Sleep Heart Research Articles

Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk.

Although related, the precise mechanisms linking obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are unclear. Platelets are mediators of CVD risk and thrombosis and prior studies suggested associations of OSA and platelet activity. The aim of this study is to assess the link between OSA, platelet activity, and CVD-related risk factors. We studied the association of OSA-measures and platelet aggregation in participants dually enrolled in the SHHS (Sleep Heart and Health Study) and FHS (Framingham Heart Study). We applied linear regression models with adjustment for demographic and clinical covariates and explored interactions with OSA and CVD-related factors, including age, sex, body mass index, hypertension, OSA diagnosis (apnea-hypopnea index 4%≥5), and aspirin use. Our final sample was of 482 participants (60 years [14.00], 50.4% female). No associations were observed between apnea-hypopnea index 4% and platelet aggregation in the main sample. Stratified analysis revealed an association in aspirin users (n=65) for our primary exposure (apnea-hypopnea index 4%, β=0.523; P<0.001; n=65), and secondary exposures: hypoxic burden (β=0.358; P<0.001), minimum saturation (β=-0.519; P=0.026), and oxygen desaturation index 3% (β=74.672; P=0.002). No associations were detected in nonaspirin users (n=417). No associations were detected between OSA and platelet aggregation in a community sample. Our finding that OSA associates with increased platelet aggregation in the aspirin group, most of whom use it for primary prevention of CVD, suggests that platelet aggregation may mediate the adverse impact of OSA on vascular health in individuals with existing CVD risk, supporting further investigation.

Abstract MP57: Objectively-Assessed Sleep Duration And Incident Heart Failure: The Atherosclerosis Risk In Communities Study-Sleep Heart Health Study

Introduction: Evidence is mixed on short sleep duration and heart failure (HF) risk. Notably, no studies have investigated objectively-assessed sleep duration or controlled for comorbid sleep apnea in this context. Objective: To examine the independent associations of objective short sleep duration with incident HF, accounting for sleep apnea. Methods: We studied ARIC-SHHS study participants free of HF at visit 4 (1996-98). Sleep duration was measured by at-home polysomnography (PSG) and defined as: 7 to &lt;9 hours (reference), 6 to &lt;7 hours, 5 to &lt;6 hours, and &lt;5 hours. The apnea-hypopnea index (AHI; defined as: &lt;5, 5 to &lt;15, 15 to &lt;30, and ≥30), a measure of sleep apnea, was also measured by at-home PSG. Cox proportional hazards models, with progressive adjustment for comorbidities and AHI, were used to evaluate the association of sleep duration with incident HF (hospitalizations or deaths with HF diagnosis). Results: We included 1,056 participants (mean age 62 years, 50% female, 99% White). During a median follow-up of 22 years, there were 211 HF events. Participants with sleep duration &lt;5 hours had a higher risk of incident HF in unadjusted and age-sex-adjusted models, with corresponding hazard ratios of 2.44 (95% CI : 1.40-4.26) and 1.88 (95% CI : 1.07-3.29) ( Table ). However, further adjustment for clinical factors attenuated the results. The associations for sleep duration appeared more evident when we restricted our analysis to participants without prevalent cardiovascular disease ( Table ). The AHI was not a significant predictor of incident HF in the presence of sleep duration. Conclusions: Objectively-assessed short sleep duration &lt;5 hours was modestly associated with HF risk. Our study suggests the need and value of larger studies exploring objectively-assessed sleep duration in terms of HF risk. Importantly, sleep duration may be objectively measured without PSG, using wearable devices.

