Effect of upper airway surgery on heart rate variability in patients with obstructive sleep apnoea syndrome

To determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea-hypopnoea index (AHI), minimum SaO(2)] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h(-1), P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h(-1), P < 0.001), minimum SaO(2) (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms(2), P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms(2), P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.     

Reduced cardiac sympathetic autonomic tone after long-term nasal continuous positive airway pressure in obstructive sleep apnoea syndrome.

The increased sympathetic activation that occurs in obstructive sleep apnoea (OSA) may play an important role in associated morbidity. We investigated the effect of long-term (3 month) nasal continuous positive airway pressure (CPAP) on the autonomic nervous system assessed by heart rate variability (HRV). Fourteen patients (12 men), mean age 61.4 +/- 8.1 years, with OSA underwent continuous synchronized electrocardiographic and polysomnographic monitoring. The apnoea/hypopnoea index (AHI) decreased from 50.6 +/- 13.7 to 2.2 +/- 2.5 events h-1 after CPAP. HRV analysis showed significant decreases in low frequency (LF; from 7.12 +/- 1.06 to 6.22 +/- 1.18 ln ms2 Hz-1; P < 0.001), high frequency (HF; from 5.91 +/- 0.87 to 5.62 +/- 0.92 ln ms2 Hz-1; P < 0.05) and LF/HF (from 1.21 +/- 0.12 to 1.11 +/- 0.15 ln ms2 Hz-1; P < 0.001) when the patients were asleep. The decrease in LF/HF was prolonged into the daytime (from 1.33 +/- 0.22 to 1.24 +/- 0.21 ln ms2 Hz-1; P < 0.001). Treatment of OSA by CPAP significantly reduced the parameters of cardiac sympathetic tone, a favourable effect.     

Cardiac variability and heart-rate increment as a marker of sleep fragmentation in patients with a sleep disorder: a preliminary study

STUDY OBJECTIVES: The ratio between the heart-rate increment to total power spectral density (%VLFI) has been introduced as a sensitive measure of sleep-related breathing disorders (SRBD). Since a complex interaction is present between sleep disorders and occurrence of arousals, we hypothesized that %VLFI and other indexes of heart-rate variability (HRV) measures reflect the degree of sleep fragmentation. METHODS: The high- and low-frequency peaks from spectral analysis (FFT) of R-R intervals, the HRV changes using wavelet transform (WT), the geometric and time domain HRV, and the %VLFI were measured in 336 sleep studies performed in patients with insomnia, SRBD and restless legs syndrome/periodic limb movement disorder (RLS/PLMD). The ability of HRV measures to assess sleep fragmentation was examined by correlation analysis and from the area under the receiver operating characteristic (ROC) curve. RESULTS: The ratio of low frequency to high frequency (LF/HF ratio) at the FFT and WT and the %VLFI were higher in patients with SRBD and RLS/PLMD, compared with patients with insomnia. These measures were related to the arousal (MA) index as well as to the apnea-hypopnea index, oxygen desaturations, and periodic leg movement index (p < .001). The presence of a sleep fragmentation defined as an MA index > 20 was well detected by the %VLFI (ROC area: 0.66 +/- 0.03) and the LF/HF ratio at WT (ROC area: 0.66 +/- 0.03). CONCLUSION: The %VLFI and LF/HF ratio provide indirect measures of sleep fragmentation, suggesting that HRV measures during sleep assess more the associated sleep fragmentation than the presence of a specific sleep disorder.     

