Artículos de revistas
Day-night pattern of autonomic nervous system modulation in patients with heart failure with and without sleep apnea
Fecha
2011Registro en:
INTERNATIONAL JOURNAL OF CARDIOLOGY, v.148, n.1, p.53-58, 2011
0167-5273
10.1016/j.ijcard.2009.10.023
Autor
UENO, Linda M.
DRAGER, Luciano F.
RODRIGUES, Ana C. T.
RONDON, Maria U. P. B.
MATHIAS JR., Wilson
KRIEGER, Eduardo M.
FAZAN JUNIOR, Rubens
NEGRAO, Carlos E.
LORENZI-FILHO, Geraldo
Institución
Resumen
Introduction: Among patients with congestive heart failure (CHF) both obstructive and central sleep apnea (SA) are associated with increased sympathetic activity. However, the day-night pattern of cardiac autonomic nervous system modulation in CHF patients with and without sleep apnea is unknown. Material and methods: Twenty-five CHF patients underwent polysomnography with simultaneous beat-to-beat blood pressure (Portapres), respiration and electrocardiogram monitoring. Patients were divided according to the presence (SA, n=17) and absence of SA (NoSA, n=8). Power spectral analyses of heart rate variability (HRV) and spontaneous baroreflex sensitivity (BRS) were determined in periods with stable breathing while awake at 6 AM, 10 AM, 10 PM, as well as during stage 2 sleep. In addition, muscle sympathetic nerve activity (MSNA) was evaluated at 10 AM. Results: RR variance, low-frequency (LF), high-frequency (HF) powers of HRV, and BRS were significantly lower in patients with SA compared with NoSA in all periods. HF power, a marker of vagal activity, increased during sleep in patients with NoSA but in contrast did not change across the 24-hour period in patients with SA. MSNA was significantly higher in patients with SA compared with NoSA. RR variance, LF and HF powers correlated inversely with simultaneous MSNA (r=-0.64, -0.61, and -0.61 respectively; P < 0.01). Conclusions: Patients with CHF and SA present a reduced and blunted cardiac autonomic modulation across the 24-hour period. These findings may help to explain the increased cardiovascular risk in patients with CHF and SA. (C) 2009 Elsevier Ireland Ltd. All rights reserved.