Abstract MP60: Sleep Fragmentation, Sleep Medications, And Incident Heart Failure And Subtypes In Post-menopausal Women

Background: Women, specifically post-menopausal women, have poorer sleep quality and an increased risk for insomnia relative to men. Insomnia is more prevalent among patients with heart failure, and prior research has shown a dose-dependent association between the severity of insomnia and the risk of heart failure. However, it is unclear which aspects of insomnia are most associated with heart failure, and whether any associations exist between sleep medication use and incident heart failure subtypes. Methods: This is a prospective cohort study of 42,832 post-menopausal women from the Women’s Health Initiative (WHI). Insomnia was assessed using the validated WHI Insomnia Rating Scale (WHIIRS) which includes sleep fragmentation, trouble falling asleep, waking up early, difficulty in falling back asleep upon waking up, and perceived sleep quality. Sleep medication use was asked and arranged into three categories. Association between insomnia components and sleep medication use and incident HF and its subtypes were evaluated using Cox proportional hazard models. Results: In our multivariable-adjusted model, Sleep fragmentation for more than two nights per week is associated with incident overall HF (HR=1.32, 95% CI: 1.19 - 1.46) and HFpEF (HR=1.43, 95% CI: 1.24 - 1.65). Sleep medications use for more than two nights per week was associated with HF (HR=1.46, 95% CI: 1.28 - 1.67), HFpEF (HR=1.40, 95% CI: 1.16- 1.68), and HFrEF (HR=1.44, 95% CI: 1.12 - 1.85). There were no significant associations between HF and the remaining insomnia components. Conclusions: In postmenopausal women, sleep fragmentation is associated with an increased risk of incident HF and HFpEF. Sleep medication use for more than two nights per week is associated with an increased risk of incident HF, HFpEF, and HFrEF among postmenopausal women. Whether interventions to decrease the frequency of sleep fragmentation and sleep medication use in older adults will reduce HF risk warrants further study.

The crossroad between obstructive sleep apnea and heart failure: A novel perspective at an old parameter.

The crossroad between obstructive sleep apnea and heart failure: A novel perspective at an old parameter.

Abstract 10744: Efficacy of Remote Pulmonary Artery Hemodynamic Monitoring in Reducing Heart Failure Readmissions Among Patients with Obstructive Sleep Apnea of Varying Severity

Introduction: Obstructive sleep apnea (OSA) and heart failure (HF) often co-exist. Remote pulmonary artery (PA) hemodynamic monitoring has shown to decrease HF readmissions. However, there is limited data regarding its efficacy in patients with OSA of varying severity. Hypothesis: Outcomes of remote PA hemodynamic monitoring using CardioMEMS device in reducing HF hospitalization in patients with mild [apnea-hypopnea index (AHI)=5-14], moderate (AHI=15-30) and severe OSA (AHI&gt;30). Methods: Retrospective data was collected for HF patients who had CardioMEMS device implanted based on FDA indications from April 2015 to August 2020. Number of hospitalizations, emergency department (ED) and HF clinic visits data was collected for 1-year pre and 1-year post-implantation. Mortality data was collected at 1-year post-implantation. Severity of OSA was based on AHI documented in the sleep study. Analysis was done using Kruskal-Wallis test for comparison between OSA groups. Mortality was compared with Pearson’s chi-squared test. Results: CardioMEMS device was implanted in 177 patients during the study period. Of this, 108(61%) patients had OSA diagnosed at the time of implantation. Among OSA patients, 52(48%) had severe OSA. There was a statistically significant decrease in overall mean HF admissions from 1.80(± 1.55) to 0.62(± 1.07), 65.6%, p&lt;0.001 and mean HF ED visits from 1.37(± 1.50) to 0.5(± 0.95), 63.5%, p&lt;0.001 in 1-year pre-and post-implantation among all OSA patients. When comparing different OSA groups, there was no statistically significant difference between them in all-cause admissions, HF admissions, ED visits, ED HF visits, and HF clinic visits 1-year pre and post-implantation. No statistically significant difference was observed in mortality. Conclusions: PA hemodynamic monitoring using CardioMEMS device had a net benefit in reducing HF admissions and HF ED visits in OSA patients and this benefit remained unchanged across different OSA groups.

