Correlation Analysis between Obstructive Sleep Apnea Syndrome (OSAS) and Heart Rate Variability
AbstractBackground: Heart rate variability (HRV) represents the sympathetic nervous system activity induced by apnea or hypopnea events among OSAS patients. However, few studies have been conducted to clarify the association between HRV parameters and polysomnography (PSG) diagnostic indices. In our study, we postulate that the prevalence of cardiac arrhythmias is associated with OSAS, and HRV parameters may be an effective method for OSAS screening.Methods: Overall, 168 participants had been collected from 2011 to 2016 in the Second Affiliated Hospital of Soochow University. By apnea-hypopnea index (AHI), patients were separated into three subsets: AHI < 5 as control group, 5≤AHI<30 as mild-moderate OSAS group and AHI≥30as severe OSAS group. HRV and PSG parameters were collected based on electrocardiography and polysomnography system. Correlation analyses between standard deviation of R-R intervals (SDNN), SDNN index, RMSSD, PNN50, low frequency (LF), high frequency (HF) and LF/HF ratio and the AHI, ODI and MI were performed by Spearman's correlation analysis.Results: Compared with control group (64.5%) or mild-moderate OSAS group (67.3%), the prevalence of arrhythmias was considerably greater in severe OSAS group (P<0.05). Moreover, we demonstrated that LF/HF was greater in two OSAS groups than the normal group.Conclusion: Correlation analyses revealed a significant and positive relation between the LF/HF and AHI, ODI and MI in OSAS patients. Severe OSAS could be attributed to enhanced danger of incident arrhythmia. LF/HF ratio as a relevant feature may be an effective parameter for detecting OSAS.
Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM, Handa KK (2006). Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res, 1249 (3): 281-90.
Zinchuk AV, Gentry MJ, Concato J, Yaggi HK (2016). Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev, 35: 113-23.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013). Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 177 (9): 1006-14.
Gong X, Huang L, Liu X, et al (2016). Correlation Analysis between Polysomnography Diagnostic Indices and Heart Rate Variability Parameters among Patients with Obstructive Sleep Apnea Hypopnea Syndrome. PloS One, 11 (6): e0156628.
Zhang W, Si LY (2012). Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches. Ups J Med Sci, 117 (4): 370-82.
Nagayoshi M, Punjabi NM, Selvin E, et al (2016). Obstructive sleep apnea and incident type 2 diabetes. Sleep Med, 25: 156-161.
Alves ES, Lira FS, Santos RV, Tufik S, de Mello MT (2011). Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy. Lipids Health Dis, 10: 148.
Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O (2015). Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol, 31: 928-934.
Anker SD, von Haehling S, Germany R (2016). Sleep-disordered breathing and cardiovascular disease. Indian Heart J, 68 Suppl 1: S69-76.
Grimm W, Koehler U (2014). Cardiac arrhythmias and sleep-disordered breathing in patients with heart failure. Int J Mol Sci, 15 (10): 18693-705.
Rao A, Georgiadou P, Francis DP, et al (2006). Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms. J Sleep Res, 15 (1): 81-8.
Christ M, Sharkova Y, Fenske H, et al (2007). Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients. Int J Cardiol, 116 (1): 62-9.
Oldenburg O, Bitter T, Wiemer M, Langer C, Horstkotte D, Piper C (2009). Pulmonary capillary wedge pressure and pulmonary arterial pressure in heart failure patients with sleep-disordered breathing. Sleep Med, 10 (7): 726-30.
Lemmer B, Scholtze J, Schmitt J (2016). Circadian rhythms in blood pressure, heart rate, hormones, and on polysomnographic parameters in severe obstructive sleep apnea syndrome patients: effect of continuous positive airway pressure. Blood Press Monit, 21 (3): 136-43.
Kaditis A, Kheirandish-Gozal L, Gozal D (2016). Pediatric OSAS: Oximetry can provide answers when polysomnography is not available. Sleep Med Rev, 27: 96-105.
Lipford MC, Flemming KD, Calvin AD, et al (2015). Associations between Cardioembolic Stroke and Obstructive Sleep Apnea. Sleep, 38 (11): 1699-705.
Mehra R, Benjamin EJ, Shahar E, et al (2006). Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med, 173 (8): 910-6.
Monahan K, Storfer-Isser A, Mehra R, et al (2009). Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol, 54 (19): 1797-804.
Gami AS, Hodge DO, Herges RM, et al (2007). Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol, 49 (5): 565-71.
Simantirakis EN, Schiza SI, Marketou ME, et al (2004). Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J, 25 (12): 1070-6.
Kim YS, Kim SY, Park DY, Wu HW, Hwang GS, Kim HJ (2015). Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients. J Craniofac Surg, 26 (5): 1592-5.
Selim BJ, Koo BB, Qin L, et al (2016). The Association between Nocturnal Cardiac Arrhythmias and Sleep-Disordered Breathing: The DREAM Study. J Clin Sleep Med, 12 (6): 829-37.
Mehra R, Stone KL, Varosy PD, et al (2009). Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Arch Intern Med, 169 (12): 1147-55.
Sahadevan J, Srinivasan D (2012). Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. Curr Treat Options Cardiovasc Med, 14 (5): 520-8.
Peng YJ, Overholt JL, Kline D, Kumar GK, Prabhakar NR (2003). Induction of sensory long-term facilitation in the carotid body by intermittent hypoxia: implications for recurrent apneas. Proc Natl Acad Sci USA, 100 (17): 10073-8.
Asemu G, Neckar J, Szarszoi O, Papousek F, Ostadal B, Kolar F (2000). Effects of adaptation to intermittent high-altitude hypoxia on ischemic ventricular arrhythmias in rats. Physiol Res, 49 (5): 597-606.
Tsuji H, Larson MG, Venditti FJ, Jr., et al (1996). Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation, 94 (11): 2850-5.
Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS (2006). Heart rate variability: a review. Med Biol Eng Comput, 44 (12): 1031-51.
Roche F, Gaspoz JM, Court-Fortune I, et al (1999). Screening of obstructive sleep apnea syndrome by heart rate variability analysis. Circulation, 100 (13): 1411-5.
Flevari A, Vagiakis E, Zakynthinos S (2015). Heart rate variability is augmented in patients with positional obstructive sleep apnea, but only supine LF/HF index correlates with its severity. Sleep Breath, 19 (1): 359-67.
Park DH, Shin CJ, Hong SC, et al (2008). Correlation between the severity of obstructive sleep apnea and heart rate variability indices. J Korean Med Sci, 23 (2): 226-31.
Doret M, Spilka J, Chudacek V, Goncalves P, Abry P (2015). Fractal Analysis and Hurst Parameter for Intrapartum Fetal Heart Rate Variability Analysis: A Versatile Alternative to Frequency Bands and LF/HF Ratio. PLoS One, 10: e0136661.