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Sleep and Breathing
Published in: Sleep and Breathing 4/2018

01-12-2018 | Sleep Breathing Physiology and Disorders • Original Article

The independent and combined effects of respiratory events and cortical arousals on the autonomic nervous system across sleep stages

Authors: Jiuxing Liang, Xiangmin Zhang, Xiaomin He, Li Ling, Chunyao Zeng, Yuxi Luo

Published in: Sleep and Breathing | Issue 4/2018

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Abstract

Purpose

During sleep, respiratory events readily modulate the autonomic nervous system (ANS). Whether such modulation is caused by the respiratory event itself or the cortical arousal that follows and whether these influences differ across sleep stages are not clear. Thus, we aimed to study the independent and combined effects of respiratory events and cortical arousals on the ANS across sleep stages.

Methods

We recruited 22 male patients with sleep apnea-hypopnea syndrome (SAHS) and analyzed the differences in the indices of heart rate variability among normal respiration (NR), pathological respiratory events without cortical arousals (PR), cortical arousals without respiratory events (CA), and the coexistence of PR and CA (PR&CA), by sleep stage.

Results

Compared with NR, four indices of variation of the beat-to-beat interval demonstrated consistent results in all sleep stages generally: PR&CA showed the biggest difference, followed by PR and followed by CA, which exhibited the least difference. Thus, the respiratory event itself affects ANS modulation, but the cortical arousal that follows generally enhances this effect. For low-frequency power and low-frequency/high-frequency power ratio (LF/HF), PR&CA had the greatest impact. For mean beat-to-beat interval and high-frequency power (HFP), the influence of PR, CA, and PR&CA depended on sleep depth. However, PR&CA had a different influence on HFP in N2 stage vs. REM stage.