Age-related changes in cardiac autonomic control during sleep

Aging is commonly associated with decreased sleep quality and increased periodic breathing (PB) that can influence heart rate variability (HRV). Cardiac autonomic control, as inferred from HRV analysis, was determined, taking into account the sleep quality and breathing patterns. Two groups of 12 young (21.1 +/- 0.8 years) and 12 older (64.9 +/- 1.9 years) volunteers underwent electroencephalographic, cardiac, and respiratory recordings during one experimental night. Time and frequency domain indices of HRV were calculated in 5-min segments, together with electroencephalographic and respiratory power spectra. In the elderly, large R-R oscillations in the very-low frequency (VLF) range emerged, that reflected the frequency of PB observed in 18% of the sleep time. PB occurred more frequently during rapid eye movement sleep (REM) sleep and caused a significant (P < 0.02) increase in the standard deviation of normal R-R intervals (SDNN) and absolute low-frequency (LF) power. With normal respiratory patterns, SDNN, absolute VLF, LF, and high frequency (HF) power fell during each sleep stage (P < 0.01) compared with young subjects, with no significant sleep-stage dependent variations. An overall decrease (P < 0.01) in normalized HF/(LF + HF) was observed in the elderly, suggesting a predominant loss of parasympathetic activity which may be related to decreased slow-wave sleep duration. These results indicate that two distinct breathing features, implying different levels of autonomic drive to the heart, influence HRV in the elderly during sleep. The breathing pattern must be considered to correctly interpret HRV in the elderly.     

Autonomic cardiovascular regulation in patients with obstructive sleep apnoea: a study based on spectral analysis of heart rate variability.

The aim of this study was to assess the function of the autonomic nervous system in patients with obstructive sleep apnoea syndrome (OSAS). The study was designed as a cross-sectional case-control study. Fifty-one patients were included, and the findings were compared with those in 66 controls. Spectral analysis of heart rate variability (HRV) during supine rest, during controlled breathing and after tilting was performed in each patient and control case. The patients performed overnight sleep recordings the night before the HRV recordings. Individuals with an apnoea-hypopnoea index (AHI) above 20 were regarded as OSAS patients and those with AHI lower than 20 as snorers. Differences in HRV and blood pressure between patients and controls were analysed by multiple linear regression with age, body mass index and sex as independent variables. During free and controlled breathing there was a significant decrease in indices reflecting vagal modulation, indicating parasympathetic dysfunction in OSAS patients compared with controls. The mid-frequency component was also significantly reduced in OSAS patients after tilting but not in the lying position. This may be related to the parasympathetic dysfunction, but could also indicate a decreased sympathetic reserve capacity. We found no significant relation between AHI and indices of vagal modulation in the patient group. Our findings show an autonomic dysfunction in patients with OSAS. The dysfunction involves the parasympathetic system, and may be related to the increased cardiovascular mortality and malignant arrhythmia described in OSAS.     

Sleep apnea in heart failure increases heart rate variability and sympathetic dominance

AIMS: Sleep disordered breathing (SDB) is common in heart failure and ventilation is known to influence heart rate. Our aims were to assess the influence of SDB on heart rate variability (HRV) and to determine whether central sleep apnea (CSA) and obstructive sleep apnea (OSA) produced different patterns of HRV. METHODS AND RESULTS: Overnight polysomnography was performed in 21 patients with heart failure and SDB. Two 10-minute segments each of SDB and stable breathing from each patient were visually identified and ECG signal exported for HRV analysis. SDB increased total power (TP) with very low frequency (VLF) power accounting for the greatest increase (1.89+/-0.54 vs 2.96+/-0.46 ms2, P <0.001); LF/HF ratio increased during SDB (1.2+/-1.0 vs 2.7+/-2.1, P <0.001). Compared to OSA, CSA was associated with lower absolute LF (2.10+/-0.47 vs 2.52+/-0.55 ms2, P = 0.049) and HF power (1.69+/-0.41 vs 2.34+/-0.58 ms2, P = 0.004), increased VLF% (78.9%+/-13.4% vs 60.9%+/-19.2%, P = 0.008), decreased HF% (6.9%+/-7.8% vs 16.0%+/-11.7%, P = 0.046) with a trend to higher LF/HF ratio. CONCLUSIONS: SDB increases HRV in the setting of increased sympathetic dominance. HRV in CSA and OSA have unique HRV patterns which are likely to reflect the different pathophysiological mechanisms involved.     

