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
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