Skip to main content
Top
Published in:

03-01-2024 | Sleep-Related Breathing Disorders | Sleep Breathing Physiology and Disorders • Original Article

The value of circadian heart rate variability for the estimation of obstructive sleep apnea severity in adult males

Authors: Baokun Zhang, Mengke Zhao, Xiao Zhang, Xiaoyu Zhang, Xiaomin Liu, Weiwei Huang, Shanshan Lu, Juanjuan Xu, Ying Liu, Wei Xu, Xiuhua Li, Jiyou Tang

Published in: Sleep and Breathing | Issue 3/2024

Login to get access

Abstract

Objectives

Heart rate variability (HRV) is becoming more prevalent as a measurable parameter in wearable sleep-monitoring devices, which are simple and effective instruments for illness evaluation. Currently, most studies on investigating OSA severity and HRV have measured heart rates during wakefulness or sleep. Therefore, the objective of this study was to investigate the circadian rhythm of HRV in male patients with OSA and its value for the estimation of OSA severity using group-based trajectory modeling.

Methods

Patients with complaints of snoring were enrolled from the Sleep Center of Shandong Qianfoshan Hospital. Patients were divided into 3 groups according to apnea hypopnea index (AHI in events/h), as follows: (<15, 15≤AHI<30, and ≥30). HRV parameters were calculated using 24 h Holter monitoring, which included time-domain and frequency-domain indices. Circadian differences in the standard deviation of normal to normal (SDNN) were evaluated for OSA severity using analysis of variance, trajectory analysis, and multinomial logistic regression.

Results

A total of 228 patients were enrolled, 47 with mild OSA, 48 moderate, and 133 severe. Patients with severe OSA exhibited reduced triangular index and higher very low frequency than those in the other groups. Circadian HRV showed that nocturnal SDNN was considerably higher than daytime SDNN in patients with severe OSA. The difference among the OSA groups was significant at 23, 24, 2, and 3 o’clock sharp between the severe and moderate OSA groups (all P<0.05). The heterogeneity of circadian HRV trajectories in OSA was strongly associated with OSA severity, including sleep structure and hypoxia-related parameters. Among the low-to-low, low-to-high, high-to-low, and high-to-high groups, OSA severity in the low-to-high group was the most severe, especially compared with the low-to-low and high-to-low SDNN groups, respectively.

