title: Cardiac variability and heart-rate increment as a marker of sleep fragmentation in patients with a sleep disorder: a preliminary study.
abstract: OBJECTIVE
  The ratio between the heart-rate increment to total power spectral density (%VLFI) has been introduced as a sensitive measure of sleep-related breathing disorders (SRBD). Since a complex interaction is present between sleep disorders and occurrence of arousals, we hypothesized that %VLFI and other indexes of heart-rate variability (HRV) measures reflect the degree of sleep fragmentation.
  
  
  METHODS
  The high- and low-frequency peaks from spectral analysis (FFT) of R-R intervals, the HRV changes using wavelet transform (WT), the geometric and time domain HRV, and the %VLFI were measured in 336 sleep studies performed in patients with insomnia, SRBD and restless legs syndrome/periodic limb movement disorder (RLS/PLMD). The ability of HRV measures to assess sleep fragmentation was examined by correlation analysis and from the area under the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The ratio of low frequency to high frequency (LF/HF ratio) at the FFT and WT and the %VLFI were higher in patients with SRBD and RLS/PLMD, compared with patients with insomnia. These measures were related to the arousal (MA) index as well as to the apnea-hypopnea index, oxygen desaturations, and periodic leg movement index (p < .001). The presence of a sleep fragmentation defined as an MA index > 20 was well detected by the %VLFI (ROC area: 0.66 +/- 0.03) and the LF/HF ratio at WT (ROC area: 0.66 +/- 0.03).
  
  
  CONCLUSIONS
  The %VLFI and LF/HF ratio provide indirect measures of sleep fragmentation, suggesting that HRV measures during sleep assess more the associated sleep fragmentation than the presence of a specific sleep disorder.
authors.affiliation: Sleep laboratory, Department of Psychiatry, University Hospital, Geneva, Switzerland. Emilia.Sforza@hcuge.ch
authors.forename: Emilia
authors.initials: E
authors.lastname: Sforza
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichot
authors.forename: Katerina
authors.initials: K
authors.lastname: Cervena
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Barthélémy
authors.forename: Frederic
authors.initials: F
authors.lastname: Roche
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D015415:Biomarkers; D004562:Electrocardiography; D005260:Female; D005583:Fourier Analysis; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D017286:Polysomnography; D012815:Signal Processing, Computer-Assisted; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D014851:Wakefulness / Q000502:physiology
chemical_list: D015415:Biomarkers