驾驶精神疲劳的心率变异性和血压变异性综合效应分析

驾驶精神疲劳是威胁人们健康与生命安全的严重问题.本研究的目的是基于心率变异性与血压变异性功率谱分析综合评估驾驶员精神疲劳.20个健康男性样本(28.8±4.3)岁参加90 min的模拟驾驶操作实验,实验后计算分析实验样本心率变异性和血压变异性的频域指标,如:低频成分(0.04～0.15 Hz,LF),高频成分(0.15～0.4Hz,HF),代频与高频比值(LF/HF);同时分析反映血流动力学指标的血压和心率.研究表明,样本在实验结束后交感神经兴奋性增强,迷走神经兴奋性减弱,交感迷走平衡性升高;同时,心率变异性与血压变异性的对应指标在实验过程中具有良好的相关性(P＜0.05).研究认为采用多变量综合效应分析方式评价自主神经系统功能是科学和客观的.     

N-terminal pro-brain natriuretic peptide for detection of cardiovascular stress in patients with obstructive sleep apnea syndrome

Patients with obstructive sleep apnea syndrome (OSAS) have an elevated incidence of cardiovascular events that may be related to an increased ventricular load and hypoxemia caused by apneas and hypopneas. N-terminal pro-brain natriuretic peptide (NTproBNP) appears to be an excellent marker of myocardial stretch and could serve as an indicator of subclinical cardiac stress, thereby identifying a patient population at risk for cardiac effects from OSAS. Adult patients presenting with suspected OSAS and scheduled for nocturnal polysomnography were recruited. Patients with heart or renal failure or severe lung disease were excluded. NTproBNP was measured the evening before and the morning after sleep. Blood pressure (BP) was monitored intermittently throughout the night. Fifteen male and 15 female subjects with a mean +/- SD body mass index of 38.2 +/- 9.8 were studied. Mean Apnea-Hypopnea Index (AHI) was 38.4 +/- 26, with 17 subjects having severe OSAS (AHI > 30). No subject had a significant rise in BP. NTproBNP values overnight decreased in 19 patients and rose in 11 (mean change 3.8 +/- 33 pg mL(-1)), but only one patient had an abnormal morning value. Three patients had an abnormal NTproBNP value prior to sleep, but their levels decreased with sleep. No correlations were detected between the evening baseline or postsleep NTproBNP levels and OSAS. Monitoring pre- and postsleep NTproBNP levels revealed no association with the occurrence or degree of OSAS, making it unlikely that NTproBNP could serve as a marker of cardiac stress in OSAS patients with stable BP and without overt heart failure.     

Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP

STUDY OBJECTIVES: To compare in a multicenter prospective study the efficacy and cost of conventional nasal continuous positive airway pressure (nCPAP) initiated at the sleep laboratory versus auto-nCPAP initiated at home. DESIGN: Patients with severe obstructive sleep apnea syndrome (OSAS) were randomized to treatment with either the REM+ auto device in constant mode at the effective pressure determined by titration at the sleep laboratory (n=17) or the REM+ auto device in automatic mode initiated at the patients home by a nurse (n=18). After 2 months, the efficacy and cost of nCPAP therapy and the time from diagnosis to nCPAP were evaluated. All values are reported as means +/- SD. PATIENTS: Thirty-five subjects with newly diagnosed OSAS (8 women and 27 men, mean age: 54.3 +/- 10.6 years, apnea-hypopnea index (AHI) 58.1 +/- 14.0 h(-1)). INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: Both treatments were used properly and induced similar decreases in the AHI (7.6 +/- 6.9 vs. 10.4 +/ -12.5 h(-1) for auto-nCPAP and conventional nCPAP, respectively; NS) and Epworth Sleepiness score (from 15.5 +/- 4.7 to 7.5 +/- 3.4 vs. 14.7 +/- 3.9 to 7.6 +/- 3.4 for auto-nCPAP and conventional nCPAP, respectively; NS). With auto-nCPAP initiated at home, the time from diagnosis to final adjustment of nCPAP was shorter (16.3 +/- 5.0 vs. 47.2 +/- 46.5 days with conventional nCPAP, P < 0.02) and the cost was lower (1,263 +/- 352 vs. 1720+/-455 E, respectively; P < 0.05). CONCLUSIONS: Treatment of OSAS with auto-nCPAP initiated at home is effective and reliable and reduces the time from diagnosis to therapy and the cost of treatment.     

