Apnea‐Related Heart Rate Variability in Congestive Heart Failure Patients

Abstract

Sleep-disordered breathing (SDB) causes fluctuation of the RR interval. However, the details are uncertain. We studied the characteristics of sleep-related heart rate variation (HRV) in congestive heart failure (CHF) patients with SDB. Ambulatory electrocardiograms and data on respiration (oronasal flow, trachea sound, abdominal wall movement, and oxygen saturation) were simultaneously recorded by a multi-channel digital recorder for 13 CHF patients (8 men and 5 women; mean age, 68 +/- 4 years). Heart rate variation occurred as a result of cyclical apnea attacks between 0.005 and 0.03 Hz (apnea band). The proportion of the apnea band (% apnea) increased with the number of apnea episodes, and SDB was highly likely when the % apnea was > or = 80%. Low-flow oxygen administration effectively reduced apnea frequency, and the apnea-related HRV also decreased. We concluded that apnea-related HRV was useful for detecting and following SDB in CHF cases.

Sleep disordered breathing in chronic heart failure

“…In 1984, Guilleminault et al reported cyclical variation in the RR intervals of simultaneously recorded electrocardiograms during apnoeic events in patients with sleep apnoea. Technological advances allow more sophisticated analysis of HRV and its derivatives in sleep apnoea [25], with one study reporting characteristic HRV changes in relation to apnoea events in patients with CHF and SDB [26]. During nocturnal Cheyne-Stokes respiration in CHF, very low frequency heart rate oscillations were powerfully induced by the ventilatory oscillations of the periodic breathing, rather than via oxygenation, both in sinus rhythm and in atrial fibrillation [27,28].…”

Sleep in Congestive Heart Failure

“…34 Heart rate variation in response to apnea events has been used to diagnose SDB in patients with CHF. 35 Thoracic impedance monitoring has been used to measure cardiac output variation in response to apnea events in CHF patients with SDB. 36 These new techniques are not being used widely to diagnose SDB in CHF patients, and the authors await further data before giving any definitive recommendations.…”

Resuscitation After Hemorrhagic Shock in the Microcirculation: Targeting Optimal Oxygen Delivery in the Design of Artificial Blood Substitutes

“…Previous in vitro studies showed that shear significantly increased glycosaminoglycan synthesis in endothelial cells (3). Fluid shear stress on the endothelium modifies the organization of inter-endothelial junctions (4) and can alter the barrier properties of the endothelium by activating intracellular signaling events (3)(4)(5). The glycocalyx represents a major barrier against the extravasation of fluids and colloids; sieving and binding of intravascular colloids from the plasma restrict transport of other plasma molecules (6).…”