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Statello R, Rossi S, Pisani F, Bonzini M, Andreoli R, Martini A, Puligheddu M, Cocco P, Miragoli M. Nocturnal Heart Rate Variability Might Help in Predicting Severe Obstructive Sleep-Disordered Breathing. BIOLOGY 2023; 12:biology12040533. [PMID: 37106734 PMCID: PMC10135696 DOI: 10.3390/biology12040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Obstructive sleep apnea (OSA) can have long-term cardiovascular and metabolic effects. The identification of OSA-related impairments would provide diagnostic and prognostic value. Heart rate variability (HRV) as a measure of cardiac autonomic regulation is a promising candidate marker of OSA and OSA-related conditions. We took advantage of the Physionet Apnea-ECG database for two purposes. First, we performed time- and frequency-domain analysis of nocturnal HRV on each recording of this database to evaluate the cardiac autonomic regulation in patients with nighttime sleep breathing disorders. Second, we conducted a logistic regression analysis (backward stepwise) to identify the HRV indices able to predict the apnea–hypopnea index (AHI) categories (i.e., “Severe OSA”, AHI ≥ 30; “Moderate-Mild OSA”, 5 ≥ AHI < 30; and “Normal”, AHI < 5). Compared to the “Normal”, the “Severe OSA” group showed lower high-frequency power in normalized units (HFnu) and higher low-frequency power in normalized units (LFnu). The standard deviation of normal R–R intervals (SDNN) and the root mean square of successive R–R interval differences (RMSSD) were independently associated with sleep-disordered breathing. Our findings suggest altered cardiac autonomic regulation with a reduced parasympathetic component in OSA patients and suggest a role of nighttime HRV in the characterization and identification of sleep breathing disorders.
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Onanga M, Joanny S, Rivals I, Perger E, Arnulf I, Redolfi S, Sevoz-Couche C. Screening of obstructive sleep apnea syndrome by the deep breathing technique. J Clin Sleep Med 2023; 19:293-302. [PMID: 36148620 PMCID: PMC9892745 DOI: 10.5664/jcsm.10314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea syndrome (OSAS) is associated with alterations in heart rate variability (HRV) in relation to chronic autonomic dysfunction. We tested the ability of the deep breathing technique-a simple way to evaluate HRV-to identify patients with OSAS. METHODS Consecutive patients referred for suspected OSAS (without obesity, diabetes, and heart diseases) were included. They underwent a measure of HRV at rest and of heart rate oscillations during expiration vs inspiration (DeltaHRDB) when breathing deeply at the resonant frequency of 6 cycles per minute (deep breathing technique) while sitting awake, followed by a nighttime polysomnography. We measured DeltaHRDB and performed temporal and spectral HRV analysis. RESULTS Of 31 included participants (77% male), 14 had mild to moderate OSAS (apnea-hypopnea index median [IQR]: 18 [12]) and 17 had no OSAS. The conventional HRV analysis did not reveal any difference between the groups with vs without OSAS. However, the DeltaHRDB was lower in those with than without OSAS. Lower DeltaHRDB correlated with higher apnea-hypopnea index, arousal index, and desaturation degree. A DeltaHRDB below 11 beats per minute (bpm) predicted OSAS with a sensitivity of 100% and specificity of 86%. CONCLUSIONS The deep breathing technique accurately identifies a reduction in cardiac changes in patients with mild to moderate OSAS. It could be used as a simple screening tool to select patients for polysomnography. CITATION Onanga M, Joanny S, Rivals I, et al. Screening of obstructive sleep apnea syndrome by the deep breathing technique. J Clin Sleep Med. 2023;19(2):293-302.