Maintenance of wakefulness test as a predictor of driving performance in patients with untreated obstructive sleep apnea

STUDY OBJECTIVE: To determine the ability of Maintenance of Wakefulness Test (MWT) to predict simulated driving performance in patients suffering from sleep apnea syndrome. DESIGN: Study involving one hour of simulated driving, one night of polysomnography (PSG), and a 4 x 40-minute MWT. SETTING: Sleep laboratory. PATIENTS: Thirty male patients with untreated obstructive sleep apnea syndrome (OSAS) (mean age [+/- SD] = 51 +/- 8 years, range 34-62; mean body mass index (BMI) [+/- SD] = 29 +/- 3, range 24-37; mean apnea/hypopnea index (AHI) [+/- SD] = 43 +/- 24, range 14-96). As defined by MWT mean sleep latency, 23.3% of the patients were sleepy (0-19 min), 33.3% were alert (20-33 min), and 43.4% were fully alert (34-40 min). MEASUREMENTS: Nocturnal PSG, mean sleep latency at 4 x 40-minute MWT trials, Epworth Sleepiness Scale (ESS), and standard deviation from the center of the road (SDS) on driving simulator. RESULTS: Mean MWT scores inversely correlated with SDS during the simulated driving session (Pearson's r = -0.513, P < 0.01). We found a significant effect of MWT groups (sleepy, alert, or fully alert) on SDS (ANOVA, F(2, 29) = 5.861, P < 0.01). Post hoc tests revealed that the sleepy group had a higher SDS than the fully alert group (P = 0.006). ESS, AHI, microarousal index, and total sleep time did not predict simulated driving performance. CONCLUSIONS: A pathological MWT mean sleep latency (0-19 min) is associated with simulated driving impairment. Before MWT can be used to predict the driving ability of untreated patients with OSAS, further studies are needed to confirm that pathological MWT scores are associated with real driving impairment.     

The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: A review with emphasis on a reanalysis of previous studies

This article evaluates the suitability of low frequency (LF) heart rate variability (HRV) as an index of sympathetic cardiac control and the LF/high frequency (HF) ratio as an index of autonomic balance. It includes a comprehensive literature review and a reanalysis of some previous studies on autonomic cardiovascular regulation. The following sources of evidence are addressed: effects of manipulations affecting sympathetic and vagal activity on HRV, predictions of group differences in cardiac autonomic regulation from HRV, relationships between HRV and other cardiac parameters, and the theoretical and mathematical bases of the concept of autonomic balance. Available data challenge the interpretation of the LF and LF/HF ratio as indices of sympathetic cardiac control and autonomic balance, respectively, and suggest that the HRV power spectrum, including its LF component, is mainly determined by the parasympathetic system.     

Exhaled nitric oxide in patients with sleep apnea

Cardiovascular diseases are frequent in patients with obstructive sleep apnea syndrome (OSAS), but the mechanisms underlying this association are largely unknown. Nitric oxide (NO) is a key regulatory element of vascular physiology. The concentration of NO in the exhaled air ([NOexh]) appears to be reduced in patients with systemic and pulmonary hypertension. This study sought to investigate whether [NOexh] is abnormal in patients with OSAS, and to explore potential relationships between [NOexh] and the severity of OSAS. We measured [NOexh] in 24 patients with OSAS (apnea-hypopnea index (AHI), 55 +/- 4 hour-1) (x +/- SEM), and in 7 healthy volunteers in whom OSAS was excluded clinically. [NOexh] was measured on line by a chemiluminescence analyzer (Dasibi Environmental Corporation, Glendale, Calif). Seven patients with OSAS (29%) had a positive history of cardiovascular disease. Mean [NOexh] was 19.7 +/- 3.2 ppb in healthy subjects, and 22.2 +/- 3.0 ppb in patients with OSAS (p = ns). [Noexh] was not significantly different in those patients with or without cardiovascular disease. [NOexh] was not significantly related to the AHI, the body mass index, or the arterial O2 saturation at night. These results show that [NOexh] is not abnormal in patients with OSAS, and that it does not relate to the presence of cardiovascular disease or to any of various common indices of disease severity.     

