title: Effect of mild, asymptomatic obstructive sleep apnea on daytime heart rate variability and impedance cardiography measurements.
abstract: Dysregulation of autonomic nervous system dynamics is important in the pathophysiology of cardiovascular risk in obstructive sleep apnea (OSA). Heart rate variability (HRV) and impedance cardiography measures can estimate autonomic activity but have not gained traction clinically. The hypothesis of this study was that even in a cohort of patients with mild, asymptomatic OSA without overt cardiovascular disease, daytime HRV metrics and impedance cardiography measurements of preejection period would demonstrate increased sympathetic and decreased parasympathetic modulation compared to matched controls. Obese subjects (body mass index ≥30 kg/m(2)) without any known cardiovascular or inflammatory co-morbidities were recruited from the community. Subjects underwent standard in-laboratory polysomnography followed by simultaneous electrocardiographic and impedance cardiographic recordings while supine, supine with paced breathing, and after standing. Seventy-four subjects were studied, and 59% had OSA (apnea-hypopnea index ≥10 events/hour), with a median apnea-hypopnea index of 25.8 events/hour. Subjects with OSA had significantly decreased daytime time- and frequency-domain HRV indexes, but not significantly different preejection periods, compared to controls. Apnea-hypopnea index was a significant independent predictor of time-domain HRV measures in all awake conditions, after controlling for age, gender, blood pressure, fasting cholesterol levels and glycosylated hemoglobin. In conclusion, these results demonstrate reductions in cardiac vagal modulation, as measured by multiple daytime time-domain markers of HRV, in patients with asymptomatic OSA compared to controls. Further prospective outcomes-based studies are needed to evaluate the applicability of these metrics for noninvasive screening of obese patients with asymptomatic OSA, before the onset of overt cardiovascular disease.
authors.affiliation: Sleep Disorders Research Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. jsbalach@hotmail.com
authors.forename: Jay S
authors.initials: JS
authors.lastname: Balachandran
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.forename: Shilpa
authors.initials: S
authors.lastname: Rahangdale
authors.forename: Susie
authors.initials: S
authors.lastname: Yim-Yeh
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Mietus
authors.forename: Ary L
authors.initials: AL
authors.lastname: Goldberger
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002307:Cardiography, Impedance / Q000379:methods*; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D013997:Time Factors