Published ahead of print on December 27, 2002, doi:10.1164/rccm.200201-006OC Am. J. Respir. Crit. Care Med., Volume 167, Number 6, March 2003, 902-910 A more recent version of this article appeared on March 15, 2003
Submitted on January 4, 2002 Autonomic control of heart rate during obstructive and central apneas in sleep-disordered breathingLucia Spicuzza1*,1 University of Catania, Institute of Respiratory Diseases, Catania, Italy, 2 IRCCS Policlinico S. Matteo and University of Pavia, Department of Internal Medicine, Pavia, Italy * To whom correspondence should be addressed. E-mail: luciaspicuzza{at}tiscalinet.it.
Sleep-disordered breathing is associated to an altered sympatho-vagal. The aim of this study was to determine whether the autonomic modulation of heart rate during obstructive and central apneas 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 and the high frequency components of the R-R interval reflecting, at large, respectively, the sympathetic and the parasympathetic modulation, during obstructive and central apneas and during the post-apneic hyperventilation. In both types of apneas we found cyclic lengthening/shortening in R-R interval, during apneas/post-apneic hyperventilation, respectively, with more marked bradycardia during obstructive apneas (R-R:1011±23 ms vs 893±30 ms, P<0.01). In obstructive apneas the high frequency oscillations decreased from the apnea to the post-apneic hyperventilation (from 1964±244 to 387±98 ms2, P<0.0001), whereas the low frequency increased (from 2649±230 to 9820±716 ms2, P<0.0001). At the opposite, in central apneas the high frequency increased from the apnea to the post-apneic hyperventilation (from 452±177 to 1485±406 ms2, P<0.0001), whereas the low frequency component remained unchanged. These results show markedly different autonomic alterations during and after obstructive vs central apneas, suggesting a surge in sympathetic modulation after the obstructive episodes. Key words: sleeep-disordered breathing, obstructive apneas, central apneas, autonomic nervous system, Wigner-Ville transform
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