleep Apnea Syndrome during Sleep Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 128 - 136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Planes, M. Leroy, G. Fayet, P. Aegerter, A. Foucher, and B. Raffestin Exacerbation of sleep-apnoea related nocturnal blood-pressure fluctuations in hypertensive subjects Eur. Respir. J., July 1, 2002; 20(1): 151 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Harrington, T. Kirjavainen, A. Teng, and C. E. Sullivan Altered Autonomic Function and Reduced Arousability in Apparent Life-Threatening Event Infants with Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1048 - 1054. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Bijaoui, V. Champagne, P. F. Baconnier, R. J. Kimoff, and J. H. T. Bates Mechanical Properties of the Lung and Upper Airways in Patients with Sleep-disordered Breathing Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1055 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Garrigue, P. Bordier, P. Jais, D. C. Shah, M. Hocini, C. Raherison, M. Tunon De Lara, M. Haissaguerre, and J. Clementy Benefit of Atrial Pacing in Sleep Apnea Syndrome N. Engl. J. Med., February 7, 2002; 346(6): 404 - 412. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Belozeroff, R. B. Berry, C. S. H. Sassoon, and M. C. K. Khoo Effects of CPAP therapy on cardiovascular variability in obstructive sleep apnea: a closed-loop analysis Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H110 - H121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. T. LEUNG and T. DOUGLAS BRADLEY Sleep Apnea and Cardiovascular Disease Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165. [Full Text] [PDF]
|
|
|
|
|
|
M. C. K. KHOO, V. BELOZEROFF, R. B. BERRY, and C. S. H. SASSOON Cardiac Autonomic Control in Obstructive Sleep Apnea . Effects of Long-term CPAP Therapy Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 807 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.F. Hilton, M.J. Chappell, W.A. Bartlett, A. Malhotra, J.M. Beattie, and R.M. Cayton The sleep apnoea/hypopnoea syndrome depresses waking vagal tone independent of sympathetic activation Eur. Respir. J., June 1, 2001; 17(6): 1258 - 1266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Nelesen, H. Yu, M. G. Ziegler, P. J. Mills, J. L. Clausen, and J. E. Dimsdale Continuous Positive Airway Pressure Normalizes Cardiac Autonomic and Hemodynamic Responses to a Laboratory Stressor in Apneic Patients Chest, April 1, 2001; 119(4): 1092 - 1101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E C FLETCHER Hypertension in patients with sleep apnoea, a combined effect? Thorax, September 1, 2000; 55(9): 726 - 728. [Full Text]
|
|
|
|
|
|
S. Teramoto, T. Matsuse, Y. Ouchi, K. Narkiewicz, P. van de Borne, M. E. Dyken, N. Montano, C. Cogliati, and V. K. Somers Does the Altered Cardiovascular Variability Associated With Obstructive Sleep Apnea Contribute to Development of Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome? • Response Circulation, December 21, 1999; 100 (25): e136 - e137. [Full Text] [PDF]
|
|
|
|
|
|
K. Narkiewicz, M. Kato, B. G. Phillips, C. A. Pesek, D. E. Davison, and V. K. Somers Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea Circulation, December 7, 1999; 100(23): 2332 - 2335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Roche, J.-M. Gaspoz, I. Court-Fortune, P. Minini, V. Pichot, D. Duverney, F. Costes, J.-R. Lacour, and J.-C. Barthelemy Screening of Obstructive Sleep Apnea Syndrome by Heart Rate Variability Analysis Circulation, September 28, 1999; 100(13): 1411 - 1415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C. Fletcher, G. Bao, and R. Li Renin Activity and Blood Pressure in Response to Chronic Episodic Hypoxia Hypertension, August 1, 1999; 34(2): 309 - 314. [Abstract] [Full Text] [PDF]
|
|