Beat-to-beat blood pressure variability in patients with obstructive sleep apnea

• Published in: Journal of clinical sleep medicine Vol. 17; no. 3; pp. 381 - 392
• Main Authors: Pal, Amrita, Martinez, Fernando, Aguila, Andrea P, Akey, Margaret A, Chatterjee, Roopsha, Conserman, Merry Grace E, Aysola, Ravi S, Henderson, Luke A, Macey, Paul M
• Format: Journal Article
• Language: English
• Published: United States American Academy of Sleep Medicine 01.03.2021
• Subjects: Autonomic Nervous System; Autonomic Nervous System Diseases; Blood Pressure; Female; Heart Rate; Humans; Male; Scientific Investigations; Sleep Apnea, Obstructive; cardiovascular disease; autonomic nervous system; baroreflex; sleep-disordered breathing
• ISSN: 1550-9389; 1550-9397
• DOI: 10.5664/jcsm.8866

Cardiovascular comorbidities in obstructive sleep apnea (OSA) are difficult to treat, perhaps due to autonomic dysfunction. We assessed beat-to-beat blood pressure (BP) variability (BPV) in OSA while considering other markers derived from electrocardiogram and continuous BP signals. We studied 66 participants (33 participants with OSA: respiratory event index [mean ± SEM]: 21.1 ± 2.7 events/h; 12 females, aged 51.5 ± 2.4 years; body mass index: 32.8 ± 1.4 kg/m²; 33 healthy controls: 20 females; aged 45.3 ± 2.4 years; body mass index: 26.3 ± 0.7 kg/m²). We collected 5-minute resting noninvasive beat-to-beat BP and electrocardiogram values. From BP, we derived systolic, diastolic, and mean BP values, and calculated variability as standard deviations (systolic BPV, diastolic BPV, BPV). We also calculated diastole-to-systole time (time to peak). From the electrocardiogram, we derived QRS markers and calculated heart rate and heart rate variability. We performed a multivariate analysis of variance based on sex and group (OSA vs control), with Bonferroni-corrected post hoc comparisons (P ≤ .05) between groups. We calculated correlations of BPV with biological variables. Multivariate analysis of variance showed effects of diastolic BPV and BPV in OSA; post hoc comparisons revealed high diastolic BPV and BPV only in female participants with OSA vs controls. QRS duration was higher in OSA, with post hoc comparisons showing the effect only in males. BPV correlated positively with heart rate variability in controls but not in participants with OSA. BPV correlated positively with time to peak in females with OSA and OSA combined, whereas there was no BPV-time-to-peak correlation in healthy participants. The findings show sex-specific autonomic dysfunction reflected in beat-to-beat BP in OSA. The higher BPV may reflect poor baroreflex control or vascular damage in OSA, which are potential precursors to cardiovascular complications.