Conclusions

Circadian HRV in patients with OSA emerged as low daytime and high nocturnal in SDNN, particularly in men with severe OSA. The heterogeneity of circadian HRV revealed that trajectories with low daytime and significantly high nighttime were more strongly associated with severe OSA. Thus, circadian HRV trajectories may be useful to identify the severity of OSA.
Appendix
Available only for authorised users
Literature
1.
go back to reference Dos Santos RR et al (2022) Correlation between heart rate variability and polysomnography-derived scores of obstructive sleep apnea. Front Netw Physiol 2:958550PubMedPubMedCentral Dos Santos RR et al (2022) Correlation between heart rate variability and polysomnography-derived scores of obstructive sleep apnea. Front Netw Physiol 2:958550PubMedPubMedCentral
2.
go back to reference Shieu MM et al (2022) Positive airway pressure and cognitive disorders in adults with obstructive sleep apnea: a systematic review of the literature. Neurology 99(4):e334–e346PubMedPubMedCentral Shieu MM et al (2022) Positive airway pressure and cognitive disorders in adults with obstructive sleep apnea: a systematic review of the literature. Neurology 99(4):e334–e346PubMedPubMedCentral
3.
go back to reference Redline S, Azarbarzin A, Peker Y (2023) Obstructive sleep apnoea heterogeneity and cardiovascular disease. Nat Rev Cardiol 20(8):560–573PubMed Redline S, Azarbarzin A, Peker Y (2023) Obstructive sleep apnoea heterogeneity and cardiovascular disease. Nat Rev Cardiol 20(8):560–573PubMed
5.
go back to reference Khurana S et al (2021) Current and future strategies for diagnostic and management of obstructive sleep apnea. Expert Rev Mol Diagn 21(12):1287–1301PubMed Khurana S et al (2021) Current and future strategies for diagnostic and management of obstructive sleep apnea. Expert Rev Mol Diagn 21(12):1287–1301PubMed
6.
go back to reference Sleep disorder group of chinese thoracic society, group of sleep disordered breathing, committee of respiratory diseases of china association of medical equipment [Expert consensus for the use of home sleep apnea test in the diagnosis of obstructive sleep apnea in adults] (2022). Zhonghua Jie He He Hu Xi Za Zhi 45(2):133–142 Sleep disorder group of chinese thoracic society, group of sleep disordered breathing, committee of respiratory diseases of china association of medical equipment [Expert consensus for the use of home sleep apnea test in the diagnosis of obstructive sleep apnea in adults] (2022). Zhonghua Jie He He Hu Xi Za Zhi 45(2):133–142
7.
go back to reference Ucak S et al (2021) Heart rate variability and obstructive sleep apnea: current perspectives and novel technologies. J Sleep Res 30(4):e13274PubMed Ucak S et al (2021) Heart rate variability and obstructive sleep apnea: current perspectives and novel technologies. J Sleep Res 30(4):e13274PubMed
8.
go back to reference Pumprla J et al (2002) Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol 84(1):1–14PubMed Pumprla J et al (2002) Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol 84(1):1–14PubMed
9.
go back to reference Fang SC, Wu YL, Tsai PS (2020) Heart rate variability and risk of all-cause death and cardiovascular events in patients with cardiovascular disease: a meta-analysis of cohort studies. Biol Res Nurs 22(1):45–56PubMed Fang SC, Wu YL, Tsai PS (2020) Heart rate variability and risk of all-cause death and cardiovascular events in patients with cardiovascular disease: a meta-analysis of cohort studies. Biol Res Nurs 22(1):45–56PubMed
10.
go back to reference Nordholm D et al (2023) A longitudinal study on physiological stress in individuals at ultra high-risk of psychosis. Schizophr Res 254:218–226PubMed Nordholm D et al (2023) A longitudinal study on physiological stress in individuals at ultra high-risk of psychosis. Schizophr Res 254:218–226PubMed
11.
go back to reference Statello R et al (2023) Nocturnal heart rate variability might help in predicting severe obstructive sleep-disordered breathing. Biology (Basel) 12(4):533PubMed Statello R et al (2023) Nocturnal heart rate variability might help in predicting severe obstructive sleep-disordered breathing. Biology (Basel) 12(4):533PubMed
