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Yilmaz G, Ong JL, Ling LH, Chee MWL. Insights into vascular physiology from sleep photoplethysmography. Sleep 2023; 46:zsad172. [PMID: 37379483 PMCID: PMC10566244 DOI: 10.1093/sleep/zsad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/19/2023] [Indexed: 06/30/2023] Open
Abstract
STUDY OBJECTIVES Photoplethysmography (PPG) in consumer sleep trackers is now widely available and used to assess heart rate variability (HRV) for sleep staging. However, PPG waveform changes during sleep can also inform about vascular elasticity in healthy persons who constitute a majority of users. To assess its potential value, we traced the evolution of PPG pulse waveform during sleep alongside measurements of HRV and blood pressure (BP). METHODS Seventy-eight healthy adults (50% male, median [IQR range] age: 29.5 [23.0, 43.8]) underwent overnight polysomnography (PSG) with fingertip PPG, ambulatory blood pressure monitoring, and electrocardiography (ECG). Selected PPG features that reflect arterial stiffness: systolic to diastolic distance (∆T_norm), normalized rising slope (Rslope) and normalized reflection index (RI) were derived using a custom-built algorithm. Pulse arrival time (PAT) was calculated using ECG and PPG signals. The effect of sleep stage on these measures of arterial elasticity and how this pattern of sleep stage evolution differed with participant age were investigated. RESULTS BP, heart rate (HR) and PAT were reduced with deeper non-REM sleep but these changes were unaffected by the age range tested. After adjusting for lowered HR, ∆T_norm, Rslope, and RI showed significant effects of sleep stage, whereby deeper sleep was associated with lower arterial stiffness. Age was significantly correlated with the amount of sleep-related change in ∆T_norm, Rslope, and RI, and remained a significant predictor of RI after adjustment for sex, body mass index, office BP, and sleep efficiency. CONCLUSIONS The current findings indicate that the magnitude of sleep-related change in PPG waveform can provide useful information about vascular elasticity and age effects on this in healthy adults.
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Affiliation(s)
- Gizem Yilmaz
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lieng-Hsi Ling
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore and
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael W L Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Huang M, Bliwise DL, Shah A, Johnson DA, Clifford GD, Hall MH, Krafty RT, Goldberg J, Sloan R, Ko YA, Da Poian G, Perez-Alday EA, Murrah N, Levantsevych OM, Shallenberger L, Abdulbaki R, Vaccarino V. The temporal relationships between sleep disturbance and autonomic dysregulation: A co-twin control study. Int J Cardiol 2022; 362:176-182. [PMID: 35577169 PMCID: PMC10197091 DOI: 10.1016/j.ijcard.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sleep disturbance is associated with autonomic dysregulation, but the temporal directionality of this relationship remains uncertain. The objective of this study was to evaluate the temporal relationships between objectively measured sleep disturbance and daytime or nighttime autonomic dysregulation in a co-twin control study. METHODS A total of 68 members (34 pairs) of the Vietnam Era Twin Registry were studied. Twins underwent 7-day in-home actigraphy to derive objective measures of sleep disturbance. Autonomic function indexed by heart rate variability (HRV) was obtained using 7-day ECG monitoring with a wearable patch. Multivariable vector autoregressive models with Granger causality tests were used to examine the temporal directionality of the association between daytime and nighttime HRV and sleep metrics, within twin pairs, using 7-day collected ECG data. RESULTS Twins were all male, mostly white (96%), with mean (SD) age of 69 (2) years. Higher daytime HRV across multiple domains was bidirectionally associated with longer total sleep time and lower wake after sleep onset; these temporal dynamics were extended to a window of 48 h. In contrast, there was no association between nighttime HRV and sleep measures in subsequent nights, or between sleep measures from previous nights and subsequent nighttime HRV. CONCLUSIONS Daytime, but not nighttime, autonomic function indexed by HRV has bidirectional associations with several sleep dimensions. Dysfunctions in autonomic regulation during wakefulness can lead to subsequent shorter sleep duration and worse sleep continuity, and vice versa, and their influence on each other may extend beyond 24 h.