Reproducibility of resting heart rate variability with short sampling periods.

The purpose of this study was to determine whether resting heart rate variability (HRV) is reproducible with short sampling measurement periods using an office-based personal computer measurement system. Eight healthy active women participated in ECG analyses on 2 days within 1 week under controlled environmental and physiological conditions. After they rested for 10 minutes, a 10-min ECG was recorded. HRV was determined from a 2.5- and 5-min sample period using both time domain variables (meanRR and SDNN) and frequency domain variables (LF, HF, LF:HF). Repeated measures ANOVA found no significant differences between Day 1 and Day 2 for either sampling period (p > or = 0.23). For both the 2.5- and 5-min sampling periods, the intraclass correlations between days for the time domain variables showed good reproducibility (R = 0.86-0.90). The reproducibility of the frequency domain variable was only average (R = 0.67-0.96), with the LF:HF ratio yielding the higher R values.     

Resting and postexercise cardiac autonomic control in trained master athletes

This study used measures of heart rate variability during recovery from high-intensity exercise in trained Master athletes to examine postexercise cardiac autonomic regulation. Seven males (mean age 52.1 +/- 3.3 yr; mass 85.1 +/- 18.0 kg) and 6 females (mean age 50.5 +/- 2.9 yr; mass 63.1 +/- 6.0 kg) performed incremental exercise to an intensity that induced a >4.5 mmol capillary blood lactate concentration, followed by incremental exercise to volitional exhaustion (VO2(max)). A 6 min ECG recording before (Pre) and after (Post) exercise was analyzed in the time (mean rr interval, sd rr) and frequency domains (total power, very low frequency [VLF: 0-0.04 Hz], low frequency [LF: 0.04-0.15 Hz], high frequency [HF: 0.15-0.4 Hz]). VO2(max) for males and females was 49.4 +/- 7.1 ml kg(-1) min(-1) and 45.1 +/- 10.1 ml kg(-1) min(-1), respectively. Lower mean rr interval (Pre: 1,048 +/- 128 ms; Post: 730 +/- 78 ms; P < 0.001) and lower sd rr (Pre: 77 +/- 30 ms; Post: 43 +/- 17 ms; P < 0.001) were recorded following exercise, with no differences based on gender. Total power decreased following exercise (Pre: 6,331 +/- 6,119 ms; Post: 1,921 +/- 1,552 ms). When normalized for changes in total power, a decreased HF component (Pre: 34.52 +/- 14.79 n.u.; Post: 18.49 +/- 13.64 n.u.; P < 0.05) with no change in LF component (Pre: 61.00 +/- 18.66 n.u.; Post: 69.63 +/- 23.97 n.u.; P = 0.34) was recorded. No gender differences in HRV in the frequency domain were recorded. Decreased heart rate variability in both time and frequency domains suggested an increased parasympathetic withdrawal during the autonomic control of postexercise tachycardia in trained Master athletes.     

Heart rate variability and its determinants in patients with severe or mild essential hypertension.