12.
go back to reference Qin H et al (2021) Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity. Sleep 44(5):zsab018 Qin H et al (2021) Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity. Sleep 44(5):zsab018
13.
go back to reference Lao M et al (2021) The predictive value of Holter monitoring in the risk of obstructive sleep apnea. J Thorac Dis 13(3):1872–1881PubMedPubMedCentral Lao M et al (2021) The predictive value of Holter monitoring in the risk of obstructive sleep apnea. J Thorac Dis 13(3):1872–1881PubMedPubMedCentral
14.
go back to reference Martín-González S et al (2023) Combining heart rate variability and oximetry to improve apneic event screening in non-desaturating patients. Sensors (Basel, Switzerland) 23(9):4267PubMed Martín-González S et al (2023) Combining heart rate variability and oximetry to improve apneic event screening in non-desaturating patients. Sensors (Basel, Switzerland) 23(9):4267PubMed
15.
go back to reference Correia FJ et al (2019) Repercussion of medium and long treatment period with continuous positive airways pressure therapy in heart rate variability of obstructive sleep apnea. Sleep Sci 12(2):110–115PubMedPubMedCentral Correia FJ et al (2019) Repercussion of medium and long treatment period with continuous positive airways pressure therapy in heart rate variability of obstructive sleep apnea. Sleep Sci 12(2):110–115PubMedPubMedCentral
16.
go back to reference Kwon S, Kim H, Yeo WH (2021) Recent advances in wearable sensors and portable electronics for sleep monitoring. iScience 24(5):102461PubMedPubMedCentral Kwon S, Kim H, Yeo WH (2021) Recent advances in wearable sensors and portable electronics for sleep monitoring. iScience 24(5):102461PubMedPubMedCentral
17.
go back to reference Li Y et al (2022) Sleep quality evaluation based on single-lead wearable cardiac cycle acquisition device. Sensors (Basel, Switzerland) 23(1):328PubMed Li Y et al (2022) Sleep quality evaluation based on single-lead wearable cardiac cycle acquisition device. Sensors (Basel, Switzerland) 23(1):328PubMed
18.
go back to reference Pastore CA et al (2019) Applicability of the electro-vectorcardiogram in current clinical practice. Arq Bras Cardiol 113(1):87–99PubMedPubMedCentral Pastore CA et al (2019) Applicability of the electro-vectorcardiogram in current clinical practice. Arq Bras Cardiol 113(1):87–99PubMedPubMedCentral
19.
go back to reference Saffitz JE, Corradi D (2016) The electrical heart: 25 years of discovery in cardiac electrophysiology, arrhythmias and sudden death. Cardiovasc Pathol 25(2):149–157PubMed Saffitz JE, Corradi D (2016) The electrical heart: 25 years of discovery in cardiac electrophysiology, arrhythmias and sudden death. Cardiovasc Pathol 25(2):149–157PubMed
20.
go back to reference Ooi EL, Rajendran S (2023) Obstructive sleep apnea in coronary artery disease. Curr Probl Cardiol 48(8):101178PubMed Ooi EL, Rajendran S (2023) Obstructive sleep apnea in coronary artery disease. Curr Probl Cardiol 48(8):101178PubMed
21.
go back to reference Dong R et al (2018) Prevalence, risk factors, outcomes, and treatment of obstructive sleep apnea in patients with cerebrovascular disease: a systematic review. J Stroke Cerebrovasc Dis 27(6):1471–1480PubMed Dong R et al (2018) Prevalence, risk factors, outcomes, and treatment of obstructive sleep apnea in patients with cerebrovascular disease: a systematic review. J Stroke Cerebrovasc Dis 27(6):1471–1480PubMed
22.
go back to reference Bradicich M et al (2020) Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the Sleep Heart Health Study. J Thorac Dis 12(Suppl 2):S129–s138PubMedPubMedCentral Bradicich M et al (2020) Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the Sleep Heart Health Study. J Thorac Dis 12(Suppl 2):S129–s138PubMedPubMedCentral
23.
go back to reference Fitzpatrick M et al (2020) SIESTA - Home sleep study with BresoDx for obstructive sleep apnea: a randomized controlled trial. Sleep Med 65:45–53PubMed Fitzpatrick M et al (2020) SIESTA - Home sleep study with BresoDx for obstructive sleep apnea: a randomized controlled trial. Sleep Med 65:45–53PubMed