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Affiliation(s)
- Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine (Cardiology), School of Medicine, Emory University, Atlanta, GA, USA; Atlanta Veteran Affairs Medical Center, Decatur, GA, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Martica H Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jack Goldberg
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA, USA
| | - Richard Sloan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Giulia Da Poian
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Erick A Perez-Alday
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rami Abdulbaki
- Department of Pathology, Georgia Washington University Hospital, Washington, DC, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine (Cardiology), School of Medicine, Emory University, Atlanta, GA, USA.
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Investigation on the Prediction of Cardiovascular Events Based on Multi-Scale Time Irreversibility Analysis. Symmetry (Basel) 2021. [DOI: 10.3390/sym13122424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Investigation of the risk factors associated with cardiovascular disease (CVD) plays an important part in the prevention and treatment of CVD. This study investigated whether alteration in the multi-scale time irreversibility of sleeping heart rate variability (HRV) was a risk factor for cardiovascular events. The D-value, based on analysis of multi-scale increments in HRV series, was used as the measurement of time irreversibility. Eighty-four subjects from an open-access database (i.e., the Sleep Heart Health Study) were included in this study. None of them had any CVD history at baseline; 42 subjects had cardiovascular events within 1 year after baseline polysomnography and were classed as the CVD group, and the other 42 subjects in the non-CVD group were age matched with those in the CVD group and had no cardiovascular events during the 15-year follow-up period. We compared D-values of sleeping HRV between the CVD and non-CVD groups and found that the D-values of the CVD group were significantly lower than those of the non-CVD group on all 10 scales, even after adjusting for gender and body mass index. Moreover, we investigated the performance of a machine learning model to classify CVD and non-CVD subjects. The model, which was fed with a feature space based on the D-values on 10 scales and trained by a random forest algorithm, achieved an accuracy of 80.8% and a positive prediction rate of 86.7%. These results suggest that the decreased time irreversibility of sleeping HRV is an independent predictor of cardiovascular events that could be used to assist the intelligent prediction of cardiovascular events.
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Son DY, Kwon HB, Lee DS, Jin HW, Jeong JH, Kim J, Choi SH, Yoon H, Lee MH, Lee YJ, Park KS. Changes in physiological network connectivity of body system in narcolepsy during REM sleep. Comput Biol Med 2021; 136:104762. [PMID: 34399195 DOI: 10.1016/j.compbiomed.2021.104762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Narcolepsy is marked by pathologic symptoms including excessive daytime drowsiness and lethargy, even with sufficient nocturnal sleep. There are two types of narcolepsy: type 1 (with cataplexy) and type 2 (without cataplexy). Unlike type 1, for which hypocretin is a biomarker, type 2 narcolepsy has no adequate biomarker to identify the causality of narcoleptic phenomenon. Therefore, we aimed to establish new biomarkers for narcolepsy using the body's systemic networks. METHOD Thirty participants (15 with type 2 narcolepsy, 15 healthy controls) were included. We used the time delay stability (TDS) method to examine temporal information and determine relationships among multiple signals. We quantified and analyzed the network connectivity of nine biosignals (brainwaves, cardiac and respiratory information, muscle and eye movements) during nocturnal sleep. In particular, we focused on the differences in network connectivity between groups according to sleep stages and investigated whether the differences could be potential biomarkers to classify both groups by using a support vector machine. RESULT In rapid eye movement sleep, the narcolepsy group displayed more connections than the control group (narcolepsy connections: 24.47 ± 2.87, control connections: 21.34 ± 3.49; p = 0.022). The differences were observed in movement and cardiac activity. The performance of the classifier based on connectivity differences was a 0.93 for sensitivity, specificity and accuracy, respectively. CONCLUSION Network connectivity with the TDS method may be used as a biomarker to identify differences in the systemic networks of patients with narcolepsy type 2 and healthy controls.
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Affiliation(s)
- Dong Yeon Son
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, 03080, South Korea; Integrated Major in Innovative Medical Science, College of Medicine, Seoul National University, Seoul, 03080, South Korea
| | - Hyun Bin Kwon
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, 03080, South Korea
| | - Dong Seok Lee
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, 03080, South Korea
| | - Hyung Won Jin
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, 03080, South Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, 03080, South Korea
| | - Jong Hyeok Jeong
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, 03080, South Korea; Integrated Major in Innovative Medical Science, College of Medicine, Seoul National University, Seoul, 03080, South Korea
| | - Jeehoon Kim
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, 03080, South Korea
| | - Sang Ho Choi
- School of Computer and Information Engineering, Kwangwoon University, Seoul, 01897, South Korea
| | - Heenam Yoon
- Department of Human-Centered Artificial Intelligence, Sangmyung University, Seoul, 03016, South Korea
| | - Mi Hyun Lee
- Department of Neuropsychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Yu Jin Lee
- Department of Neuropsychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Kwang Suk Park
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, 03080, South Korea; Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, 03080, South Korea.