How cardiac autonomic nervous control is related to the severity of essential hypertension in patients receiving long-term antihypertensive therapy is not well known. The aim of this study was to examine heart rate variability (HRV), a non-invasive measure of cardiac autonomic function, in patients with long-term and medically treated mild and severe essential hypertension and healthy control subjects, and to assess the clinical determinants of HRV in these patients. Thirty-four patients with severe essential hypertension (SEHT) and 29 with mild essential hypertension (MEHT) as well as healthy age- and sex-matched control subjects were studied. HRV was assessed from 10 min ECG-recordings during paced (0.2 Hz) breathing at rest and expressed as time and frequency domain measures. In the SEHT group time (SDNN, RMSSD) and frequency domain measures (total power, low-frequency (LF) power and high-frequency (HF) power of HRV in absolute units, and LF and HF power of HRV in normalized units) of HRV were significantly lower when compared with those of the control group. The MEHT and control groups did not differ from each other with respect to time or frequency domain measures of HRV. Comparison between the hypertensive groups showed that SDNN, total power, LF power and HF power were lower in the SEHT group compared with the MEHT group (P<0.05 for all). Among hypertensive patients RR-interval, age, gender, systolic finger blood pressure and diastolic office blood pressure as well as 24-h blood pressure were significant determinants of HRV. In conclusion, we found that the severity of chronic essential hypertension seems to be related to the severity of impairment of cardiac autonomic control.     

Sleep apnea in acute cerebrovascular diseases: final report on 128 patients

Although obstructive sleep apnea (OSA) appears to be a cardiovascular risk factor, its frequency in patients with transient ischemic attack (TIA) and stroke remains poorly known. We prospectively studied 128 patients (mean +/- SD age = 59 +/- 15 years) with stroke (n = 75) or TIA (n = 53). Assessment included body mass index (BMI); history of snoring and daytime sleepiness; cardiovascular risk factors and diseases; and severity of stroke (Scandinavian Stroke Scale = SSS). Polysomnography (PSG) was obtained in 80 subjects (group 1), a mean of 9 days (range, 1-71 days) after TIA or stroke. In 48 subjects (group 2), PSG was not available, refused, or inadequate. Groups 1 and 2 were similar with the exception of gender distribution. Clinical and PSG data were compared to those of 25 healthy controls matched for age, gender, and BMI. An apnea-hypopnea index (AHI) > 10 was found in 62.5% of subjects and 12.5% of controls. Between patients and controls there was a significant difference in AHI (mean [range]: 28 (0-140) vs 5 (0-24), p < 0.001), maximal apnea duration (mean + SD: 37 +/- 23 vs 23 +/- 13 seconds, p = 0.009), and minimal oxygen saturation (mean + SD: 82 +/- 10% vs 90 +/- 5%, p < 0.001). Conversely, frequency and severity of OSA were similar in stroke and TIA subjects. Multiple regression analysis identified age, BMI, diabetes, and SSS as independent predictors of AHI. Sleep apnea has a high frequency in patients with TIA and stroke, particularly in older patients with high BMI, diabetes, and severe stroke. These results may have implications for prevention, acute treatment, and rehabilitation of patients with acute cerebrovascular diseases.     

Sleep‐disordered breathing in children is associated with impairment of sleep stage‐specific shift of cardiac autonomic modulation

We examined the effects of sleep stages and sleep‐disordered breathing (SDB) on autonomic modulation in 700 children. Apnea hypopnea index (AHI) during one 9 h night‐time polysomnography was used to define SDB. Sleep stage‐specific autonomic modulation was measured by heart rate variability (HRV) analysis of the first available 5 min RR intervals from each sleep stage. The mean [standard deviation (SD)] age was 112 (21) months (49% male and 25% non‐Caucasian). The average AHI was 0.79 (SD = 1.03) h^?1, while 73.0%, 25.8% and 1.2% of children had AHI <1 (no SDB), 1–5 (mild SDB) and ≥5 (moderate SDB), respectively. In the no SDB group, the high frequency (HF) and root mean square SD (RMSSD) increased significantly from wake to Stage 2 and slow wave sleep (SWS), and then decreased dramatically when shifting into rapid eye movement (REM) sleep. In the moderate SDB group, the pattern of HRV shift was similar to that of no SDB. However, the decreases in HF and RMSSD from SWS to REM were more pronounced in moderate SDB children [between‐group differences in HF (?24% in moderate SDB versus ?10% in no SDB) and RMSSD (?27% versus ?12%) were significant (P < 0.05)]. The REM stage HF is significantly lower in the moderate SDB group compared to the no SDB group [mean (standard error): 4.49 (0.43) versus 5.80 (0.05) ms², respectively, P < 0.05]. Conclusions are that autonomic modulation shifts significantly towards higher parasympathetic modulation from wake to non‐rapid eye movement sleep, and reverses to a less parasympathetic modulation during REM sleep. However, the autonomic modulation is impaired among children with moderate SDB in the directions of more reduction in parasympathetic modulation from SWS to REM sleep and significantly weaker parasympathetic modulation in REM sleep, which may lead to higher arrhythmia vulnerability, especially during REM sleep.     