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Affiliation(s)
- Mwetty Onanga
- Assistance Publique- Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire APHP–Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
| | - Sarah Joanny
- Assistance Publique- Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire APHP–Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
| | - Isabelle Rivals
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Equipe de Statistique Appliquée, École supérieure de physique et de chimie industrielles de la ville de Paris (ESPCI), Paris, Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Elisa Perger
- Assistance Publique- Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire APHP–Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
| | - Isabelle Arnulf
- Assistance Publique- Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire APHP–Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
- Sorbonne Université, Pitié Salpêtrière Hospital, Institut du Cerveau et de la Moelle, Paris, France
| | - Stefania Redolfi
- Assistance Publique- Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire APHP–Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Caroline Sevoz-Couche
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Qin H, Steenbergen N, Glos M, Wessel N, Kraemer JF, Vaquerizo-Villar F, Penzel T. The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea. Front Psychiatry 2021; 12:642333. [PMID: 34366907 PMCID: PMC8339263 DOI: 10.3389/fpsyt.2021.642333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan F. Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Saratov State University, Russian Federation, Saratov, Russia
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Álvarez D, Arroyo CA, de Frutos JF, Crespo A, Cerezo-Hernández A, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Barroso-García V, Moreno F, Ruiz T, Hornero R, del Campo F. Assessment of Nocturnal Autonomic Cardiac Imbalance in Positional Obstructive Sleep Apnea. A Multiscale Nonlinear Approach. ENTROPY (BASEL, SWITZERLAND) 2020; 22:E1404. [PMID: 33322747 PMCID: PMC7764670 DOI: 10.3390/e22121404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
Positional obstructive sleep apnea (POSA) is a major phenotype of sleep apnea. Supine-predominant positional patients are frequently characterized by milder symptoms and less comorbidity due to a lower age, body mass index, and overall apnea-hypopnea index. However, the bradycardia-tachycardia pattern during apneic events is known to be more severe in the supine position, which could affect the cardiac regulation of positional patients. This study aims at characterizing nocturnal heart rate modulation in the presence of POSA in order to assess potential differences between positional and non-positional patients. Patients showing clinical symptoms of suffering from a sleep-related breathing disorder performed unsupervised portable polysomnography (PSG) and simultaneous nocturnal pulse oximetry (NPO) at home. Positional patients were identified according to the Amsterdam POSA classification (APOC) criteria. Pulse rate variability (PRV) recordings from the NPO readings were used to assess overnight cardiac modulation. Conventional cardiac indexes in the time and frequency domains were computed. Additionally, multiscale entropy (MSE) was used to investigate the nonlinear dynamics of the PRV recordings in POSA and non-POSA patients. A total of 129 patients (median age 56.0, interquartile range (IQR) 44.8-63.0 years, median body mass index (BMI) 27.7, IQR 26.0-31.3 kg/m2) were classified as POSA (37 APOC I, 77 APOC II, and 15 APOC III), while 104 subjects (median age 57.5, IQR 49.0-67.0 years, median BMI 29.8, IQR 26.6-34.7 kg/m2) comprised the non-POSA group. Overnight PRV recordings from positional patients showed significantly higher disorderliness than non-positional subjects in the smallest biological scales of the MSE profile (τ = 1: 0.25, IQR 0.20-0.31 vs. 0.22, IQR 0.18-0.27, p < 0.01) (τ = 2: 0.41, IQR 0.34-0.48 vs. 0.37, IQR 0.29-0.42, p < 0.01). According to our findings, nocturnal heart rate regulation is severely affected in POSA patients, suggesting increased cardiac imbalance due to predominant positional apneas.
