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Sandhu A, Wang L, Bena J, Kaffashi F, Loparo K, Aylor J, Nawabit R, Chung M, Van Wagoner D, Walia H, Mehra R. 0614 Diurnal Patterning of Autonomic Measures in Sleep Apnea and Paroxysmal Atrial Fibrillation and Response to Continuous Positive Airway Pressure Therapy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Diurnal patterning of autonomic function in paroxysmal atrial fibrillation (PAF) and sleep disordered breathing (SDB) is unknown. We hypothesize heart rate variability (HRV) as surrogates of autonomic function, exhibit diurnal differences in PAF relative to SDB severity and treatment.
Methods
We leveraged the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT,NCT02576587) study focused on participants with PAF and SDB (apnea hypopnea index,AHI≥15,3% oxygen desaturation hypopnea). Attended 16-channel polysomnography (PSG) and continuous ECG monitoring (Heartrak Telemetry®) for 7-21 days was performed at baseline and after 3-months of continuous positive airway pressure (CPAP). Linear mixed-effects models (least square means,95%CI) were used to assess relationships between daily average HRV measures (frequency domain:LF,HF,LF/HF;time domain:MNN,RMSSD,SD1,SD ratio and novel non-linear:DFA-alpha measures) with SDB (AHI),%sleep time with SaO2<90%(TRT<90): per 5-unit increase),effect of 3-month CPAP relative to sleep-wake and statistical interaction of sleep-wake. Analyses were conducted using SAS version v.9.4, Cary, NC.
Results
The analytic sample was comprised of 33 cases with PAF and SDB:61.1±11.7 years,62.5% male, BMI:33.9±7.2kg/m2,75% Caucasian,AHI 15.1 (IQR: 4.4,29.4) and 68.8% on atrioventricular nodal blocking medications. AHI was associated with frequency (HF:0.08[0.01,0.16] and LF/HF:-0.11[-0.20, -0.01]), time (SD1:0.08[0.02,0.14] and SD ratio: 0.09[0.04,0.14]) and non-linear (DFA-alpha1: -0.02[-0.036,-0.003]) domain measures during wake, but not sleep. Significant sleep-wake and AHI as well as TRT<90 interactions relative to HRV measures were observed (p≤0.001). Only SD ratio was associated with TRT<90 (0.12[0.03,0.24]). Baseline to follow-up CPAP time domain measures were altered mainly during wake versus sleep with MNN increased 0.13: [0.08,0.19],p<0.001; RMSSD increased 0.13 [0.08,0.19], p<0.001; SD1 increased 30% [0.09,0.55], p=0.004; SD ratio increased 20% [0.01,0.43], p=0.033,and also frequency domain: HF increased 33%[0.03,0.72], p=0.028.
Conclusion
SDB defined by AHI--more so than nocturnal hypoxia--was associated with surrogate autonomic measures impacted by CPAP intervention during wake and not sleep in PAF. SDB-related autonomic influences in PAF appear to be more pronounced during wakefulness suggesting long-term potentiation-like influences.
Support
This study was supported by the National Heart, Lung and Blood Institute (NHLBI) [Grant R01 HL108493] and National Institutes of Health (NIH) National Center for Research Resources [Grant UL1 RR024989]
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Affiliation(s)
- A Sandhu
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - L Wang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - J Bena
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - F Kaffashi
- School of Engineering, Case Western Reserve University, Cleveland, OH
| | - K Loparo
- School of Engineering, Case Western Reserve University, Cleveland, OH
| | - J Aylor
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - R Nawabit
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - M Chung
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - D Van Wagoner
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - H Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - R Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Bhat AS, Wang L, Kaur S, Nawabit R, Highland K, Park M, Jellis C, Kwon D, Hill N, Mehra R, Pvdomics P. 0558 Sleep Disordered Breathing and Right Ventricular Electrocardiographic and Functional Characteristics in Group 1 Pulmonary Arterial Hypertension. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Right ventricular (RV) electrophysiologic and functional alterations related to sleep disordered breathing (SDB) in pulmonary arterial hypertension (PAH) are not well understood. We hypothesize an association between SDB and RV electrophysiological/functional measures in World Symposium of Pulmonary Hypertension (WSPH) Group 1 PAH.
Methods
The NHLBI multicenter PVDOMICS study (NCT02980887) enrolls patients with PAH undergoing a battery of assessments including home sleep apnea testing(NOX-T3, Carefusion®) or with historical sleep study data. Logistic(OR,95%CI) and linear(beta coefficients,95%CI) regression models adjusted for age, sex, race, body mass index (BMI, kg/m2), PAH medications, supplemental oxygen(O2), positive airway pressure(PAP) were used to assess associations of SDB(apnea hypopnea index,(AHI), ≥3% desaturations(hypopnea), percentage recording time with SaO2<90% (TRT<90%) with electrocardiographic measures: RV hypertrophy(RVH), right bundle branch block(RBBB), and right axis deviation(RAD), echocardiographically-derived RV systolic pressure(RVSP) and RV ejection fraction(RVEF) from cardiac MRI. Analyses were performed based on an overall significance level of 0.05, using SAS software (version 9.4, Cary, NC).