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5
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Kong SDX, Hoyos CM, Phillips CL, McKinnon AC, Lin P, Duffy SL, Mowszowski L, LaMonica HM, Grunstein RR, Naismith SL, Gordon CJ. Altered heart rate variability during sleep in mild cognitive impairment. Sleep 2021; 44:5988607. [PMID: 33306103 DOI: 10.1093/sleep/zsaa232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/31/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Cardiovascular autonomic dysfunction, as measured by short-term diurnal heart rate variability (HRV), has been reported in older adults with mild cognitive impairment (MCI). However, it is unclear whether this impairment also exists during sleep in this group. We, therefore, compared overnight HRV during sleep in older adults with MCI and those with subjective cognitive impairment (SCI). METHODS Older adults (n = 210) underwent overnight polysomnography. Eligible participants were characterized as multi-domain MCI or SCI. The multi-domain MCI group was comprised of amnestic and non-amnestic subtypes. Power spectral analysis of HRV was conducted on the overnight electrocardiogram during non-rapid eye movement (NREM), rapid eye movement (REM), N1, N2, N3 sleep stages, and wake periods. High-frequency HRV (HF-HRV) was employed as the primary measure to estimate parasympathetic function. RESULTS The MCI group showed reduced HF-HRV during NREM sleep (p = 0.018), but not during wake or REM sleep (p > 0.05) compared to the SCI group. Participants with aMCI compared to SCI had the most pronounced reduction in HF-HRV across all NREM sleep stages-N1, N2, and N3, but not during wake or REM sleep. The naMCI sub-group did not show any significant differences in HF-HRV during any sleep stage compared to SCI. CONCLUSIONS Our study showed that amnestic MCI participants had greater reductions in HF-HRV during NREM sleep, relative to those with SCI, suggesting potential vulnerability to sleep-related parasympathetic dysfunction. HF-HRV, especially during NREM sleep, may be an early biomarker for dementia detection.
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Affiliation(s)
- Shawn D X Kong
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Camilla M Hoyos
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
| | - Craig L Phillips
- CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew C McKinnon
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Pinghsiu Lin
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Shantel L Duffy
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Haley M LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Ronald R Grunstein
- CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Christopher J Gordon
- CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
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Gümüştakim RŞ, Ayhan Baser D, Cevik M, Bilgili P, Çelik MA, Güngör T, Karahan Sarper H. Evaluation of sleep quality, insomnia severity and OSAS risk in primary care population: A descriptive study. Int J Clin Pract 2021; 75:e13786. [PMID: 33103321 DOI: 10.1111/ijcp.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In our study, we aimed to evaluate the sleep quality, insomnia presence and severity, obstructive sleep apnoea syndrome (OSAS) risk of the patients who applied to family health centres and to determine the situations that might be related with these features. METHODS This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Centre policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centres for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality questionare and insomnia severity questionare were applied by the researchers from October to December 2017 by using face-to-face interview method. RESULTS Two hundred nineteen nine people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Questionare, it was found that 27.1% of the participants' sleep quality was good; according to the Berlin sleep questionnaire, 27.4% of the participants had high OSAS risk. According to Insomnia Severity Questionare, 27.1% of them had insomnia lower threshold, 15.4% had moderate insomnia and 3.7% severe insomnia. CONCLUSIONS In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary healthcare institutions and the other patients to be delivered to the related upper levels.
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Affiliation(s)
- Raziye Şule Gümüştakim
- Department of Family Medicine, Faculty of Medicine, Sütcü Imam University, Maraş, Turkey
| | - Duygu Ayhan Baser
- Department of Family Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Cevik
- Ankara Güdül Family Health Center, Ankara, Turkey
| | - Pınar Bilgili
- Antalya Değirmenönü Family Health Center, Antalya, Turkey
| | | | - Tayyar Güngör
- Bursa Sırameşeler Family Health Center, Bursa, Turkey
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