Modulation of heart rate variability based on sleep pattern in shift workers of automobile sector

Background: Altered circadian rhythm for sleep-wakeful cycle is seen in shift work, leading to sleep deprivation which may affect the cardiac autonomic nervous system (ANS). In the past two decades, a significant relationship has been established between impaired ANS activity and cardiovascular mortality. This effect is not addressed in workers working in both shifts. Aims and Objectives: This study aims to assess sleep quality and heart rate variability (HRV) before and after day and night shift work. Materials and Methods: A total of 140 healthy male workers aged between 24 years and 45 years working in alternate weekday and night shift at least for more than 2 years in automobile factory. Procedure: Before and after both day and night shifts sleep quality were noted by Pittsburgh Sleep Quality Index along with HRV parameters such as mean RR interval (mRRI) and low-frequency power/high-frequency power (LF/HF). Results: Global score was statistically increased with reduced mRRI and increased LF/HF after night shift. Conclusion: Reduced sleep quality and HRV may reflect sympathetic excitation and further leading to increased risk for cardiovascular diseases among the shift workers.

Nutritional Supplements &amp; Athletes- An Analysis of Potential Side Effects

Nutritional supplements are commonly accessible products used as an extension to the normal diet and are mostly used by athletes. Among all users of supplements, the utilization among athletes tends to be more noteworthy than the overall public. With such a vast number of athletes utilizing dietary supplements, it is vital to evaluate about side effects of nutritional supplements among gymnasium going athletes. This study was Analytical, conducted on 57 male athletes from Lahore, who were regularly going to gymnasium since past three months and were using nutritional supplements at the time of evaluation. The most frequently used supplements were the mostly consumed nutritional supplements were protein or whey protein powders (61.4%), multivitamins (56.1%), and creatine (38.6%). Most common side effects after utilizing nutritional supplements were Dry Mouth/Dehydration (n=28, 49.1%), Constipation (n=22, 38.6%), Insomnia/Lack of Sleep (n=18, 31.5%) Nausea (n=17, 29.8%) and Heart Palpitations/Abnormal Heartbeats (n=16, 28%). Pearson’s Correlation indicated that the casein protein and soy protein were the major cause of many side effects. It is concluded that athletes were having some side effects after utilizing nutritional supplements and they were utilizing supplements without consulting a proper nutritionist/dietitian.

Obstructive sleep apnea and heart rhythm disorders: current state of the problem

The factors contributing to the development of cardiac arrhythmias in obstructive sleep apnea syndrome and the main methods of treating this syndrome have been analyzed and summarized.The review discusses the relationships of obstructive sleep apnea syndrome (OSAS) with various types of heart rhythm disorders. Pathogenetic factors of obstructive sleep apnea syndrome leading to the development of cardiac arrhythmias, current treatment strategies and their impact on heart rhythm disorders are summarized.

Sleep-Disordered Breathing and Diastolic Heart Disease

Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF), and the coexistence of these two disease conditions increases mortality. The purpose of this review is to examine the mechanistic interactions and associations between SBD, specifically obstructive sleep apnea (OSA), obesity hypoventilation (OHS), left ventricular (LV) diastolic heart function, and pulmonary hypertension (PH), as factors that directly contribute to the development of HF. The mechanistic interactions may be thought of as direct and indirect effects. The direct effects are related to abnormalities caused by sleep-disordered breathing that induce LV remodeling. Recent studies support the notion that the severity of OSA and recurrent hypoxia enhance LV remodeling even after accounting for age, weight, and underlying cardiorespiratory comorbid conditions. Indirect effects are due to the mechanical alterations intrathoracic organs during sleep due to negative intrathoracic pressure, obesity, as well as multiple derangements causing activation of the sympathetic nervous system and endothelium. The review also delineates multiple mechanisms that eventually lead to pulmonary vascular remodeling and PH. The severity of daytime arterial oxygen levels and/or duration of nocturnal hypoxia, rather than the severity of SDB, seems to be the major determinants of PH in SBD, after adjusting for other cardiorespiratory diseases. Mechanisms by which hypercapnia contributes to PH and diastolic dysfunction need to be explored. Moreover, interactions between central sleep apnea and diastolic heart function are not well delineated. Further investigations are needed to elucidate any direct effect of hypercapnia on pulmonary pressures and potential cardiovascular consequences. There is limited evidence on the impact of PAP or oxygen therapy on these intermediary mechanisms of HF in SDB populations. The collection of evidence indicates that PAP may enhance diastolic function and reduce pulmonary artery pressure in OSA whereas studies in OHS populations are sparse and inconclusive. Thus, future research should delineate whether pathophysiology-based therapies can alleviate HF and HF related mortality in these SDB populations.