24.
go back to reference Wang MP et al (2021) Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study. Mil Med Res 8(1):40PubMedPubMedCentral Wang MP et al (2021) Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study. Mil Med Res 8(1):40PubMedPubMedCentral
25.
go back to reference Nagin DS, Odgers CL (2010) Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 6:109–138PubMed Nagin DS, Odgers CL (2010) Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 6:109–138PubMed
26.
go back to reference Shi Q et al (2013) Using group-based trajectory modeling to examine heterogeneity of symptom burden in patients with head and neck cancer undergoing aggressive non-surgical therapy. Qual Life Res 22(9):2331–2339PubMed Shi Q et al (2013) Using group-based trajectory modeling to examine heterogeneity of symptom burden in patients with head and neck cancer undergoing aggressive non-surgical therapy. Qual Life Res 22(9):2331–2339PubMed
27.
go back to reference Ram N, Grimm KJ (2009) Growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups. Int J Behav Dev 33(6):565–576PubMedPubMedCentral Ram N, Grimm KJ (2009) Growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups. Int J Behav Dev 33(6):565–576PubMedPubMedCentral
28.
go back to reference Berry RB et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619PubMedPubMedCentral Berry RB et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619PubMedPubMedCentral
29.
go back to reference Tanaka K et al (2022) Temporal trajectory of systolic blood pressure and outcomes in acute intracerebral hemorrhage: ATACH-2 trial cohort. Stroke 53(6):1854–1862PubMedPubMedCentral Tanaka K et al (2022) Temporal trajectory of systolic blood pressure and outcomes in acute intracerebral hemorrhage: ATACH-2 trial cohort. Stroke 53(6):1854–1862PubMedPubMedCentral
30.
go back to reference Zhang MQ et al (2023) Effect of objective daytime sleepiness on heart rate variability in patients with obstructive sleep apnea. Sichuan Da Xue Xue Bao Yi Xue Ban 54(2):298–303PubMed Zhang MQ et al (2023) Effect of objective daytime sleepiness on heart rate variability in patients with obstructive sleep apnea. Sichuan Da Xue Xue Bao Yi Xue Ban 54(2):298–303PubMed
31.
go back to reference Scherbakov N et al (2020) Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome. ESC Heart Fail 7(5):2983–2991PubMedPubMedCentral Scherbakov N et al (2020) Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome. ESC Heart Fail 7(5):2983–2991PubMedPubMedCentral
32.
go back to reference Hämmerle P et al (2020) Heart rate variability triangular index as a predictor of cardiovascular mortality in patients with atrial fibrillation. J Am Heart Assoc 9(15):e016075PubMedPubMedCentral Hämmerle P et al (2020) Heart rate variability triangular index as a predictor of cardiovascular mortality in patients with atrial fibrillation. J Am Heart Assoc 9(15):e016075PubMedPubMedCentral
33.
go back to reference Mamode N et al (2001) The role of myocardial perfusion scanning, heart rate variability and D-dimers in predicting the risk of perioperative cardiac complications after peripheral vascular surgery. Eur J Vasc Endovasc Surg 22(6):499–508PubMed Mamode N et al (2001) The role of myocardial perfusion scanning, heart rate variability and D-dimers in predicting the risk of perioperative cardiac complications after peripheral vascular surgery. Eur J Vasc Endovasc Surg 22(6):499–508PubMed
34.
go back to reference Marin JM et al (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053PubMed Marin JM et al (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053PubMed
35.
go back to reference Frenneaux MP (2004) Autonomic changes in patients with heart failure and in post-myocardial infarction patients. Heart 90(11):1248–1255PubMedPubMedCentral Frenneaux MP (2004) Autonomic changes in patients with heart failure and in post-myocardial infarction patients. Heart 90(11):1248–1255PubMedPubMedCentral
36.
go back to reference Platisa MM, Gal V (2006) Reflection of heart rate regulation on linear and nonlinear heart rate variability measures. Physiol Meas 27(2):145–154PubMed Platisa MM, Gal V (2006) Reflection of heart rate regulation on linear and nonlinear heart rate variability measures. Physiol Meas 27(2):145–154PubMed
