Effect of Objective Daytime Sleepiness on Heart Rate Variability in Patients With Obstructive Sleep Apnea

ZHANG Meng-qi , REN Rong, ZHANG Ye, SHI Yuan, ZHU Jie, TAN Lu, LI Tao-mei, TANG Xiang-dong

Abstract

Excessive daytime sleepiness (EDS) is associated with cardiovascular events in patients with obstructive sleep apnea (OSA). Our study explored the correlation between objective daytime sleepiness assessed with daytime multiple sleep latency tests (MSLT) and heart rate variability (HRV) in OSA patients. The results may provide insight into possible mechanisms underlying increased risk of cardiovascular events in patients with OSA.  Methods  A retrospective analysis was conducted with the data of 139 patients with OSA and 35 patients with primary snoring. All subjects underwent polysomnography (PSG) and MSLT at West China Hospital between January 2019 and May 2022. We used mean sleep latency (MSL) to measure the severity of EDS and to categorize OSA patients into three groups, severe EDS, light EDS, and non-EDS, with MSL of less than 5 minutes, 5 to 10 minutes, and greater than 10 minutes as the respective defining criteria for classification. A comparison of sleep structure, clinical characteristics, and HRV parameters was performed in order to evaluate the difference between OSA subgroups with varying levels of objective EDS and the primary snoring group. In addition, we also analyzed the correlation between MSL and HRV parameters.   Results  Severe EDS patients had higher values of standard deviation of all N–N intervals (SDNN), total spectral power (TOT), and low-frequency power (LF) as compared to non-EDS patients, which was indicative of sympathetic stimulation (P<0.05). Additionally, high-frequency power (HF) was also higher in severe EDS patients, which indicated decreased parasympathetic drive. A significantly positive correlation was found between MSL and the values of SDNN, TOT, LF, and HF in OSA patients.  Conclusion  OSA patients with objective EDS have elevated sympathetic drive and decreased parasympathetic drive. A positive correlation was found between this change in neural activity and the shortening of MSL.

 

Keywords: Heart rate variability, Obstructive sleep apnea, Excessive daytime sleepiness, Multiple sleep latency test


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References


CHEN X， WANG R， ZEE P， et al. Racial/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep， 2015，38(6): 877–888. doi: 10.5665/sleep.4732.

DEMPSEY J A， VEASEY S C， MORGAN B J， et al. Pathophysiology of sleep apnea. Physiol Rev，2010，90(1): 47–112. doi: 10.1152/physrev. 00043.2008.

KAPUR V K， BALDWIN C M， RESNICK H E， et al. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep，2005， 28: 472–477. doi: 10.1093/sleep/28.4.472.

SOMERS V K， WHITED P， AMIN R， 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. J Am Coll Cardiol，2008，52(8): 686–717. doi: 10.1016/j.jacc.2008.05.002.

JAVAHERI S， BARBE F， CAMPOS-RODRIGUEZ F， et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol，2017，69(7): 841–858. doi: 10.1016/j.jacc.2016.11.069.

PUNJABI N M， CAFFO B S， GOODWIN J L， et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med，2009， 6(8): e1000132. doi: 10.1371/journal.pmed.1000132.

PUNJABI N M. The epidemiology of adultobstructive sleep apnea. Proc Am Thorac Soc，2008，5(2): 136–143. doi: 10.1513/pats.200709-155MG.

JOHNS M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep，1991，14: 540–545. doi: 10.1093/sleep/14. 6.540.

ARAND D L， BONNET M H. The multiple sleep latency test. Handb Clin Neurol，2019，160: 393–403. doi: 10.1016/B978-0-444-64032-1. 00026-6.

REN R， LI Y， ZHANG J， et al. Obstructive sleep apnea with objective daytime sleepiness is associated with hypertension. Hypertension，2016， 68(5): 1264–1270. doi: 10.1161/HYPERTENSIONAHA.115.06941.

NARKIEWICZ K， MONTANO N， COGLIATI C， et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation，1998， 98(11): 1071–1077. doi: 10.1161/01.cir.98.11.1071.

UCAK S， DISSANAYAKE H U， SUTHERLAND K， et al. Heart rate variability and obstructive sleep apnea: current perspectives and novel technologies. J Sleep Res，2021，30(4): e13274. doi: 10.1111/jsr.13274.

FANG S C， WU Y L， TSAI P S. Heart rate variability and risk of all-cause death and cardiovascular events in patients with cardiovascular disease: a meta-analysis of cohort studies. Biol Res Nurs，2020，22(1): 45–56. doi: 10. 1177/1099800419877442.

AZARBARZIN A， SANDS S A， STONE K L， et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J，2019，40(14): 1149–1157. doi: 10.1093/eurheartj/ehy624.

CARSKADON M A， DEMENT W C， MITLER M M， et al. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep，1986，9(4): 519–524. doi: 10.1093/sleep/9.4.519. BERRY R B， BROOKS R， GAMALDO C， et al. AASM scoring manual updates for 2017 (Version 2.4). J Clin Sleep Med，2017，13(5): 665–666. doi: 10.5664/jcsm.6576.


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