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Affiliation(s)
- Daniel Álvarez
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - C. Ainhoa Arroyo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Julio F. de Frutos
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Andrea Crespo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Ana Cerezo-Hernández
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Verónica Barroso-García
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Tomás Ruiz
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Félix del Campo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
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Baty F, Boesch M, Widmer S, Annaheim S, Fontana P, Camenzind M, Rossi RM, Schoch OD, Brutsche MH. Classification of Sleep Apnea Severity by Electrocardiogram Monitoring Using a Novel Wearable Device. SENSORS 2020; 20:s20010286. [PMID: 31947905 PMCID: PMC6983183 DOI: 10.3390/s20010286] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
Sleep apnea (SA) is a prevalent disorder diagnosed by polysomnography (PSG) based on the number of apnea–hypopnea events per hour of sleep (apnea–hypopnea index, AHI). PSG is expensive and technically complex; therefore, its use is rather limited to the initial diagnostic phase and simpler devices are required for long-term follow-up. The validity of single-parameter wearable devices for the assessment of sleep apnea severity is still debated. In this context, a wearable electrocardiogram (ECG) acquisition system (ECG belt) was developed and its suitability for the classification of sleep apnea severity was investigated using heart rate variability analysis with or without data pre-filtering. Several classification algorithms were compared and support vector machine was preferred due to its simplicity and overall performance. Whole-night ECG signals from 241 patients with a suspicion of sleep apnea were recorded using both the ECG belt and patched ECG during PSG recordings. 65% of patients had an obstructive sleep apnea and the median AHI was 21 [IQR: 7–40] h−1. The classification accuracy obtained from the ECG belt (accuracy: 72%, sensitivity: 70%, specificity: 74%) was comparable to the patched ECG (accuracy: 74%, sensitivity: 88%, specificity: 61%). The highest classification accuracy was obtained for the discrimination between individuals with no or mild SA vs. moderate to severe SA. In conclusion, the ECG belt provided signals comparable to patched ECG and could be used for the assessment of sleep apnea severity, especially during follow-up.
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Affiliation(s)
- Florent Baty
- Cantonal Hospital St. Gallen, Lung Center, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland; (M.B.); (S.W.); (O.D.S.); (M.H.B.)
- Correspondence:
| | - Maximilian Boesch
- Cantonal Hospital St. Gallen, Lung Center, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland; (M.B.); (S.W.); (O.D.S.); (M.H.B.)
| | - Sandra Widmer
- Cantonal Hospital St. Gallen, Lung Center, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland; (M.B.); (S.W.); (O.D.S.); (M.H.B.)
| | - Simon Annaheim
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (S.A.); (P.F.); (M.C.); (R.M.R.)
| | - Piero Fontana
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (S.A.); (P.F.); (M.C.); (R.M.R.)
| | - Martin Camenzind
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (S.A.); (P.F.); (M.C.); (R.M.R.)
| | - René M. Rossi
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (S.A.); (P.F.); (M.C.); (R.M.R.)
| | - Otto D. Schoch
- Cantonal Hospital St. Gallen, Lung Center, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland; (M.B.); (S.W.); (O.D.S.); (M.H.B.)
| | - Martin H. Brutsche
- Cantonal Hospital St. Gallen, Lung Center, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland; (M.B.); (S.W.); (O.D.S.); (M.H.B.)
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Efazati N, Rahimi B, Mirdamadi M, Edalatifard M, Tavoosi A. Changes in heart rate variability (HRV) in patients with severe and moderate obstructive sleep apnea before and after acute CPAP therapy during nocturnal polysomnography. Sleep Sci 2020; 13:97-102. [PMID: 32742578 PMCID: PMC7384525 DOI: 10.5935/1984-0063.20200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea is an important risk factor for cardiovascular disease. Noninvasive positive pressure ventilation is the standard treatment of this disease, and it can reduce mortality in patients. Dysfunction of the autonomic system is one of the reasons for an increased risk of cardiovascular disease in these patients. The purpose of the present study was to investigate the effect of positive airway pressure (PAP) therapy on heart rate variability (HRV) indices. METHODS The study population was comprised of 55 patients, who underwent nocturnal polysomnography for the diagnosis of obstructive sleep apnea and PAP titration on the same night. The levels of continuous positive airway pressure (CPAP) and bilevel positive airway pressure were adjusted to relieve obstructive sleep apnea, hypopnea, and desaturation. The patients' heart changes and cardiac characteristics were recorded before and after the start of routine CPAP therapy. Finally, the cases' sleep and polysomnography tests were analyzed and interpreted in collaboration with a sleep specialist and their cardiac changes with the aid of a cardiologist before and after treatment with CPAP. RESULTS The participants were 55 patients at a mean age of 57.04±12.9 years. There were 34 (61.8%) male and 21 (38.2%) female cases. PAP therapy on the same night resulted in a decreased standard deviation of the N-N interval index (p=0.036) and a low-frequency index (p=0.021), as well as increased high-frequency index (p<0.001) and low frequency / high frequency ratios (p=0.008). CONCLUSION Our findings indicate a relative improvement in the activity of the autonomic system in patients with obstructive sleep apnea after 1 night of PAP therapy. Overwhelming evidence suggests that improvement in the sympathetic balance can reduce the risk of cardiovascular disease in patients.