37.
go back to reference Meng G et al (2022) Successful continuous positive airway pressure treatment reduces skin sympathetic nerve activity in patients with obstructive sleep apnea. Heart Rhythm 19(1):127–136PubMed Meng G et al (2022) Successful continuous positive airway pressure treatment reduces skin sympathetic nerve activity in patients with obstructive sleep apnea. Heart Rhythm 19(1):127–136PubMed
38.
go back to reference Noda A et al (2019) Very low frequency component of heart rate variability as a marker for therapeutic efficacy in patients with obstructive sleep apnea: Preliminary study. J Res Med Sci 24:84PubMedPubMedCentral Noda A et al (2019) Very low frequency component of heart rate variability as a marker for therapeutic efficacy in patients with obstructive sleep apnea: Preliminary study. J Res Med Sci 24:84PubMedPubMedCentral
39.
go back to reference Shaffer F, McCraty R, Zerr CL (2014) A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol 5:1040PubMedPubMedCentral Shaffer F, McCraty R, Zerr CL (2014) A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol 5:1040PubMedPubMedCentral
40.
go back to reference Hietakoste S et al (2020) Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea. Sci Rep 10(1):21556PubMedPubMedCentral Hietakoste S et al (2020) Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea. Sci Rep 10(1):21556PubMedPubMedCentral
41.
go back to reference Ryan ML et al (2011) Clinical applications of heart rate variability in the triage and assessment of traumatically injured patients. Anesthesiol Res Pract 2011:416590PubMedPubMedCentral Ryan ML et al (2011) Clinical applications of heart rate variability in the triage and assessment of traumatically injured patients. Anesthesiol Res Pract 2011:416590PubMedPubMedCentral
42.
go back to reference Tiwari R et al (2021) Analysis of heart rate variability and implication of different factors on heart rate variability. Curr Cardiol Rev 17(5):e160721189770PubMedPubMedCentral Tiwari R et al (2021) Analysis of heart rate variability and implication of different factors on heart rate variability. Curr Cardiol Rev 17(5):e160721189770PubMedPubMedCentral
43.
go back to reference Kim JB, Seo BS, Kim JH (2019) Effect of arousal on sympathetic overactivity in patients with obstructive sleep apnea. Sleep Med 62:86–91PubMed Kim JB, Seo BS, Kim JH (2019) Effect of arousal on sympathetic overactivity in patients with obstructive sleep apnea. Sleep Med 62:86–91PubMed
44.
go back to reference May AM, Van Wagoner DR, Mehra R (2017) OSA and cardiac arrhythmogenesis: mechanistic insights. Chest 151(1):225–241PubMed May AM, Van Wagoner DR, Mehra R (2017) OSA and cardiac arrhythmogenesis: mechanistic insights. Chest 151(1):225–241PubMed
45.
go back to reference Becker H et al (1995) Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure. Am J Respir Crit Care Med 151(1):215–218PubMed Becker H et al (1995) Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure. Am J Respir Crit Care Med 151(1):215–218PubMed
46.
go back to reference Teo YH et al (2022) Prevalence, types and treatment of bradycardia in obstructive sleep apnea - a systematic review and meta-analysis. Sleep Med 89:104–113PubMed Teo YH et al (2022) Prevalence, types and treatment of bradycardia in obstructive sleep apnea - a systematic review and meta-analysis. Sleep Med 89:104–113PubMed
47.
go back to reference Sakamoto JT et al (2018) Heart rate variability analysis in patients who have bradycardia presenting to the emergency department with chest pain. J Emerg Med 54(3):273–280PubMed Sakamoto JT et al (2018) Heart rate variability analysis in patients who have bradycardia presenting to the emergency department with chest pain. J Emerg Med 54(3):273–280PubMed
48.
go back to reference McLachlan CS et al (2010) Increased total heart rate variability and enhanced cardiac vagal autonomic activity in healthy humans with sinus bradycardia. Proc (Bayl Univ Med Cent) 23(4):368–370PubMed McLachlan CS et al (2010) Increased total heart rate variability and enhanced cardiac vagal autonomic activity in healthy humans with sinus bradycardia. Proc (Bayl Univ Med Cent) 23(4):368–370PubMed
