Abnormal nocturnal heart rate variability response among chronic kidney disease and dialysis patients during wakefulness and sleep.
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.
Roumelioti
Maria-Eleni
ME
Renal-Electrolyte Division, University of Pittsburgh Medical Center, A909 Scaife Hall, Pittsburgh, PA 15261, USA. mar127@pitt.edu
Ranpuria
Reena
R
Hall
Martica
M
Hotchkiss
John R
JR
Chan
Chris T
CT
Unruh
Mark L
ML
Argyropoulos
Christos
C
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*
D001639:Bicarbonates
Annu Rev Med. 1999;50:249-61
10073276
Lancet. 2003 Jul 5;362(9377):7-13
12853193
J Appl Physiol (1985). 2008 Dec;105(6):1873-6
18845779
Ther Adv Cardiovasc Dis. 2009 Feb;3(1):29-43
19124389
Am J Physiol Regul Integr Comp Physiol. 2002 Oct;283(4):R815-26
12228049
Psychosom Med. 2008 May;70(4):410-6
18480189
Circulation. 1995 Apr 1;91(7):1918-22
7895347
ASAIO J. 2006 Nov-Dec;52(6):e11-4
17117036
Clin Sci (Lond). 2007 Aug;113(3):131-40
17381425
Am J Epidemiol. 2003 Feb 15;157(4):364-75
12578807
Sleep. 2009 May;32(5):589-97
19480225
Sleep. 2007 Nov;30(11):1509-14
18041483
Diabetes Care. 2005 Mar;28(3):668-74
15735206
Circulation. 2005 Oct 18;112(16):2426-35
16143696
Circulation. 2005 Aug 9;112(6):786-8
16087808
Jpn Circ J. 1996 Dec;60(12):925-32
8996682
JAMA. 1999 Nov 10;282(18):1737-44
10568646
Acta Physiol Scand. 1995 Nov;155(3):267-73
8619324
Clin Sci (Lond). 2007 Aug;113(3):129-30
17451377
Eur Heart J. 1996 Mar;17(3):354-81
8737210
Clin Neurophysiol. 2004 Oct;115(10):2236-46
15351364
Ann Intern Med. 1999 Mar 16;130(6):461-70
10075613
J Nephrol. 2008 Jan-Feb;21(1):45-52
18264936
J Am Board Fam Pract. 2005 Mar-Apr;18(2):97-103
15798138
Acta Anaesthesiol Scand. 1996 Aug;40(7):804-8
8874566
J Ren Nutr. 2008 Jan;18(1):118-21
18089457
Auton Neurosci. 2009 Jun 15;148(1-2):5-15
19268634
Crit Care. 2004 Dec;8(6):R367-84
15566580
Psychosomatics. 2004 Mar-Apr;45(2):129-34
15016926
Clin J Am Soc Nephrol. 2007 May;2(3):410-2
17699443
Hypertension. 2001 Jun;37(6):1351-6
11408376
J Hypertens. 2009 Mar;27(3):562-6
19330916
Am J Kidney Dis. 2008 Jul;52(1):118-27
18589216
Nephrol Dial Transplant. 2005 Jul;20(7):1422-8
15840682
Nephrol Dial Transplant. 2004 Aug;19(8):2053-60
15161953
Am J Epidemiol. 1998 Apr 1;147(7):694-703
9554609
Am J Physiol Regul Integr Comp Physiol. 2003 Nov;285(5):R927-31
14557228
Lancet. 1999 Jun 12;353(9169):2001-7
10376614
Am J Hypertens. 1998 Feb;11(2):196-202
9524048
Nephrol Dial Transplant. 2007 Aug;22(8):2256-62
17400561
Lancet. 1999 Jan 2;353(9146):9-13
10023943
Curr Opin Pulm Med. 2008 Nov;14(6):543-50
18812831
Kidney Int. 2004 Feb;65(2):661-5
14717939
Biol Psychol. 2003 May;63(2):149-62
12738405
Med Biol Eng Comput. 2006 Dec;44(12):1031-51
17111118
Nephrol Dial Transplant. 2003 Mar;18(3):563-9
12584280
Ren Fail. 2003 Sep;25(5):845-53
14575292
Clin Neurophysiol. 2007 Feb;118(2):438-48
17140849
J Am Coll Cardiol. 1998 Mar 1;31(3):593-601
9502641
Am J Physiol Heart Circ Physiol. 2002 Jan;282(1):H6-20
11748042
Chronobiol Int. 2009 Aug;26(6):1206-21
19731113