Conclusions

Sleep stage also has an effect on this neuromodulatory mechanism. These findings may help clarify the relationship between SAHS and cardiovascular disease.
Glossary
N1
light sleep occurs mostly in the beginning of sleep, with slow eye movement
N2
no eye movement occurs, and dreaming is very rare
N3
deep sleep, slow-wave sleep
QRS
a voltage waveform due to ventricular contraction
R Peak
a summation wave generated by the depolarization front as it transits the atria
REM
desynchronized sleep similarities to waking states, including rapid, low-voltage desynchronized brain waves
RR
the beat-to-beat interval of the heart
Literature
1.
Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P (2016) Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 26:43–56CrossRef
2.
Selim B, Won C, Yaggi HK (2010) Cardiovascular consequences of sleep apnea. Clin Chest Med 31:203–220CrossRef
3.
Celen YT, Peker Y (2010) Cardiovascular consequences of sleep apnea: I—epidemiology. Anadolu Kardiyol Derg 10:75–80CrossRef
4.
Narkiewicz KMN, Cogliati C, van de Borne PJ, Dyken ME, Somers VK (1998) Altered cardiovascular variability in obstructive sleep apnea. Circulation 98:1071–1077CrossRef
5.
Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Bohm M, Oldenburg O (2015) The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 104:705–718CrossRef
6.
Electrophysiology TFotESoCtNASoP (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation 93:1043–1065CrossRef
7.
Stein PK, Pu Y (2012) Heart rate variability, sleep and sleep disorders. Sleep Med Rev 16:47–66CrossRef
8.
Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS (2006) Heart rate variability: a review. Med Biol Eng Comput 44:1031–1051CrossRef
9.
Leung RS (2009) Sleep-disordered breathing: autonomic mechanisms and arrhythmias. Prog Cardiovasc Dis 51:324–338CrossRef
10.
Kim H, Bae J (2013) Heart rate variability (HRV) in sleep apnea patients. Sleep Med 14:e170CrossRef
11.
Miglis MG (2016) Autonomic dysfunction in primary sleep disorders. Sleep Med 19:40–49CrossRef
12.
Hakim F, Gozal D, Kheirandish-Gozal L (2012) Sympathetic and catecholaminergic alterations in sleep apnea with particular emphasis on children. Front Neurol 3:7CrossRef
13.
Yan J, Zhang X, Yen C-W, Sun L, Yu E, Luo Y (2016) Role of electroencephalogram and oxygen saturation in the induction mechanism of arousal for obstructive sleep apnea-hypopnea syndrome patients. Biol Rhythm Res 47:483–495CrossRef
14.
Goff EA, O’Driscoll DM, Simonds AK, Trinder J, Morrell MJ (2008) The cardiovascular response to arousal from sleep decreases with age in healthy adults. Sleep 31:1009–1017PubMedPubMedCentral
15.
Goff EA, Nicholas CL, Kleiman J, Spear O, Morrell MJ, Trinder J (2012) The effect of flow limitation on the cardiorespiratory response to arousal from sleep under controlled conditions of chemostimulation in healthy older adults. J Sleep Res 21:718–723CrossRef
16.
Sforza E, Jouny C, Ibanez V (2000) Cardiac activation during arousal in humans: further evidence for hierarchy in the arousal response. Clin Neurophysiol 111:1611–1619CrossRef
17.
Horner RL, Brooks D, Kozar LF, Tse S, Phillipson EA (1995) Immediate effects of arousal from sleep on cardiac autonomic outflow in the absence of breathing in dogs. J Appl Physiol 79:151–162CrossRef
18.
Palma JA, Urrestarazu E, Lopez-Azcarate J, Alegre M, Fernandez S, Artieda J, Iriarte J (2013) Increased sympathetic and decreased parasympathetic cardiac tone in patients with sleep related alveolar hypoventilation. Sleep 36:933–940CrossRef
19.
Jo JA, Blasi A, Valladares E, Juarez R, Baydur A, Khoo MC (2005) Determinants of heart rate variability in obstructive sleep apnea syndrome during wakefulness and sleep. Am J Physiol Heart Circ Physiol 288:H1103–H1112CrossRef
20.
Vanninen E, Tuunainen A, Kansanen M, Uusitupa M, Länsimies E (1996) Cardiac sympathovagal balance during sleep apnea episodes. Clin Physiol 16:209–216CrossRef
21.
Gula LJ, Krahn AD, Skanes A, Ferguson KA, George C, Yee R, Klein GJ (2003) Heart rate variability in obstructive sleep apnea: a prospective study and frequency domain analysis. Ann Noninvasive Electrocardiol 8:144–149CrossRef
22.
Duschek S, Werner NS, Reyes Del Paso GA (2013) The behavioral impact of baroreflex function: a review. Psychophysiology 50:1183–1193CrossRef
23.
Prabhakar NR, Kumar GK (2010) Mechanisms of sympathetic activation and blood pressure elevation by intermittent hypoxia. Respir Physiol Neurobiol 174:156–161CrossRef
24.
Lofaso F, Goldenberg F, d’Ortho MP, Coste A, Harf A (1998) Arterial blood pressure response to transient arousals from NREM sleep in nonapneic snorers with sleep fragmentation. Chest 113:985–991CrossRef
25.
Davies RJ, Belt PJ, Roberts SJ, Ali NJ, Stradling JR (1993) Arterial blood pressure responses to graded transient arousal from sleep in normal humans. J Appl Physiol (1985) 74:1123–1130CrossRef
26.
Chouchou F, Pichot V, Barthelemy JC, Bastuji H, Roche F (2014) Cardiac sympathetic modulation in response to apneas/hypopneas through heart rate variability analysis. PLoS One 9:e86434CrossRef
27.
Uyama H, Yamauchi M, Fujita Y, Yoshikawa M, Ohnishi Y, Kimura H (2017) The effects of arousal accompanying an apneic event on blood pressure and sympathetic nerve activity in severe obstructive sleep apnea. Sleep Breath 22:149–155CrossRef
28.
Berry RB, Brooks, R., Gamaldo, C.E., Harding, S.M., Marcus, C.L. and Vaughn, B.V. for the American Academy of Sleep Medicine (2012) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.0. www.​aasmnet.​org, Darien, Illinois: American Academy of Sleep Medicine
29.
Ghaffari A, Golbayani H, Ghasemi M (2008) A new mathematical based QRS detector using continuous wavelet transform. Comput Electron Eng 34:81–91CrossRef
30.
Huang G, Newchurch MJ, Kuang S, Buckley PI, Cantrell W, Wang L (2015) Definition and determination of ozone laminae using continuous wavelet transform (CWT) analysis. Atmos Environ 104:125–131CrossRef
31.
Pichon A, Roulaud M, Antoine-Jonville S, de Bisschop C, Denjean A (2006) Spectral analysis of heart rate variability: interchangeability between autoregressive analysis and fast Fourier transform. J Electrocardiol 39:31–37CrossRef
32.
Liang J, Zhang X, Luo Y, Wang T, Sun L, Huang S (2018) The impact of respiratory events on the autonomic nervous system during sleep. Int Heart J 59:378–386CrossRef
33.
Gomez P, von Gunten A, Danuser B (2016) Autonomic nervous system reactivity within the valence–arousal affective space: modulation by sex and age. Int J Psychophysiol 109:51–62CrossRef
34.
Bianchin M, Angrilli A (2012) Gender differences in emotional responses: a psychophysiological study. Physiol Behav 105:925–932CrossRef
Metadata
Title
The independent and combined effects of respiratory events and cortical arousals on the autonomic nervous system across sleep stages
Authors
Jiuxing Liang
Xiangmin Zhang
Xiaomin He
Li Ling
Chunyao Zeng
Yuxi Luo
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 4/2018
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-018-1669-8

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