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Affiliation(s)
- Neda Efazati
- Tehran University of Medical Sciences, Department of Internal Medicine - Tehran - Iran
| | - Besharat Rahimi
- Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran
| | - Mahsa Mirdamadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran - Iran
| | - Maryam Edalatifard
- Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran
| | - Anahita Tavoosi
- Tehran University of Medical Sciences, Imam Khomeini Hospital - Tehran - Iran
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Kim JB, Seo BS, Kim JH. Effect of arousal on sympathetic overactivity in patients with obstructive sleep apnea. Sleep Med 2019; 62:86-91. [DOI: 10.1016/j.sleep.2019.01.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
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Fontana P, Martins NRA, Camenzind M, Rossi RM, Baty F, Boesch M, Schoch OD, Brutsche MH, Annaheim S. Clinical Applicability of a Textile 1-Lead ECG Device for Overnight Monitoring. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2436. [PMID: 31141955 PMCID: PMC6603515 DOI: 10.3390/s19112436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
Abstract
Even for 1-lead electrocardiography (ECG), single-use gel conductive electrodes are employed in a clinical setting. However, gel electrodes show limited applicability for long-term monitoring due to skin irritation and detachment. In the present study, we investigated the validity of a textile ECG-belt suitable for long-term measurements in clinical use. In order to assess the signal quality and validity of the ECG-belt during sleep, 242 patients (186 males and 56 females, age 52 (interquartile range 42-60) years, body mass index 29 (interquartile range 26-33) kg·m-2) with suspected sleep apnoea underwent overnight polysomnography including standard 1-lead ECG recording. The single intervals between R-peaks (RR-intervals) were calculated from the ECG-signals. We found a mean difference for average RR-intervals of -2.9 ms, a standard error of estimate of 0.39%, as well as a Pearson r of 0.91. Furthermore, we found that the validity of the ECG-belt decreases when lying on the side, which was potentially due to the fitting of the belt. In conclusion, the validity of RR-interval measurements using the ECG-belt is high and it may be further improved for future applications by optimizing wear fitting.
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Affiliation(s)
- Piero Fontana
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
- High-performance Scientific GmbH, Wilenstrasse 24, 8832 Wilen bei Wollerau, Switzerland.
| | - Neusa R Adão Martins
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
- Campo Grande, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal.
| | - Martin Camenzind
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
| | - René M Rossi
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
| | - Florent Baty
- Kantonsspital St. Gallen, Klinik für Pneumologie/Schlafmedizin, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
| | - Maximilian Boesch
- Kantonsspital St. Gallen, Klinik für Pneumologie/Schlafmedizin, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
| | - Otto D Schoch
- Kantonsspital St. Gallen, Klinik für Pneumologie/Schlafmedizin, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
| | - Martin H Brutsche
- Kantonsspital St. Gallen, Klinik für Pneumologie/Schlafmedizin, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
| | - Simon Annaheim
- Empa, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
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Berger M, Raffin J, Pichot V, Hupin D, Garet M, Labeix P, Costes F, Barthélémy JC, Roche F. Effect of exercise training on heart rate variability in patients with obstructive sleep apnea: A randomized controlled trial. Scand J Med Sci Sports 2019; 29:1254-1262. [PMID: 31050034 DOI: 10.1111/sms.13447] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/22/2019] [Accepted: 04/24/2019] [Indexed: 12/16/2022]
Abstract
