Published ahead of print on December 27, 2002, doi:10.1164/rccm.200201-006OC
American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 902-910, (2003)
© 2003 American Thoracic Society
Autonomic Modulation of Heart Rate during Obstructive versus Central Apneas in Patients with Sleep-disordered Breathing
Lucia Spicuzza,
Luciano Bernardi,
Alessandro Calciati and
Giuseppe Ugo Di Maria
Department of Internal Medicine, University of Catania, Catania; and Department of Internal Medicine, IRCCS Policlinico S. Matteo and University of Pavia, Italy
Correspondence and requests for reprints should be addressed to Lucia Spicuzza, M.D., Istituto di Malattie Respiratorie, Via Passo Gravina 187, 95125 Catania, Italy. E-mail: luciaspicuzza{at}tiscalinet.it
Sleep-disordered breathing is associated with an altered sympathovagal balance determined by the nocturnal cyclic alternating of apneas and hyperventilation. The aim of this study was to determine whether the autonomic modulation of heart rate during obstructive apneas (OA) and central apneas (CA) in patients with sleep-disordered breathing is different. Therefore, by using the time-varying Wigner-Ville transform spectral analysis we described, in 17 patients, the time course of the low-frequency (LF) and the high-frequency (HF) components of the interbeat interval (R-R interval) reflecting, at large, respectively, the sympathetic and the parasympathetic modulation, during OA (n = 185) and CA (n = 51) and during the postapneic hyperventilation. In both types of apneas we found cyclic lengthening/shortening in R-R interval, during apneas/postapneic hyperventilation, respectively, with more marked bradycardia during OA (R-R: 1,011 ± 23 versus 893 ± 30 ms2, p < 0.01). In OA the HF oscillations decreased from the apnea to the postapneic hyperventilation (from 1,964 ± 244 to 387 ± 98 ms2, p < 0.0001), whereas the LF oscillations increased (from 2,649 ± 230 to 9,820 ± 716 ms2, p < 0.0001). Conversely, in CA the HF oscillations increased from the apnea to the postapneic hyperventilation (from 452 ± 177 to 1,485 ± 406 ms2, p < 0.0001), whereas the LF component remained unchanged. These results show markedly different autonomic alterations during and after OA versus CA, suggesting a surge in sympathetic modulation after the obstructive episodes.
Key Words: obstructive apneas • central apneas • autonomic nervous system
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