Key result
Subjects with sleep apnea and concurrent or future cardiovascular disease exhibited a significantly reduced sympathovagal balance during sleep compared to controls (p < 0.05).
Why the study?
It was unknown how altered autonomic control is reflected in subjects suffering from sleep apnea syndrome and cardiovascular disease simultaneously compared with sleep apnea syndrome alone.
Does the presence of cardiovascular disease alter autonomic control (measured by HRV) in patients with sleep apnea syndrome?
Observational (n=199)
Yes
Does the presence of cardiovascular disease alter autonomic control (measured by HRV) in patients with sleep apnea syndrome?
Absolute Event Rate: 0.38% vs 0.47%
p-value: p=<0.05
Patients with both sleep apnea and cardiovascular disease exhibit altered autonomic responses with reduced sympathovagal balance compared to those with sleep apnea alone, suggesting HRV could aid in cardiovascular risk phenotyping.
Altered HRV may signal CVD risk in sleep apnea; hypothesis-generating for phenotyping and requires prospective validation.
The high prevalence of sleep apnea syndrome (SAS) and its direct relationship with an augmented risk of cardiovascular disease (CVD) have raised SAS as a primary public health problem. For this reason, extensive research aiming to understand the interaction between both conditions has been conducted. The advances in non-invasive autonomic nervous system (ANS) monitoring through heart rate variability (HRV) analysis have revealed an increased sympathetic dominance in subjects suffering from SAS when compared with controls. Also HRV analysis of subjects with CVD suggests altered autonomic activity. In this work, we analyzed how altered autonomic control is reflected in subjects suffering from SAS and CVD (or at high risk of CVD) simultaneously, when compared with SAS patients. The analysis was performed over 199 subjects during night-time, and the effects of the physiological response that follows an apneic episode, sleep stages and respiration on HRV were taken into account. Results, as measured by HRV, suggest a decreased sympathetic dominance in those subjects suffering from both conditions, which was reflected in a significantly reduced sympathovagal balance (p < 0.05). In this way, ANS monitoring could contribute to patient phenotyping, as an altered response might have direct implications on cardiovascular health.
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Milagro et al. (2019) conducted an observational in Sleep Apnea Syndrome (n=199). Cardiovascular disease or risk vs. Sleep apnea without cardiovascular disease or risk was evaluated on Sympathovagal balance (normalized low-frequency power, PeLFn) during NREM sleep excluding apneic episodes (p=<0.05). Subjects with sleep apnea and concurrent or future cardiovascular disease exhibited a significantly reduced sympathovagal balance during sleep compared to controls (p < 0.05).
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