While obstructive sleep apnea (OSA) increases chemoreflex, leading to an autonomic dysfunction in the long term, no studies have yet assessed the potential benefit of exercise on cardiac autonomic activity in these patients. The aim of this study was to evaluate potential improvement in cardiac autonomic function (CAF) measured through heart rate variability (HRV) after a 9-month physical activity program in patients with OSA. Seventy-four patients with moderate OSA, aged 40-80 years, were randomly assigned to an exercise group (n = 36, 3 × 1 h/wk) or a control group (n = 38) during 9 months. Linear and nonlinear HRV parameters were measured during night using a Holter ECG. After 9 months, mean R-R intervals increased in the exercise group without any changes in HRV parameters, while controls decreased global (standard deviation of normal-to-normal intervals, total power) and parasympathetic (root mean square successive difference of N-Ns, very low frequency, high frequency, and standard deviation of the instantaneous beat-to-beat variability) indices of HRV (P < 0.05 for all). Significant correlations with moderate effect size were found between changes in apnea severity and changes in R-R intervals (P < 0.05). Improvement in moderate-to-vigorous physical activity was also correlated to improvement in nocturnal oxygen parameters (P < 0.05). In conclusion, supervised community physical activity may prevent a decline in nighttime CAF observed in nontreated community-dwelling patients with moderate OSA over a 9-month period. Thus, beyond apnea-hypopnea index improvement, exercise may be cardioprotective in OSA patients through bradycardia, CAF preservation, and VO2peak increase.
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Affiliation(s)
- Mathieu Berger
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.,IRAPS, Fédération Française d'Éducation Physique et de Gymnastique Volontaire (FFEPGV), Montreuil, France
| | - Jérémy Raffin
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Vincent Pichot
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - David Hupin
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Martin Garet
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Pierre Labeix
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Frédéric Costes
- Service de Physiologie de l'Exercice, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Claude Barthélémy
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Frédéric Roche
- Laboratoire SNA-EPIS, EA 4607, Université de Lyon, Université Jean Monnet Saint-Etienne, Saint-Etienne, France.,Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
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10
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Al-Abed MA, Al-Bashir AK, Saraereh OA, Al-Refaie FA, Qaqi RA, Al-Marahlah SM, Saleh YE. Computer simulated assessment of radio frequency electromagnetic waves for the detection of obstructive sleep apnea. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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11
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Heart Rate Variability in the Diagnostics and CPAP Treatment of Obstructive Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1176:25-33. [PMID: 31073928 DOI: 10.1007/5584_2019_385] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obstructive sleep apnea (OSA) is the most common manifestation of sleep-related breathing disorders that are often accompanied by dysfunction of the autonomic nervous system. The main objective of the study was to assess the usefulness of heart rate variability (HRV) analysis in the diagnosis of patients with severe OSA and in the assessment of the effects of 3-month treatment with continuous positive airway pressure (CPAP). There were 54 patients enrolled in the study. The OSA group consisted of 39 patients suffering from severe OSA (apnea/hypopnea index >30/h), and the control group included 15 non-OSA patients with matched demographic characteristics and comorbidities. All patients underwent 24-h Holter electrocardiographic monitoring. HRV was analyzed using the time- and frequency-domains. We found that OSA patients had decreases in time-domains and increases in frequency-domains of HRV, compared to non-OSA controls, which strongly suggested a clinically disadvantageous shift in the balance of parasympathetic/sympathetic activity toward the latter. Further, CPAP treatment, partly, albeit significantly, reversed the OSA-induced changes in HRV. We conclude that HRV analysis may be of help in the diagnosis of OSA and in the monitoring of the effectiveness of treatment.
