Abstract
Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.
Highlights
Obstructive sleep apnea (OSA) is closely associated with neurocognitive, behavioral, psychophysiological states, and cardiovascular outcomes [1,2,3]
This review focuses on neuro-cardiac autonomic regulatory mechanisms and the multifaceted applications of Heart rate variability (HRV) in OSA as a potential additional clinical diagnostic tool
With more sophisticated analytical approaches and techniques developing, HRV measures could provide additional electrophysiological information on impaired cardiovascular alternation, which might be related to subclinical cardiovascular outcomes in patients with OSA
Summary
Obstructive sleep apnea (OSA) is closely associated with neurocognitive, behavioral, psychophysiological states, and cardiovascular outcomes [1,2,3]. The role of cardiovascular autonomic dysfunction has received increasing attention as an independent risk factor for clinical complications in OSA [5]. Heart rate variability (HRV) has been generally accepted as a non-invasive tool to quantify cardiovascular autonomic modulation under varying healthy and pathogenic conditions [6, 7]. HRV measures the variation between beat-to-beat intervals over a time series [6]. It is an integrated reflection of central-peripheral neural feedback mechanisms to the heart via mediating sympathovagal inflow and outflow [8]. Previous studies suggested that in conjunction with brain imaging, HRV analysis has been used to investigate the connection between autonomic cardiac modulation and sleeping brain activity [9]
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