Comparison of autonomic withdrawal in men with obstructive sleep apnea syndrome, systemic hypertension, and neither condition.

Obstructive sleep apnea syndrome is characterized by obesity, nocturnal breathing abnormalities, arterial hypertension, and an increased number of cardiovascular events. Sympathetic activity is increased during nocturnal apneic episodes, which may mediate the cardiovascular complications of sleep apnea. We studied 15 male subjects with obstructive sleep apnea syndrome and associated hypertension, 54 subjects with mild to moderate essential hypertension, and 25 healthy normotensive men. Cardiovascular autonomic control was assessed using frequency domain measures of heart rate variability (HRV) during a controlled breathing test and during orthostatic maneuver. Compared with normotensive and hypertensive groups, total power and low- and high-frequency components of HRV during controlled breathing were significantly (analysis of variance, p<0.0001) lower in the obstructive sleep apnea syndrome. During the orthostatic maneuver, the change in total power of HRV was different between the 3 groups (analysis of variance, p = 0.004). The total power of HRV tended to increase in the normotensive (4.11+/-12.29 ms2) and in hypertensive (2.31+/-12.65 ms2) groups, but decreased (1.13+/-1.23 ms2) in the hypertensive group with obstructive sleep apnea syndrome. According to multivariate regression analysis, age and sleep apnea were the major independent determinants of HRV. This study found that an abnormal response to autonomic nervous tests characterizes hypertension in overweight subjects with obstructive sleep apnea syndrome. This could be due to autonomic withdrawal or supersaturation of the end-organ receptors by excessive and prolonged sympathetic stimulation. Our results also show the reduced response of orthostatic maneuver and controlled breathing in the hypertensive group compared with the normotensive group.

High resolution ECG changes among Finnish pilots.

BACKGROUND: Abundant appearance of late potentials registered by high resolution ECG (HR-ECG) has been shown to predict a risk for cardiac arrhythmia. The aim of this study was to evaluate the appearance of normal and abnormal late potentials in a group of Finnish private and commercial pilots. METHODS: Standard 12-lead ECG and 40-250 Hz band-pass filtered HR-ECG were recorded in 168 healthy male pilots. The following parameters were estimated: the root-mean-square voltage in the terminal 40 ms (RMS40), the total filtered QRS duration (FQRSD) and the duration of terminal high frequency low amplitude signal (HFLAD) of less than 40 microV in the filtered QRS. RESULTS: Age (38 +/- 12 yr) and height (179 +/- 6 cm) had a significant (p < 0.005) and independent association with the total filtered QRS duration. No such correlations were observed for RMS40 or HFLAD. Mean +/- SD for RMS40 was 35.3 +/- 15.4 microV, for FQRSD 114.6 +/- 6.8 ms and for HFLAD 31.0 +/- 7.9 ms. Smokers tended to have longer late potentials (HFLAD) than non-smokers. Fasting blood glucose had a significant (p < 0.05) positive correlation with HFLAD. Serum cholesterol level had no correlation with the HR-ECG parameters. Age and height of the subject were associated with the total QRS duration as follows: FQRSD (ms) = -9.7* log age (yr) + 0.2*height (cm) + 94.6.

Association of abnormal flow velocity waveforms in the uterine artery with frequency-specific fetal heart rate variability.

The aim of the study was to determine if abnormal flow velocity waveforms in the uterine artery are associated with altered frequency-specific fetal heart rate variability (HRV). Fetuses in the last third of gestation were studied. In seven fetuses the pulsatility index (PI) of the blood flow velocity waveform in the uterine artery was increased (Group II), and in ten fetuses the PI was normal (Group I). Frequency-specific HRV (0.025-0.07 Hz, 0.07-0.13 Hz, 0.13-1.0 Hz) was quantified by power spectral analysis and correlated with the PI in the uterine artery, umbilical artery and the middle cerebral artery. The slow variability dominated the fetal HRV. There was no difference between the groups in the mean frequency-specific variability. In Group II, an increase of the PI in the umbilical artery and a decrease in the middle cerebral artery correlated with an increase of HRV, the increase being greatest at the lowest frequency band.