Results
The analysis consisted of 182 PAH participants with age: 52.5±13.9 years, 71.4% female, 88.9% Caucasian, BMI:30.3±7.8 kg/m2, RVEF: 37.3±11.6, and RVSP: 67.0±23.4. None of the electrocardiographic measures were associated with AHI and only RVH was significantly associated with TRT<90% (1.25:1.09,1.43),p=0.001. Although AHI was not associated with RVSP, a 10% increase in TRT<90% was associated with a 2.60mmHg increase in RVSP (2.60:1.44,3.76),p<0.001. Each 10-unit increase in AHI was associated with a 2.72% reduction of RVEF (-2.72:-4.89,-0.56),p=0.014, and each 10-unit increase in TRT<90% was associated with a 0.72% reduction of RVEF (-0.72:-1.38,-0.06),p=0.033.
Conclusion
We identify nocturnal hypoxia as a predictor of RV electrophysiological and functional alterations even after consideration of confounding factors. SDB as determined by AHI was also more so associated with reduced RVEF than hypoxia. Future mechanistic studies should focus on further elucidation of SDB and nocturnal hypoxia on pathogenesis of RV dysfunction in PAH.
Support
U01HL125218/U01HL125205/U01HL125212/U01HL125208/U01HL125175/U01HL125215, U01HL125177/Pulmonary Hypertension Association
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Affiliation(s)
- A S Bhat
- Cleveland Clinic Neurologic Institute, Cleveland, OH
| | - L Wang
- Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - S Kaur
- Cleveland Clinic Neurologic Institute, Cleveland, OH
| | - R Nawabit
- Cleveland Clinic Neurologic Institute, Cleveland, OH
| | - K Highland
- Cleveland Clinic Respiratory Institute, Cleveland, OH
| | - M Park
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH
| | - C Jellis
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH
| | - D Kwon
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH
| | - N Hill
- Tufts Medical Center Pulmonary, Critical Care & Sleep Divission, Boston, MA
| | - R Mehra
- Cleveland Clinic Neurologic Institute, Cleveland, OH
| | - P Pvdomics
- National Heart, Lung, Blood Institute (NHLBI), Bethesda, MD
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Nawabit R, Bena J, Pillai J, Leverenz JB, Mehra R. 0290 Objective Sleep Indices Relative to Neurocognitive Function and Cerebrospinal Fluid Biomarkers in Patients with Mild Cognitive Impairment and Alzheimer’s Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - J Bena
- Cleveland Clinic, Cleveland, OH
| | | | | | - R Mehra
- Cleveland Clinic, Cleveland, OH
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Michaels J, Wang L, Nawabit R, Stone K, Marcus G, Varosy P, Redline S, Ensurd K, Mehra R. 0604 Sleep Disordered Breathing as a Predictor of Incident Polysomnographically-Identified Cardiac Arrhythmia: The Outcomes of Sleep Disorders in Older Men study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Michaels
- Cleveland Clinic foundation, Cleveland, OH
| | - L Wang
- Cleveland Clinic foundation, Cleveland, OH
| | - R Nawabit
- Cleveland Clinic foundation, Cleveland, OH
| | - K Stone
- California Pacific Medical Center, San Francisco, CA
| | - G Marcus
- University of California, San Francisco, CA
| | - P Varosy
- University of Colorado, Aurora, CA
| | | | - K Ensurd
- University of Minnesota Medical School, Minneapolis, MN
| | - R Mehra
- Cleveland Clinic foundation, Cleveland, OH
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George J, Wang L, Nawabit R, Kaffashi F, Walia HK, Punjabi NM, Patel SR, Gottlieb DJ, Quan SF, Loparo K, Redline S, Mehra R. 0444 Impact of CPAP versus Supplemental Oxygen on Cardiac Electophysiological Indices in Obstructive Sleep Apnea: The HeartBEAT study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J George
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - L Wang
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - R Nawabit
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - F Kaffashi
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH
| | - H K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - N M Punjabi
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - S R Patel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D J Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - S F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - K Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH
| | - S Redline
- Department of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - R Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Kandasamy RK, Wang L, Bena J, Nawabit R, Aylor J, Walia H, Mehra R. 1053 COMPARATIVE PERFORMANCE OF STANDARD OBSTRUCTIVE SLEEP APNEA SCREENING INSTRUMENTS IN PAROXYSMAL ATRIAL FIBRILLATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sosa AE, Wang L, Nawabit R, Aylor J, Walia H, Bena J, Mehra R. 0431 PATHOPHYSIOLOGIC ASPECTS OF SLEEP DISORDERED BREATHING AND PAROXYSMAL ATRIAL FIBRILLATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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