SHORT-TERM INTRAINDIVIDUAL DYNAMICS OF HEART RATE AND COGNITIVE FUNCTIONING IN OLDER ADULTS

Short-term intraindividual variability in cognition can provide insights into the underlying processes that cannot be captured by only examining mean levels (MacDonald et al., 2003). This variability is often dependent on a number of individual or contextual characteristics. Thus, modeling the heterogeneity of the within-person variance and including meaningful covariates to account for why individuals are more variable on some occasions than others is an alternate way to understand process. The present study utilized a 14-day intensive measurement design to examine the effects of fluctuations in daily heart rate on variability in cognitive performance. Fifty-five older adults (Mage = 70.1 years) completed daily cognitive tasks and measures of well-being, while also wearing an accelerometer to capture physical activity, sleep, and continuous heart rate. Data were examined with a mixed effects location scale model (Hedeker et al., 2008; Rast et al., 2012), which incorporates both an individual’s measured level (location) and their variability around that level (scale). Both the location and the scale are permitted to be random such that on any given occasion an individual may deviate from their typical level and they may also deviate from their typical amount of variability. In this way, the location scale model allows for the heterogeneity of the variance in cognition to be modeled and accounted for with other covariates. Results revealed that there were significant amounts of variability in daily heart rate and cognition across 14 days. The impact of heart rate variability on cognitive performance will be discussed.

Evaluation of Surgical Risk

In assessing surgical risk, appropriate preoperative evaluation should systematically address a patient's pre-existing medical conditions and identifies unrecognized comorbidities, ideally leading to the anticipation and treatment of potential complications both pre- and postoperation. Thus, a thorough evaluation of the patient history and physical examination is essential. Various risk assessments discussed in this review are those for cardiac, pulmonary, renal, hepatic, and hematologic concerns. Cardiac risk assessment focuses on patient-related risk factors, including coronary artery disease, congestive heart failure, valvular heart disease, arrhythmias and conduction defects, implanted pacemakers and implantable cardiac defibrillators, cardiomyopathy, and hypertension. The pulmonary patient-related risk factors are explored and include age and general health status, smoking, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, obesity, pulmonary hypertension, and heart failure. Preoperative medication management is also explored. This review contains 3 figures, 31 tables, and 75 references. Key words: surgical risk calculators, cardiac complications, coronary artery disease, hypertension, perioperative, cardiac risk assessment, preoperative evaluation

Elderly hypertension patients with obstructive sleep apnea syndrome and heart rate and blood pressure variability and the intervention effects of home-based continuous positive airway pressure therapy

