title: Abnormal nocturnal heart rate variability response among chronic kidney disease and dialysis patients during wakefulness and sleep.
abstract: BACKGROUND
  Dialysis patients and patients with chronic kidney disease (CKD) experience a substantial risk for abnormal autonomic function and abnormal heart rate variability (HRV). It remains unknown whether HRV changes across sleep stages in patients with different severity of CKD or dialysis dependency. We hypothesized that high-frequency (HF) HRV (vagal tone) will be attenuated from wakefulness to non-rapid eye movement (NREM) and then to rapid eye movement (REM) sleep in dialysis patients as compared to patients with CKD.
  
  
  METHODS
  In-home polysomnography was performed in 95 patients with stages 4-5 CKD or end-stage renal disease (ESRD) on haemodialysis (HD) or peritoneal dialysis (PD). HRV was measured using fast Fourier transform of interbeat intervals during wakefulness and sleep. Low-frequency (LF) and HF intervals were generated. Natural logarithm HF (LNHF) and the logarithm LF/HF ratio (sympathovagal tone) were analysed by multivariable quantile regression and generalized estimating equations.
  
  
  RESULTS
  Of the 95 patients, 63.2% (n = 60) was male, 35.8% (n = 34) was African American and 20.4% (n = 19) was diabetic. Average age was 51.6 ± 15.1 (range 19-82). HRV variables were significantly associated with diabetic status, higher periodic limb movement indices and lower bicarbonate levels. Patients with advanced CKD did not differ from dialysis patients in their inability to increase vagal tone during sleep. During wakefulness, female gender (P = 0.05) was associated with the increases in the vagal tone.
  
  
  CONCLUSIONS
  Patients with CKD/ESRD exhibit dysregulation of the autonomic nervous system tone manifesting as a failure to increase HRV during wakefulness and sleep. Different patient characteristics are associated with changes in HRV at different sleep stages.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh Medical Center, A909 Scaife Hall, Pittsburgh, PA 15261, USA. mar127@pitt.edu
authors.forename: Maria-Eleni
authors.initials: ME
authors.lastname: Roumelioti
authors.forename: Reena
authors.initials: R
authors.lastname: Ranpuria
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
authors.forename: John R
authors.initials: JR
authors.lastname: Hotchkiss
authors.forename: Chris T
authors.initials: CT
authors.lastname: Chan
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
mesh_terms: D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006339:Heart Rate; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012727:Sex Characteristics; D012890:Sleep / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology*
chemical_list: D001639:Bicarbonates
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