The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea

Abstract

Continuous positive airway pressure (CPAP) improves autonomic activity in patients with chronic heart failure (CHF) and central sleep apnoea (CSA), but its effect on heart rate variability (HRV) during therapy has not been reported. We hypothesized that CPAP may decrease HRV, despite its beneficial effects on sympathetic overactivation, due to the expected stabilization of breathing. Sixty-seven CHF patients underwent polysomnography (PSG). Ten of them presented with CSA (age 66.1±8.5 years, apnoea-hypopnea index [AHI]=57.6±23.3, central AHI [cAHI]=41.6±24.6 [mean±SD]) and were subjected to a second PSG with manual CPAP titration. Beat-to-beat heart intervals for a 6-hour period of sleep were extracted from each recording and HRV was analysed. CPAP significantly reduced AHI (AHI=23.1±18.3 P=.004). Standard deviation of normal-normal interbeat interval (SDNN) (61.5±29.0 vs 49.5±19.3 ms, P=.021), root mean square of successive differences (RMSSD) (21.8±9.2 vs 16.4±7.1 ms, P=.042), total power (lnTP=7.8±1.1 vs 7.4±0.8 ms , P=.037), low frequency power (lnLF=5.5±1.5 vs 5.0±1.4 ms , P=.003) and high frequency power (lnHF=4.6±1.0 vs 4.0±1.0 ms , P=.024) were decreased. There was a strong correlation between the decrease in AHI and the decrease in lnHF (Spearman's ρ=.782). CPAP leads to a decrease in spectral and time domain parameters of HRV during therapy in CHF patients with CSA. These changes are best explained by the effect which CPAP-influenced breathing pattern and lowered AHI exert on HRV.

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

“…While the exact significance and clinical relevance of this finding is unclear, some potential insight can be drawn from the adult literature. For instance, Terziyski et al studied the acute, short‐term effects of NCPAP on HRV parameters in adults with chronic heart failure and central sleep apnea. They found that time domain HRV parameters were significantly lower with the application of NCPAP, and suggested that these changes were best explained by reduction of the apnea‐hypopnea index and stabilization of the breathing pattern.…”

Heart rate variability as predictive factor for sudden cardiac death

“…In CHF, markedly reduced HRV has been demonstrated to coincide with the severity of CHF, as well as being an independent marker of sympatho-excitation. On the other hand, after acute myocardial infarction, depressed HRV predicts cardiac mortality and malignant arrhythmias [ 103 , 104 ]. In 2007 Kiviniemi et al [ 105 ].…”

Heart rate variability during auricular acupressure at the left sympathetic point on healthy volunteers: a pilot study

“…Cardiac autonomic dysfunction can be measured noninvasively using heart rate variability (HRV) (Hillebrand et al, 2013). Many studies have Trinh et al 10.3389/fnins.2023.1116154 shown that chronic low HRV values are associated with sudden cardiac death while reduction of HR and increase of HF can be considered a beneficial direction for cardiovascular diseases (Haarala et al, 2011;Terziyski et al, 2016;Sessa et al, 2018).…”