The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients
IntroductionObstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors.MethodsWe analyzed beat-to-beat meas...
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Frontiers Media S.A.
2020-03-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2020.00104/full |
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| author | Richard Staats Richard Staats Inês Barros Dina Fernandes Dina Grencho Cátia Reis Cátia Reis Filipa Matos João Valença João Valença João Marôco António Bugalho de Almeida Cristina Bárbara Cristina Bárbara |
| author_facet | Richard Staats Richard Staats Inês Barros Dina Fernandes Dina Grencho Cátia Reis Cátia Reis Filipa Matos João Valença João Valença João Marôco António Bugalho de Almeida Cristina Bárbara Cristina Bárbara |
| author_sort | Richard Staats |
| collection | DOAJ |
| description | IntroductionObstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors.MethodsWe analyzed beat-to-beat measurements of hemodynamic parameters (HPs) during a 25-min period of wake–sleep transition. Differences in the mean HP values for heart rate (HR), systolic BP (SBP), and stroke volume (SV) during wake and sleep and their standard deviations (SDs) were compared between 34 controls (C) and 22 OSA patients. The Student’s t-test for independent samples and the effect size by Cohen’s d (d) were calculated. HP evolution was investigated by plotting the measured HP values against each consecutive pulse wave. After a simple regression analysis, the calculated coefficient beta (SCB) was used to indicate the HP evolution. We furthermore explored by a hierarchical block regression which variables increased the prediction for the SCB: model 1 BMI and age, model 2 + apnea/hypopnea index (AHI), and model 3 + arousal index (AI).ResultsBetween the two groups, the SBP increased in OSA and decreased in C resulting in a significant difference (p = 0.001; d = 0.92). The SV demonstrated a similar development (p = 0.047; d = 0.56). The wake/sleep variation of the HP measured by the SD was higher in the OSA group—HR: p < 0.001; d = 1.2; SBP: p = 0.001; d = 0.94; and SV: p = 0.005; d = 0.82. The hierarchical regression analysis of the SCB demonstrated in SBP that the addition of AI to AHI resulted in ΔR2: +0.163 and ΔF + 13.257 (p = 0.001) and for SV ΔR2: +0.07 and ΔF 4.83 (p = 0.003). The AI but not the AHI remained statistically significant in the regression analysis model 3—SBP: β = 0.717, p = 0.001; SV: β = 0.469, p = 0.033.ConclusionIn this study, we demonstrated that in OSA, the physiological dipping in SBP and SV decreased, and the variation of all investigated parameters increased. Hierarchical regression analysis indicates that the addition of the AI to BMI, age, and AHI increases the prediction of the HP evolution following sleep onset for both SBP and SV and may be the most important variable. |
| first_indexed | 2024-04-13T23:29:24Z |
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| last_indexed | 2024-04-13T23:29:24Z |
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| spelling | doaj.art-048ddbbd35cd4bf59550c9d8329d69542022-12-22T02:24:57ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2020-03-011110.3389/fphys.2020.00104503599The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea PatientsRichard Staats0Richard Staats1Inês Barros2Dina Fernandes3Dina Grencho4Cátia Reis5Cátia Reis6Filipa Matos7João Valença8João Valença9João Marôco10António Bugalho de Almeida11Cristina Bárbara12Cristina Bárbara13Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalInstituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalInstituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalCENC - Sleep Medicine Center, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalFaculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalWilliam James Centre for Research, ISPA-IU, Lisbon, PortugalFaculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalDepartamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PortugalInstituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalIntroductionObstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors.MethodsWe analyzed beat-to-beat measurements of hemodynamic parameters (HPs) during a 25-min period of wake–sleep transition. Differences in the mean HP values for heart rate (HR), systolic BP (SBP), and stroke volume (SV) during wake and sleep and their standard deviations (SDs) were compared between 34 controls (C) and 22 OSA patients. The Student’s t-test for independent samples and the effect size by Cohen’s d (d) were calculated. HP evolution was investigated by plotting the measured HP values against each consecutive pulse wave. After a simple regression analysis, the calculated coefficient beta (SCB) was used to indicate the HP evolution. We furthermore explored by a hierarchical block regression which variables increased the prediction for the SCB: model 1 BMI and age, model 2 + apnea/hypopnea index (AHI), and model 3 + arousal index (AI).ResultsBetween the two groups, the SBP increased in OSA and decreased in C resulting in a significant difference (p = 0.001; d = 0.92). The SV demonstrated a similar development (p = 0.047; d = 0.56). The wake/sleep variation of the HP measured by the SD was higher in the OSA group—HR: p < 0.001; d = 1.2; SBP: p = 0.001; d = 0.94; and SV: p = 0.005; d = 0.82. The hierarchical regression analysis of the SCB demonstrated in SBP that the addition of AI to AHI resulted in ΔR2: +0.163 and ΔF + 13.257 (p = 0.001) and for SV ΔR2: +0.07 and ΔF 4.83 (p = 0.003). The AI but not the AHI remained statistically significant in the regression analysis model 3—SBP: β = 0.717, p = 0.001; SV: β = 0.469, p = 0.033.ConclusionIn this study, we demonstrated that in OSA, the physiological dipping in SBP and SV decreased, and the variation of all investigated parameters increased. Hierarchical regression analysis indicates that the addition of the AI to BMI, age, and AHI increases the prediction of the HP evolution following sleep onset for both SBP and SV and may be the most important variable.https://www.frontiersin.org/article/10.3389/fphys.2020.00104/fullsleep disordered breathingcardiovascular risksleep disturbancearterial blood pressurestroke volume |
| spellingShingle | Richard Staats Richard Staats Inês Barros Dina Fernandes Dina Grencho Cátia Reis Cátia Reis Filipa Matos João Valença João Valença João Marôco António Bugalho de Almeida Cristina Bárbara Cristina Bárbara The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients Frontiers in Physiology sleep disordered breathing cardiovascular risk sleep disturbance arterial blood pressure stroke volume |
| title | The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients |
| title_full | The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients |
| title_fullStr | The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients |
| title_full_unstemmed | The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients |
| title_short | The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients |
| title_sort | importance of sleep fragmentation on the hemodynamic dipping in obstructive sleep apnea patients |
| topic | sleep disordered breathing cardiovascular risk sleep disturbance arterial blood pressure stroke volume |
| url | https://www.frontiersin.org/article/10.3389/fphys.2020.00104/full |
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