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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Day-night pattern of autonomic nervous system modulation in patients with heart failure with and without sleep apnea

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Author(s):
Ueno, Linda M. [1, 2] ; Drager, Luciano F. [1] ; Rodrigues, Ana C. T. [1] ; Rondon, Maria U. P. B. [1] ; Mathias, Jr., Wilson [1] ; Krieger, Eduardo M. [1] ; Fazan Junior, Rubens [3] ; Negrao, Carlos E. [1, 4] ; Lorenzi-Filho, Geraldo [4]
Total Authors: 9
Affiliation:
[1] Univ Sao Paulo, Heart Inst InCor, BR-03828000 Sao Paulo, Ermelino Matara - Brazil
[2] Univ Sao Paulo, Escola Artes Ciencias & Humanidades, BR-03828000 Sao Paulo, Ermelino Matara - Brazil
[3] Univ Sao Paulo, Sch Med Ribeirao Preto, BR-03828000 Sao Paulo, Ermelino Matara - Brazil
[4] Univ Sao Paulo, Sch Phys Educ & Sport, BR-03828000 Sao Paulo, Ermelino Matara - Brazil
Total Affiliations: 4
Document type: Journal article
Source: INTERNATIONAL JOURNAL OF CARDIOLOGY; v. 148, n. 1, p. 53-58, APR 2011.
Web of Science Citations: 12
Abstract

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. (AU)