Computer analysis of heart rate variation and breathing movements in fetal lambs.

A quantitative method for studying the frequency-specific relationships between heart rate (HR) and fetal breathing movements (FBM) was developed. The reactivity of periodic HR variation in relation to FBM was investigated by means of power spectral analysis. Seven fetal lambs were studied during the third trimester of gestation using a chronic animal model. HR variability increased at the rate of FBM, as shown by an increase of spectral density at > 0.35 Hz in the HR autospectrum and in the cross-spectrum of HR and respirogram, as well as by an increase in the short-term variability index CVS. FBM were associated with the increased HR variation in all but the lowest frequency bands (0.07-1.0 Hz). Although respiratory sinus arrhythmia was found, only 10 per cent of the total HR variability and 25 per cent of the joint-density of HR and respirogram appeared at > 0.35 Hz during FBM. The greatest variation in both the HR and respirogram spectra appeared at < 0.07 Hz. Although the low-frequency variability of HR and respirogram was simultaneous, it was on the whole not synchronised. The existence of multiple control systems that simultaneously link the cardiac and respiratory control mechanisms to each other in the fetal lamb is postulated.

Changes in autonomic cardiovascular control in mid-pregnancy.

Spectral analysis of heart rate variability was used to study autonomic nervous control in mid-pregnancy. Fifty women (age 22-36 years) with singleton pregnancies (mean duration of gestation 27.7 weeks) and 39 non-pregnant female controls (age 21-39 years) were studied using controlled breathing and orthostatic tests. During spontaneous breathing the overall heart rate variability was lower in pregnant subjects indicating a decreased parasympathetic tone at rest. The decreased parasympathetic tone probably counts for the increased heart rate in pregnancy. The parasympathetic efferent capacity of autonomic cardiac control was found to be similar in pregnant and non-pregnant subjects, as no difference was seen during controlled breathing in periodic heart rate variability between the groups. Standing up caused a similar change in low frequency and mid-frequency bands in both groups, but high frequency heart rate variability increased in pregnant subjects and decreased in the controls indicating an increased sympathetic tone at rest in mid-pregnancy.

Regulation of heart rate variation by the autonomic nervous system in neonatal lambs.

We studied the role of the autonomic nervous system in the regulation of heart rate variation (HRV) in 12 chronically instrumented neonatal lambs. HRV was quantified from ECG tracings by computing periodic HRV distributions at frequencies of 0.02-1.00 Hz, using power spectral analysis of heart rate, and also by HRV indices. Heart rate declined more during the 1st than the 2nd mo after birth. Multiple regression analysis showed that the heart rate responses to vagal and to beta-adrenergic blockade had an independent negative association both with age and with the initial mean heart rate, whereas the overall HRV response had a positive association with age. Vagal blockade led to a 70-80% decrease in the beat-to-beat HRV in all lambs (p less than 0.001). The overall HRV indices decreased by 40-65% in lambs (less than 30 d old (p less than 0.001) and about 30% in those greater than 30 d old (p less than 0.05). In the power spectrum the greatest decrease was seen in the high-frequency components of HRV. beta-Blockade led to a decrease of about 50% in all HRV (p less than 0.001) in the younger lambs, without frequency selection. In the older lambs, it had no effect on the beat-to-beat HRV, but the overall HRV (coefficient of variance) decreased maximally by 40% (p less than 0.01), with a significant reduction in the low-frequency components of HRV. These results suggest that in the regulation of HRV after birth dual control via the autonomic nervous system is most important. In the older lambs, developmental changes result in precise regulation of the fast heart rate fluctuations mainly by the vagal division, whereas the slow fluctuations are partially regulated by the vagal and beta-adrenergic divisions.