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CC BY-NC-ND 4.0 · Sleep Sci 2019; 12(03): 214-221
DOI: 10.5935/1984-0063.20190082
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Heart rate variability in adults with obstructive sleep apnea: a systematic review

Vanessa Cristina Cunha Sequeira
1   Veiga de Almeida University, Neuroscience Postgraduate - Rio de Janeiro - Rio de Janeiro - Brazil.
2   Federal University of Rio de Janeiro, Edson Saad Heart Institute - Rio de Janeiro - Rio de Janeiro - Brazil.
,
Pamela Martin Bandeira
2   Federal University of Rio de Janeiro, Edson Saad Heart Institute - Rio de Janeiro - Rio de Janeiro - Brazil.
,
João Carlos Moreno Azevedo
1   Veiga de Almeida University, Neuroscience Postgraduate - Rio de Janeiro - Rio de Janeiro - Brazil.
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Obstructive Sleep Apnea is a common respiratory disorder characterized by recurrent nocturnal episodes of normal breathing interruption due to upper airway total or partial collapse. Obstructive sleep apnea and cardiovascular diseases has similar risk factors, but the first is also a predisposing factor for cardiovascular pathologies independently of individuals demographic characteristics or risk markers. Heart rate variability is a non-invasive method to evaluate the regulation of autonomic nervous system and its a promising marker for health and disease, such as cardiovascular and respiratory diseases. The aim was to review whether heart rate variability is altered in patients with obstructive sleep apnea. We searched in five databases, including BIREME, Cochrane, Scholar Google, MEDLINE/PubMed and Periodics CAPES, and reference lists were also searched. Only cross-sectional studies comparing the heart rate variability of obstructive sleep patients with controls were included. Two authors independently extracted data and assessed trial quality. Twelve studies (513 participants with obstructive sleep apnea and 340 controls) met the inclusion criteria. This review evidence that adults with obstructive sleep apnea may demonstrate diminished vagal tone and higher sympathetic responsiveness.