Relationship between electroencephalogram slow-wave magnitude and heart rate variability during sleep in humans

To explore whether depth of sleep is related to changes in autonomic control, continuous power-spectral analysis of the electroencephalogram (EEG) and heart rate variability (HRV) was performed in ten normal subjects during nocturnal sleep. Quiet sleep (QS) was associated with an increase in high-frequency power (HF) of HRV (0.15-0.4 Hz) but a decrease in low-frequency power (LF) (0.04-0.15 Hz) to HF ratio (LF/HF) compared with awakening. During QS, LF/HF was significantly and negatively correlated with delta power of EEG (0.5-4.0 Hz), whereas mean R-R interval and HF were not. We conclude that during QS, cardiac sympathetic regulation is negatively related to the depth of sleep, although vagal regulation is not. Our methodology offers a quantitative analysis to study the interaction between cerebral cortical and autonomic functions.     

Relationship between electroencephalogram slow-wave magnitude and heart rate variability during sleep in rats

To explore whether depth of sleep is related to changes in autonomic control in rats, continuous power-spectral analysis of electroencephalogram (EEG) and heart rate variability (HRV) was performed in unanesthetized rats during normal daytime sleep. Quiet sleep (QS) was associated with an increase in high-frequency power of HRV (0.6-2.4 Hz, HF) but a decrease in low-frequency power (0.06-0.6 Hz) to HF ratio (LF/HF) compared with awakening. During QS, LF/HF was significantly and negatively correlated with delta power of EEG (0.5-4.0 Hz), whereas mean R-R interval and HF were not. As in humans, cardiac sympathetic regulation in rats is negatively related to the depth of sleep during QS, although vagal regulation is not. Our methodology offers a parallel way of studying the interaction between cerebral cortical and autonomic functions in rats.     

急性饮酒对青年心率变异的影响及性别差异研究

目的通过检测轻度急性饮酒前后心率变异性指标,评价酒精对于自主神经活动影响的性别差异。方法20例健康志愿者．其中男性10例．年龄（20．1±0．6）岁：女性10例．年龄（19．6±0．8）岁。根据受试者体质量计算乙醇溶液饮用量（0．27g／kg）。分别在饮酒前和饮酒后15min、45min共3次记录心电信号．提取RR间期时间序列,计算心率变异性（HRV）评价指标,包括时域参数RR间期的平均值（RRI）、全部RR间期标准差（SDRR）、全程相邻RR间期之差的均方根（RMSSD）、相邻RR间期之差大于50ms的心搏动数占总心搏动数的比例（pNN50）,频域参数低频频段（LF）、高频频段（HF）和LF／HF,Poincar6图参数宽度（短轴,SDl）、长度（长轴,SD2）和SDl／SD2。结果时域参数、频域参数和P0inca诺参数存急性饮酒后降低。对于RMSSD和SDRR参数．仅在女性受试者中观测到饮酒45min后降低．差异均具有统计学意义（P〈0．05）。对于LF和SDl参数在饮酒后15min即观测到在男性受试者中降低,差异均具有统计学意义（P〈0．05）。结论少量的急性饮酒降低了心率变异程度．酒精抑制了副交感神经的活动度．女性比男性对酒精的敏感程度更高．男性自主种经活动对酒精影响的响应时间更短。