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Long-term continuous positive airway pressure therapy improves cardiac autonomic tone during sleep in patients with obstructive sleep apnea

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Abstract

Background

Cardiac autonomic tone after long-term continuous positive airway pressure therapy in patients with obstructive sleep apnea remains unexplored.

Methods

Thirty patients with obstructive sleep apnea (14 with moderate and 16 with severe obstructive sleep apnea) were studied during a baseline polysomnographic study, after a full night of acute continuous positive airway pressure treatment, and after long-term (~2 years) chronic continuous positive airway pressure therapy. Twenty age- and gender-matched controls with baseline sleep study were selected for comparison purposes. Cross-spectral analysis and the low-frequency (LF) and high-frequency (HF) components of the heart rate variability were computed separately over 10-min ECG epochs during rapid eye movement sleep, non-rapid eye movement sleep, and wakefulness.

Results

During the baseline study, obstructive sleep apnea patients exhibited increased LF, decreased HF, and increased LF/HF ratio during sleep when compared to controls. In a multiple regression model, the mean oxygen saturation explained the increased LF during rapid and non-rapid eye movement sleep in obstructive sleep apnea patients. Acute continuous positive airway pressure therapy decreased the LF modulations and the LF/HF ratio and increased the HF modulations during sleep in patients with severe obstructive sleep apnea. Long-term continuous positive airway pressure therapy decreased LF modulations and LF/HF ratio with increased HF modulations during sleep in patients with moderate and severe obstructive sleep apnea.

Conclusions

Long-term continuous positive airway pressure reduces the sympathovagal imbalance in patients with moderate and severe obstructive sleep apnea, both during rapid and non-rapid eye movement sleep. Continuous positive airway pressure seems to exert its changes in cardiac autonomic modulation by decreasing the burden of nocturnal hypoxia.

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Acknowledgments

This work was funded in part by Asociacion de Amigos de la Universidad de Navarra.

Conflict of interest

The authors declare that they have no conflicts of interests.

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Authors and Affiliations

  1. Sleep Unit, Clinical Neurophysiology Section, University Clinic of Navarra, Pío XII s/n 31008, Pamplona, Spain

    Jose-Alberto Palma, Jorge Iriarte, Manuel Alegre, Julio Artieda & Elena Urrestarazu

  2. Department of Neurology, Dysautonomia Center, New York University School of Medicine, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA

    Jose-Alberto Palma

  3. Department of Otolaryngology, University Clinic of Navarra, Pamplona, Spain

    Secundino Fernandez

  4. Neurophysiology Laboratory, CIMA, University of Navarra, Pamplona, Spain

    Manuel Alegre, Miguel Valencia & Julio Artieda

Authors
  1. Jose-Alberto Palma
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  2. Jorge Iriarte
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  3. Secundino Fernandez
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  4. Manuel Alegre
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  5. Miguel Valencia
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  6. Julio Artieda
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  7. Elena Urrestarazu
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Correspondence to Jose-Alberto Palma or Jorge Iriarte.

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Palma, JA., Iriarte, J., Fernandez, S. et al. Long-term continuous positive airway pressure therapy improves cardiac autonomic tone during sleep in patients with obstructive sleep apnea. Clin Auton Res 25, 225–232 (2015). https://doi.org/10.1007/s10286-015-0297-7

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  • DOI: https://doi.org/10.1007/s10286-015-0297-7

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