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12
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Li Y, Pan W, Li K, Jiang Q, Liu G. Sliding Trend Fuzzy Approximate Entropy as a Novel Descriptor of Heart Rate Variability in Obstructive Sleep Apnea. IEEE J Biomed Health Inform 2019; 23:175-183. [DOI: 10.1109/jbhi.2018.2790968] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Moon J, Choi KH, Park JH, Song TJ, Choi YS, Kim JH, Kim HJ, Lee HW. Sympathetic Overactivity Based on Heart-Rate Variability in Patients with Obstructive Sleep Apnea and Cerebral Small-Vessel Disease. J Clin Neurol 2018; 14:310-319. [PMID: 29856154 PMCID: PMC6032004 DOI: 10.3988/jcn.2018.14.3.310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background and Purpose Obstructive sleep apnea (OSA) is associated with cerebral white-matter changes (WMC), but the underlying mechanisms are not completely understood. Our aim was to identify the cardiovascular autonomic characteristics during sleep that are associated with cerebral WMC in OSA patients. Methods We recruited subjects from our sleep-center database who underwent both polysomnography and brain MRI within a 1-year period. Sixty patients who had OSA with WMC (OSA+WMC), 44 patients who had OSA without WMC (OSA−WMC), and 31 control subjects who had neither OSA nor WMC were analyzed. Linear and nonlinear indices of heart-rate variability (HRV) were analyzed in each group according to different sleep stages and also over the entire sleeping period. Results Among the nonlinear HRV indices, the Poincaré ratio (SD12) during the entire sleep period was significantly increased in the OSA+WMC group, even after age adjustment. Meanwhile, detrended fluctuation analysis 1 during non-rapid-eye-movement sleep tended to be lowest in the OSA+WMC group. These indices were altered regardless of the presence of hypertension or diabetes. In the subgroup analysis of middle-aged OSA patients, approximate entropy during rapid-eye-movement sleep was significantly lower in OSA+WMC patients than in OSA−WMC patients. Overall, the nonlinear HRV indices suggest that sympathetic activity was higher in the OSA+WMC group than in the OSA−WMC and control groups. Conclusions Our findings suggest that dysregulation of HRV, especially overactivation of sympathetic tone, could be a pathophysiologic mechanism underlying the development of WMC in OSA patients.
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Affiliation(s)
- Jangsup Moon
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kang Hyun Choi
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jung Hyun Park
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Neurology, Heavenly Hospital, Goyang, Korea
| | - Tae Jin Song
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Yun Seo Choi
- Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Ju Hee Kim
- Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Hyeon Jin Kim
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Hyang Woon Lee
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.
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14
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Cardiovascular effects of oral appliance therapy in obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 40:55-68. [PMID: 29195726 DOI: 10.1016/j.smrv.2017.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/10/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. This study systematically reviews the effects of oral appliance therapy (OAT) on a broad spectrum of cardiovascular outcomes. A literature search was performed up to December 31st 2016. Twenty-five relevant full-text articles were retrieved. Sixteen articles were considered methodologically sufficient, including 11 randomized controlled trials. Pooled data of the RCTs showed significant reductions in daytime systolic and diastolic blood pressure compared to baseline, but no significant reductions in heart rate, except for daytime heart rate when compared to inactive/placebo OAT. OAT and continuous positive airway pressure (CPAP) were equally effective in reducing blood pressure. Studies assessing the effect of OAT on heart rate variability, circulating cardiovascular biomarkers, and endothelial function and arterial stiffness, generally involved small numbers of patients, and were heterogeneous and inconclusive. Studies assessing the effect of OAT on cardiac function showed no effects on echocardiographic outcomes. One observational study showed that OAT was as effective as CPAP in reducing cardiovascular death. It could be speculated that OAT may lead to a reduction in long-term cardiovascular morbidity and mortality in OSA patients. However, further methodologically high quality, longitudinal studies are warranted to address this key question.