Objective To study the correlation of the degree of sleep apnea with arrhythmia, heart rate variability(HRV)and blood pressure variability(BPV)in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS), and to investigate the intervention effects of home-based continuous positive airway pressure(CPAP)treatment. Methods A total of 122 elderly hypertension patients with OSAHS were recruited in the prospective study.Patients were divided into three groups according to the sleep apnea hypopnea index(apnea hypopnea index, AHI): the mild OSAHS group(5 times/h≤AHI≤15 times/h, n=42), moderate OSAHS group(15 times/h 30 times/h, n=40). All patients took ambulatory electrocardiogram and ambulatory blood pressure examinations before and after three months of CPAP treatment.The incidences of arrhythmia, HRV and BPV indexes of each group before and after CPAP treatment were compared between the groups. Results The incidences of premature atrial contraction, atrial tachycardia and premature ventricular beats were higher in the moderate and severe OSAHS groups than in the mild OSAHS group(P<0.01). Compared with the mild OSAHS group, the RR interval standard deviation(SDNN), root mean square of successive differences(rMSSD), proportion of patients with consecutive RR-interval differences greater than 50 ms(PNN5), standard deviation of the averaged normal RR intervals for all 5 min segments and deceleration capacity of rate increased in the moderate and severe OSAHS groups(P<0.05), and the increases were more obvious in the severe group.Compared with the mild OSAHS group, the standard deviation of 24-h systolic blood pressure, standard deviation of 24-h diastolic blood pressure, standard deviation of daytime systolic blood pressure, standard deviation of nighttime systolic blood pressure and incidence of non-dipper hypertension increased in the moderate and severe OSAHS groups(P<0.05), with the increases were more obvious in the severe group, and the differences was significant between the moderate and severe OSAHS groups(P<0.05). HRV and BPV indicators improved except for high frequency(HF)/low frequency(LF)in all groups(P<0.05)after home treatment of CPAP, and the improvement was more obvious in the severe group.The incidence of non-dipper circadian rhythm of blood pressure improved more significantly in the severe OSAHS group than in the moderate OSAHS group. Conclusions With aggravated sleep apnea, the incidences of arrhythmias such as premature atrial contraction, atrial tachycardia, and premature ventricular contraction are increased and the HRV and BPV are enlarged in elderly hypertension patients complicated with OSAHS.The home treatment of CPAP can improve the above indicators, and it is an effective way to treat OSAHS complicated by hypertension in elderly patients. Key words: Hypertension; Sleep apnea, obstructive; Intermittent pressure ventilation

A Comparative Study of Sleep Quality and Heart Rate Variability Index in Shifts and Non-Shift Working Population of Bengaluru

A Comparative Study of Sleep Quality and Heart Rate Variability Index in Shifts and Non-Shift Working Population of Bengaluru

Sleep Quality and Heart Rate Variability in Adolescents with Type 1 or Type 2 Diabetes

Regardless of the type of diabetes, there is twice the risk of experiencing cardiovascular (CV) disease complications in comparison to not having the disease. Although these complications and associated symptoms are rarely noted in adolescents with diabetes, early identification of biobehavioral markers for CV risks are essential for targeted approaches for prevention of later disease sequelae. Decreased sleep quality and heart rate variability (HRV) have both independently been associated with diabetes or the presence of obesity and risk for developing diabetes, as well as with CV disease. Studies exploring both sleep quality and HRV in adolescents with diabetes are not available. Thus, we conducted a secondary analysis of data from an existing study to examine differences in sleep quality and HRV in adolescents with type 1 (T1D) vs. type 2 diabetes (T2D); and to determine if there were associations between HRV and sleep quality. Adolescents with T1D (n = 101; 56 males) or T2D (n= 37; 16 males) completed 24-hour HRV Holter monitoring and measurement using Burdick Vision Premier™ ECG Analysis and Editing software system (Waukesha, WI), hemoglobin A1c (HbA1c) using the Abbott IMx® assay method, and a self-report global measure of the impact of diabetes on their sleep quality using a 5-point Likert scale. Duration of diabetes was greater (P \ .001) and measures of HRV were higher in T1D (P \ .01); BMI and BMI z-scores (P \ .001) and systolic and diastolic BP (P ≤ .05) were higher in T2D. No differences in recent or average HbA1c, Tanner staging or sleep quality were found. Both spectral and time domain measures of HRV were associated with sleep quality in T2D (r = - .51 to -.38, P \ .02); only time domain measures were associated with sleep quality in T1D (r = -. 21 to -.19, P ≤ .05). Poorer sleep quality was evident in those with lower HRV; these linkages were stronger in those with T2D. Further study is warranted to elucidate risks and improve sleep quality and CV outcomes in youth with diabetes. Disclosure M.S. Faulkner: None. A. Helvig: None.