Autonomic Nervous System - Heart Rate - Sleep Apnea - Obstructive


Publication History

Received: 29 March 2019

Accepted: 16 September 2019

Article published online:
31 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.
  • 2 Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43.
  • 3 Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009;51(4):285-93.
  • 4 Lim J, Lasserson TJ, Fleetham J, Wright J. Oral appliances for obstructive sleep apnea. Cochrane Database Syst Rev. 2004;(4):CD004435.
  • 5 Pereira A. Síndrome da apneia obstrutiva do sono: fisiopatologia, epidemiologia, consequências, diagnóstico e tratamento. Arq Med. 2007;21(5/6):159-73.
  • 6 Gozal D, Hakim F, Kheirandish-Gozal L. Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea. Respir Physiol Neurobiol. 2013;185(1):177-85.
  • 7 Cooper HE, Clutton-Brock TH, Parkes MJ. Contribution of the respiratory rhythm to sinus arrhythmia in normal unanesthetized subjects during positive-pressure mechanical hyperventilation. Am J Physiol Heart Circ Physiol. 2004;286(1):H402-11.
  • 8 Kheirandish-Gozal L, Bhattacharjee R, Gozal D. Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea. Sleep Med. 2010;11(7):714-20.
  • 9 Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Front Psychol. 2014;5:1040.
  • 10 Patel PA, Diwan JS, Shah CJ, Mehta HB. Study of heart rate variability in hypertensive subjects. Natl J Integr Res Med. 2015;6(1):1-6.
  • 11 Roque AL, Valenti VE, Massetti T, da Silva TD, Monteiro CB, Oliveira FR, et al. Chronic obstructive pulmonary disease and heart rate variability: a literature update. Int Arch Med. 2014;7:43.
  • 12 Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
  • 13 Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al.; ESH Working Group on CV Risk in Low Resource Settings. Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(1):e0147601.
  • 14 Noda A, Yasuma F, Okada T, Yokota M. Circadian rhythm of autonomic activity in patients with obstructive sleep apnea syndrome. Clin Cardiol. 1998;21(4):271-6.
  • 15 Xie J, Yu W, Wan Z, Han F, Wang Q, Chen R. Correlation Analysis between Obstructive Sleep Apnea Syndrome (OSAS) and Heart Rate Variability. Iran J Public Health. 2017;46(11):1502-11.
  • 16 Wakai M, Samejima Y, Goshima K, Yamamoto J. Altered heart rate variability in severe sleep apnea syndrome. Sleep Biol Rhythms. 2004;2(1):87-8.
  • 17 Wiklund U, Olofsson BO, Franklin K, Blom H, Bjerle P, Niklasson U. Autonomic cardiovascular regulation in patients with obstructive sleep apnoea: a study based on spectral analysis of heart rate variability. Clin Physiol. 2000;20(3):234-41.
  • 18 Aydin M, Altin R, Ozeren A, Kart L, Bilge M, Unalacak M. Cardiac autonomic activity in obstructive sleep apnea. Tex Heart Inst J. 2004;31(2):132-6.
  • 19 Chrysostomakis SI, Simantirakis EN, Schiza SE, Karalis IK, Klapsinos NC, Siafakas NM, et al. Continuous positive airway pressure therapy lowers vagal tone in patients with obstructive sleep apnoea-hypopnoea syndrome. Hellenic J Cardiol. 2006;47(1):13-20.
  • 20 Coruzzi P, Gualerzi M, Bernkopf E, Brambilla L, Brambilla V, Broia V, et al. Autonomic cardiac modulation in obstructive sleep apnea: effect of an oral jaw-positioning appliance. Chest. 2006;130(5):1362-8.
  • 21 Aytemir K, Deniz A, Yavuz B, Ugur Demir A, Sahiner L, Ciftci O, et al. Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome. Respir Med. 2007;101(6):1277-82.
  • 22 Zhu K, Chemla D, Roisman G, Mao W, Bazizi S, Lefevre A, et al. Overnight heart rate variability in patients with obstructive sleep apnoea: a time and frequency domain study. Clin Exp Pharmacol Physiol. 2012;39(11):901-8.
  • 23 Kim YS, Kim SY, Park DY, Wu HW, Hwang GS, Kim HJ. Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients. J Craniofac Surg. 2015;26(5):1592-5.
  • 24 Chang JS, Lee SD, Ju G, Kim JW, Ha K, Yoon IY. Enhanced cardiorespiratory coupling in patients with obstructive sleep apnea following continuous positive airway pressure treatment. Sleep Med. 2013;14(11):1132-8.
  • 25 Palma JA, Iriarte J, Fernandez S, Alegre M, Valencia M, Artieda J, et al. Long-term continuous positive airway pressure therapy improves cardiac autonomic tone during sleep in patients with obstructive sleep apnea. Clin Auton Res. 2015;25(4):225-32.
  • 26 Tracy LM, Ioannou L, Baker KS, Gibson SJ, Georgiou-Karistianis N, Giummarra MJ. Meta-analytic evidence for decreased heart rate variability in chronic pain implicating parasympathetic nervous system dysregulation. Pain. 2016;157(1):7-29.
  • 27 Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc. 2009;24(2):205-17.
  • 28 Dias de Carvalho T, Marcelo Pastre C, Claudino Rossi R, de Abreu LC, Valenti VE, Marques Vanderlei LC. Geometric index of heart rate variability in chronic obstructive pulmonary disease. Rev Port Pneumol. 2011;17(6):260-5.
  • 29 Ferreira MT, Messias M, Vanderlei LCM, Pastre CM. Caracterização do Comportamento Caótico da Variabilidade da Frequência Cardíaca (VFC) em Jovens Saudáveis. Tend Mat Apl Comput. 2010;11(2):141-50.
  • 30 Madeiro JPV, Seisdedos CRV, Cortez PC, Marques JAL. Análise de desempenho da entropia aproximada (ApEn) na análise da variabilidade da frequência cardíaca (VFC). In: V Latin American Congress on Biomedical Engineering CLAIB 2011; 2011 May 16-21; Habana, Cuba. p. 1182-5.
  • 31 Khayat R, Pleister A. Consequences of Obstructive Sleep Apnea: Cardiovascular Risk of Obstructive Sleep Apnea and Whether Continuous Positive Airway Pressure Reduces that Risk. Sleep Med Clin. 2016;11(3):273-86.
  • 32 Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med. 2008;4(3):261-72.
  • 33 Kufoy E, Palma JA, Lopez J, Alegre M, Urrestarazu E, Artieda J, et al. Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment. PLoS One. 2012;7(3):e33769.
  • 34 Hamilton GS, Solin P, Naughton MT. Obstructive sleep apnoea and cardiovascular disease. Intern Med J. 2004;34(7):420-6.
  • 35 Narkiewicz K, Somers VK. Cardiovascular variability characteristics in obstructive sleep apnea. Auton Neurosci. 2001;90(1-2):89-94.
  • 36 Gomes JS, Coghi MF, Coghi PF. Cardiovascular biofeedback and its applications: review of literature. Av Psicol Latinoam. 2014;32(2):199-216.
  • 37 Bauer A, Camm AJ, Cerutti S, Guzik P, Huikuri H, Lombardi F, et al. Reference values of heart rate variability. Heart Rhythm. 2017;14(2):302-3.
  • 38 Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65.
  • 39 Tada Y, Yoshizaki T, Tomata Y, Yokoyama Y, Sunami A, Hida A, et al. The Impact of Menstrual Cycle Phases on Cardiac Autonomic Nervous System Activity: An Observational Study Considering Lifestyle (Diet, Physical Activity, and Sleep) among Female College Students. J Nutr Sci Vitaminol (Tokyo). 2017;63(4):249-55.
  • 40 Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev. 2008;12(6):481-96.
  • 41 Taralov ZZ, Terziyski KV, Kostianev SS. Heart Rate Variability as a Method for Assessment of the Autonomic Nervous System and the Adaptations to Different Physiological and Pathological Conditions. Folia Med (Plovdiv). 2015;57(3-4):173-80.
  • 42 Campos-Rodriguez F, Martínez-García MA, Reyes-Nuñez N, Selma-Ferrer MJ, Punjabi NM, Farre R. Impact of different hypopnea definitions on obstructive sleep apnea severity and cardiovascular mortality risk in women and elderly individuals. Sleep Med. 2016;27-28:54-8.
  • 43 Sankari A, Finn LA, Maresh S, Hamdon MS, Al-kubaisi G, Badr MS, et al. A new marker of cardiovascular disease in patients with sleep-disordered breathing: results from the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2016;193:A2523.
  • 44 Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258.