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15
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Use of Mutual Information and Transfer Entropy to Assess Interaction between Parasympathetic and Sympathetic Activities of Nervous System from HRV. ENTROPY 2017. [DOI: 10.3390/e19090489] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Alvarez-Estevez D, Moret-Bonillo V. Spectral Heart Rate Variability analysis using the heart timing signal for the screening of the Sleep Apnea-Hypopnea Syndrome. Comput Biol Med 2016; 71:14-23. [PMID: 26866445 DOI: 10.1016/j.compbiomed.2016.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 02/07/2023]
Abstract
Some approaches have been published in the past using Heart Rate Variability (HRV) spectral features for the screening of Sleep Apnea-Hypopnea Syndrome (SAHS) patients. However there is a big variability among these methods regarding the selection of the source signal and the specific spectral components relevant to the analysis. In this study we investigate the use of the Heart Timing (HT) as the source signal in comparison to the classical approaches of Heart Rate (HR) and Heart Period (HP). This signal has the theoretical advantage of being optimal under the Integral Pulse Frequency Modulation (IPFM) model assumption. Only spectral bands defined as standard for the study of HRV are considered, and for each method the so-called LF/HF and VLFn features are derived. A comparative statistical analysis between the different resulting methods is performed, and subject classification is investigated by means of ROC analysis and a Naïve-Bayes classifier. The standard Apnea-ECG database is used for validation purposes. Our results show statistical differences between SAHS patients and controls for all the derived features. In the subject classification task the best performance in the testing set was obtained using the LF/HF ratio derived from the HR signal (Area under ROC curve=0.88). Only slight differences are obtained due to the effect of changing the source signal. The impact of using the HT signal in this domain is therefore limited, and has not shown relevant differences with respect to the use of the classical approaches of HR or HP.
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Affiliation(s)
- Diego Alvarez-Estevez
- Sleep Centre, Medisch Centrum Haaglanden and Bronovo-Nebo, The Hague, The Netherlands.
| | - Vicente Moret-Bonillo
- Laboratory for Research and Development of Artificial Intelligence, University of A Coruña, A Coruña, Spain
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17
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FAUST OLIVER, ACHARYA URAJENDRA, NG EYK, FUJITA HAMIDO. A REVIEW OF ECG-BASED DIAGNOSIS SUPPORT SYSTEMS FOR OBSTRUCTIVE SLEEP APNEA. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400042] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Humans need sleep. It is important for physical and psychological recreation. During sleep our consciousness is suspended or least altered. Hence, our ability to avoid or react to disturbances is reduced. These disturbances can come from external sources or from disorders within the body. Obstructive Sleep Apnea (OSA) is such a disorder. It is caused by obstruction of the upper airways which causes periods where the breathing ceases. In many cases, periods of reduced breathing, known as hypopnea, precede OSA events. The medical background of OSA is well understood, but the traditional diagnosis is expensive, as it requires sophisticated measurements and human interpretation of potentially large amounts of physiological data. Electrocardiogram (ECG) measurements have the potential to reduce the cost of OSA diagnosis by simplifying the measurement process. On the down side, detecting OSA events based on ECG data is a complex task which requires highly skilled practitioners. Computer algorithms can help to detect the subtle signal changes which indicate the presence of a disorder. That approach has the following advantages: computers never tire, processing resources are economical and progress, in the form of better algorithms, can be easily disseminated as updates over the internet. Furthermore, Computer-Aided Diagnosis (CAD) reduces intra- and inter-observer variability. In this review, we adopt and support the position that computer based ECG signal interpretation is able to diagnose OSA with a high degree of accuracy.
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Affiliation(s)
- OLIVER FAUST
- Faculty of Arts, Computing, Engineering and Sciences, Sheffield Hallam University, UK
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18
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Bisogni V, Pengo MF, Maiolino G, Rossi GP. The sympathetic nervous system and catecholamines metabolism in obstructive sleep apnoea. J Thorac Dis 2016; 8:243-54. [PMID: 26904265 DOI: 10.3978/j.issn.2072-1439.2015.11.14] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Obstructive sleep apnoea (OSA) is the most common sleep disorder of breathing in middle-aged and overweight subjects. It features recurrent episodes of upper airway total (apnoea) o partial (hypopnea) collapse during sleep, which are associated with a reduction in blood oxygen saturation and with arousal from sleep to re-establish airway patency. An association of OSA with dysregulation of the autonomous nervous system (ANS) and altered catecholamines (CAs) metabolism has been contended for years. However, the pathophysiology mechanisms underlying these alterations remain to be fully clarified. Nonetheless, these alterations are deemed to play a key pathogenic role in the established association of OSA with several conditions besides arterial hypertension (HT), including coronary artery disease, stroke, and, more in general, with increased risk of cardiovascular (CV) events. Hence, in this review we will analyse the relationship between the sleep disturbances associated with OSA and the altered function of the ANS, including CAs metabolism.