P870Occurrence of atrial fibrillation in pacemaker patients and its association with sleep apnea and heart rate variability

P870Occurrence of atrial fibrillation in pacemaker patients and its association with sleep apnea and heart rate variability

Effect of the intervention based on Information-Motivation-Behavioral skills on the preoperative anxiety in patients with gynecological malignancies

Objective To investigate the effect of interventions based on Information-Motivation-Behavioral skills on the preoperative anxiety in patients with gynecological malignancies. Methods A total of 64 patients with malignant tumor were divided into two groups by random digits table method with 32 cases each. The patients in the two groups received routine nursing. In addition, interventions based on Information-Motivation-Behavioral skills were provided in the intervention group. All patients were investigated by the following indexes such as the Self-Rating Anxiety Scale (SAS), sleep quality scale, blood pressure and heart rate before and after the intervention. Results After the intervention, the SAS scores in the intervention group was (49.47 ± 3.81) points, sleep quality score was (3.66 ±0.97) points, and systolic blood pressure and heart rate were (128.56±5.93) mmHg (1 mmHg=0.133 kPa), (75.09 ± 3.78) beats/min, which were lower than those in the control group (57.38 ± 3.75) points, (5.50 ± 1.50) points, (134.97 ± 7.19) mmHg, (81.34 ± 4.88) beats/min, the differences were statistically significant (t=-8.350--3.887, P<0.05). Conclusions The intervention focused on Information-Motivation-Behavioral Skills can help patients to relieve anxiety, reduce stress response, improve quality of sleep. Key words: Gynecological malignancies; Anxiety; Information-motivation-behavioral skills

Сardiac biomarkers in patients with obstructive sleep apnea syndrome and heart failure with preserved ejection fraction

Сardiac biomarkers in patients with obstructive sleep apnea syndrome and heart failure with preserved ejection fraction

Wearable Activity Trackers and Older Adults: The Social Effect and Importance in Healthcare

Background: Many older adults develop chronic diseases, such as heart disease and diabetes, which are correlated with low levels of physical activity. Chronic diseases can result in a decreased quality of life, increased health care costs, and premature mortality. Adults, specifically older adults, who started using wearable activity trackers (WATs) have exhibited an increase in daily activity levels. Although WAT use has increased, only 7% of older adults use a WAT. The use of WATs has the potential to facilitate chronic condition self-management, with patients engaging in personalized care and health care providers receiving accurate data about patient physical activity. One benefit of WATs is the opportunity to develop social relationships. Social relationships have as much impact on physical health as physical activity. Older adults with larger networks show higher levels of health.

P6410QT intervals during sleep and circadian heart rate variability in healthy and long QT syndrome (LQTS) infants

P6410QT intervals during sleep and circadian heart rate variability in healthy and long QT syndrome (LQTS) infants

Nursing study in abdominal breathing training ameliorating sleep status in elderly patients with chronic heart failure

Objective To investigate the effects of abdominal breathing training on sleep disorders in elderly patients with chronic heart failure. Methods Total of 100 patients with chronic heart failure complain of sleeping disorders and Pittsburgh Sleep Quality Index (PSQI)>7 points were assigned into two groups by random digits table method, 50 cases in each group. The observation group and the control group were nursed in the same way except that abdominal breathing was adapted to the observation group. Sleep status, heart rate, blood pressure, SpO2 and brain natriuretic peptide (BNP) were evaluated before training, one week and eight weeks after training respectively. Statistics was used to analyze the differences between two groups. Results After training one week, the sleep status of the observation group was ameliorated, but without significant difference compared to the control group (P>0.05). And after training eight weeks, the PSQI, BNP and heart rate were (9.21 ± 6.38) points, (193.78 ± 152.16) μg/L, (63.5 ± 10.8) times/min in the observation group, and (12.92 ± 0.33) points, (417.55 ± 262.47) μg/L, (70.7 ± 8.5) times/min in the control group, and there was significant differences between 2 groups (t=3.627, 2.041, 2.767, all P 0.05). Conclusions Abdominal breathing training could ameliorate sleep status in elderly patients with chronic heart failure. Key words: Aged; Sleep disorders; Chronic heart failure; Abdominal breathing