49.
go back to reference Koo BB et al (2016) Observational study of obstructive sleep apnea in wake-up stroke: the SLEEP TIGHT study. Cerebrovasc Dis 41(5-6):233–241PubMed Koo BB et al (2016) Observational study of obstructive sleep apnea in wake-up stroke: the SLEEP TIGHT study. Cerebrovasc Dis 41(5-6):233–241PubMed
50.
go back to reference Park J et al (2020) Sleep-disordered breathing and wake-up stroke: a differential association depending on etiologic subtypes. Sleep Med 76:43–47PubMed Park J et al (2020) Sleep-disordered breathing and wake-up stroke: a differential association depending on etiologic subtypes. Sleep Med 76:43–47PubMed
51.
go back to reference Gülbay B et al (2022) Is it important to know the predominant respiratory event in AHI for the management of patients with OSA? Tuberk Toraks 70(2):187–196PubMed Gülbay B et al (2022) Is it important to know the predominant respiratory event in AHI for the management of patients with OSA? Tuberk Toraks 70(2):187–196PubMed
52.
go back to reference Yoo CS et al (2011) Association of heart rate variability with the framingham risk score in healthy adults. Korean J Fam Med 32(6):334–340PubMedPubMedCentral Yoo CS et al (2011) Association of heart rate variability with the framingham risk score in healthy adults. Korean J Fam Med 32(6):334–340PubMedPubMedCentral
54.
go back to reference Ottaviani G, Buja LM (2020) Pathology of unexpected sudden cardiac death: obstructive sleep apnea is part of the challenge. Cardiovasc Pathol 47:107221PubMed Ottaviani G, Buja LM (2020) Pathology of unexpected sudden cardiac death: obstructive sleep apnea is part of the challenge. Cardiovasc Pathol 47:107221PubMed
55.
go back to reference Nokes B, Cooper J, Cao M (2022) Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology. Expert Rev Respir Med 16(8):917–929PubMed Nokes B, Cooper J, Cao M (2022) Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology. Expert Rev Respir Med 16(8):917–929PubMed
56.
go back to reference Acharya R et al (2020) Obstructive sleep apnea: risk factor for arrhythmias, conduction disorders, and cardiac arrest. Cureus 12(8):e9992PubMedPubMedCentral Acharya R et al (2020) Obstructive sleep apnea: risk factor for arrhythmias, conduction disorders, and cardiac arrest. Cureus 12(8):e9992PubMedPubMedCentral
57.
go back to reference Qiu K et al (2022) Gender-specific association between obstructive sleep apnea and cognitive impairment among adults. Sleep Med 98:158–166PubMed Qiu K et al (2022) Gender-specific association between obstructive sleep apnea and cognitive impairment among adults. Sleep Med 98:158–166PubMed
58.
go back to reference Umetani K et al (1998) Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol 31(3):593–601PubMed Umetani K et al (1998) Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol 31(3):593–601PubMed
59.
go back to reference Sprenger N et al (2022) Feasibility and reliability of smartwatch to obtain precordial lead electrocardiogram recordings. Sensors (Basel, Switzerland) 22(3):1217PubMed Sprenger N et al (2022) Feasibility and reliability of smartwatch to obtain precordial lead electrocardiogram recordings. Sensors (Basel, Switzerland) 22(3):1217PubMed
60.
go back to reference Agarwal P et al (2021) Assessing the quality of mobile applications in chronic disease management: a scoping review. NPJ Digit Med 4(1):46PubMedPubMedCentral Agarwal P et al (2021) Assessing the quality of mobile applications in chronic disease management: a scoping review. NPJ Digit Med 4(1):46PubMedPubMedCentral
Metadata
Title
The value of circadian heart rate variability for the estimation of obstructive sleep apnea severity in adult males
Authors
Baokun Zhang
Mengke Zhao
Xiao Zhang
Xiaoyu Zhang
Xiaomin Liu
Weiwei Huang
Shanshan Lu
Juanjuan Xu
Ying Liu
Wei Xu
Xiuhua Li
Jiyou Tang
Publication date
03-01-2024
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 3/2024
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-023-02983-1

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more