Day-night pattern of autonomic nervous system modulation in patients with heart failure with and without sleep apnea

作者：Ueno Linda M^*; Drager Luciano F; Rodrigues Ana C T; Rondon Maria U P B; Mathias Wilson Jr; Krieger Eduardo M; Fazan Junior Rubens; Negrao Carlos E; Lorenzi Filho Geraldo

来源：International Journal of Cardiology, 2011, 148(1): 53-58.

DOI：10.1016/j.ijcard.2009.10.023

• Chronic heart failure
• Sleep apnea
• Cardiac autonomic control
• Spontaneous baroreflex sensitivity

Introduction: Among patients with congestive heart failure (CHF) both obstructive and central sleep apnea (SA) are associated with increased sympathetic activity. However, the day-night pattern of cardiac autonomic nervous system modulation in CHF patients with and without sleep apnea is unknown.
Material and methods: Twenty-five CHF patients underwent polysomnography with simultaneous beat-to-beat blood pressure (Portapres), respiration and electrocardiogram monitoring. Patients were divided according to the presence (SA, n=17) and absence of SA (NoSA, n=8). Power spectral analyses of heart rate variability (HRV) and spontaneous baroreflex sensitivity (BRS) were determined in periods with stable breathing while awake at 6 AM, 10 AM, 10 PM, as well as during stage 2 sleep. In addition, muscle sympathetic nerve activity (MSNA) was evaluated at 10 AM.
Results: RR variance, low-frequency (LF), high-frequency (HF) powers of HRV, and BRS were significantly lower in patients with SA compared with NoSA in all periods. HF power, a marker of vagal activity, increased during sleep in patients with NoSA but in contrast did not change across the 24-hour period in patients with SA. MSNA was significantly higher in patients with SA compared with NoSA. RR variance, LF and HF powers correlated inversely with simultaneous MSNA (r=-0.64, -0.61, and -0.61 respectively; P < 0.01).
Conclusions: Patients with CHF and SA present a reduced and blunted cardiac autonomic modulation across the 24-hour period. These findings may help to explain the increased cardiovascular risk in patients with CHF and SA.

• 出版日期2011-4