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Affiliation(s)
- Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Martino F Pengo
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Padua, Italy
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Wu Y, Xu Z, Zhang L, Shen K. Screening obstructive sleep apnea–hypopnea syndrome from snorers in children by heart rate variability analysis. BIOL RHYTHM RES 2015. [DOI: 10.1080/09291016.2014.963948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Rodríguez-Liñares L, Lado MJ, Vila XA, Méndez AJ, Cuesta P. gHRV: Heart rate variability analysis made easy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 116:26-38. [PMID: 24854108 DOI: 10.1016/j.cmpb.2014.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 04/03/2014] [Accepted: 04/15/2014] [Indexed: 05/20/2023]
Abstract
In this paper, the gHRV software tool is presented. It is a simple, free and portable tool developed in python for analysing heart rate variability. It includes a graphical user interface and it can import files in multiple formats, analyse time intervals in the signal, test statistical significance and export the results. This paper also contains, as an example of use, a clinical analysis performed with the gHRV tool, namely to determine whether the heart rate variability indexes change across different stages of sleep. Results from tests completed by researchers who have tried gHRV are also explained: in general the application was positively valued and results reflect a high level of satisfaction. gHRV is in continuous development and new versions will include suggestions made by testers.
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Affiliation(s)
| | - M J Lado
- Department of Computer Science, ESEI, University of Vigo, Spain(1).
| | - X A Vila
- Department of Computer Science, ESEI, University of Vigo, Spain(1).
| | - A J Méndez
- Department of Computer Science, ESEI, University of Vigo, Spain(1).
| | - P Cuesta
- Department of Computer Science, ESEI, University of Vigo, Spain(1).
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21
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Heart rate variability is augmented in patients with positional obstructive sleep apnea, but only supine LF/HF index correlates with its severity. Sleep Breath 2014; 19:359-67. [PMID: 25012091 DOI: 10.1007/s11325-014-1029-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/01/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Data on cardiac autonomic functioning, as expressed by heart rate variability (HRV), in patients with positional obstructive sleep apnea (p-OSA) disorder are lacking. The purpose of the study was to compare HRV indices between sleep segments derived from supine body position and another body position with and without apneic events, respectively. Our intention was to find some correlation between HRV indices and the pathophysiological characteristics of the corresponding temporal period. METHODS Nocturnal polysomnograms derived from twenty-seven patients (22 men) with documented positional apnea were retrospectively reviewed. Patients never treated for OSA and free from diseases/drugs altering HRV were examined. Data from total sleep studies were collected. Two N2 sleep segments, from supine body position with sleep-disordered breathing (SDB) and another body position without SDB were analyzed. Apneic events (namely, apneas, hypopneas, and respiratory effort-related arousals (RERAs)), arousals, number of desaturations, minimum pulse oximetry (SaO2min), time domain variables (average RR, SDNN, SDSD, RMSSD, pNN50, and HRV triangular index) and frequency domain variables (VLF, LF, HF, TP, LF/HF) were recorded for both temporal periods. RESULTS With the exception of average RR and HF, all other variables were significantly higher in segments with SDB. Only LF/HF_supine ratio was positively correlated with the apneic_supine_index (t = 3.13, p < 0.01) and negatively correlated with SaO2min (t = -2.9, p < 0.01) and the desaturation_supine_index (t = -2.5, p = 0.02). Arousals were negatively correlated with SaO2min (t = -2.8, p < 0.01). CONCLUSIONS SDB augments autonomic tone in patients with p-OSA, but only LF/HF correlates with its severity and might be used as a screening tool in the future. On the contrary, parasympathetic tone, as reflected by HF, remains constant in both periods.
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22
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Is there a chronic sleep stage-dependent linear and nonlinear cardiac autonomic impairment in obstructive sleep apnea? Sleep Breath 2013; 18:403-9. [DOI: 10.1007/s11325-013-0900-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/09/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
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