J Korean Med Sci.  2008 Apr;23(2):226-231. 10.3346/jkms.2008.23.2.226.

Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

• Park DH
• Shin CJ
• Hong SC
• Yu J
• Ryu SH
• Kim EJ
• Shin HB
• Shin BH

• KMID: 1713453
• DOI: http://doi.org/10.3346/jkms.2008.23.2.226

Abstract

The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflexrelated fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4+/- 11.7 yr, apnea-hypopnea index [AHI]=43.2+/-23.4 events per hour, and AHI >15). Moderate (mean age 47.1+/-9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5 +/-12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (r(p)=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.

Keyword

Sleep Apnea, Obstructive; Heart Rate; Spectrum Analysis; Polysomnography

MeSH Terms

Adult
Cardiovascular Diseases/*diagnosis/pathology
Electrocardiography/methods
*Heart Rate
Humans
Male
Middle Aged
Oximetry
Oxygen/metabolism
Plethysmography
Polysomnography/methods
Sleep
Sleep Apnea, Obstructive/*diagnosis/pathology

Figure

• 

  Fig. 1 The correlation between AHI and LF/HF ratio controlling age and body mass index is shown by positive relationship (rp=0.610, p<0.0001) in the subjects with obstructive sleep apnea syndrome. AHI, apnea-hypopnea index; LF, low frequency; HF, high frequency.

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