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1 Respiratory Medicine, University of Edinburgh, and 2 Dynesys Ltd, Edinburgh, UK. 3 Sleep Laboratory, Charite, Humboldt University, Berlin, Germany
CORRESPONDENCE: N.J. Douglas, Respiratory Medicine, Royal Infirmary, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Fax: 44 1312421776. E-mail: n.j.douglas@ed.ac.uk
Keywords: cardiovascular disease, heart rate variability, sleep apnoea
Received: October 24, 2002
Accepted August 28, 2003
K. Dingli was supported by a Research Fellowship from the European Respiratory Society.
A recent study has shown that daytime heart rate variability is reduced in obstructive sleep apnoea/hypopnoea syndrome (OSAHS) patients. In the present study, the hypothesis was that sympathovagal balance around apnoeas/hypopnoeas and nocturnal autonomic activity are altered in OSAHS patients.
Frequency- and time-domain analyses of RR intervals were performed to monitor sympathovagal activity noninvasively. Fourteen untreated OSAHS patients and seven healthy subjects underwent overnight polysomnography.
Low (LF) and total (TF) frequency power increased 2 min around the end of apnoeas/hypopnoeas (LF 229±38 ms2, TF 345±45 ms2) compared with undisturbed sleep (LF 106±18 ms2, TF 203±23 ms2). The increase in high frequency (HF) power was not significant. LF increase was proportionally higher than the HF increase (normalised LF (LFn) 67±1 units, normalised HF (HFn) 33±1 units) compared with undisturbed sleep (LFn 52±2 units, HFn 48±2 units). RR duration did not change around apnoeas/hypopnoeas (RR 904±28 ms). The LF and TF power increase was greater around arousal-inducing (LF 260±45 ms2, TF 390±65 ms2) compared with self-terminating (LF 161±31 ms2, TF 249±40 ms2) apnoeas/hypopnoeas; the LF and LFn increases were significant in both groups compared with undisturbed sleep and HF power differences were nonsignificant. RR intervals were longer around self-terminating apnoeas/hypopnoeas (RR 914±29 ms); the differences were not significant compared with undisturbed sleep. RR interval spectral power was not influenced by the event type. RR duration decreased (912±28 ms) and LF, HF and TF power increased (LF 111±16 ms2, HF 62±6 ms2, TF 173±21 ms2) across patients, compared with healthy controls (RR 1138±91 ms, LF 57±3 ms2, HF 35±3 ms2, TF 91±6 ms2). LFn and HFn did not change significantly.
Sympathetic activity increases around apnoeas/hypopnoeas. The recurrent nocturnal fluctuations of sympathovagal balance and the overall increase of nocturnal autonomic activity may be of importance in the development of cardiovascular disease in sleep apnoea patients.
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