Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome
The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment. Cross...
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Published in | Sleep (New York, N.Y.) Vol. 38; no. 7; pp. 1059 - 1066 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Associated Professional Sleep Societies, LLC
01.07.2015
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Abstract | The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment.
Cross-sectional study.
We studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) ≥ 15 events/h in MetS + OSA (n = 30, 49 ± 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 ± 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 ± 1.7 y).
Polysomnography, microneurography, cardiopulmonary exercise test.
We evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. ΔHRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated ΔHRR at first, second, and at fourth minute than did C, and attenuated ΔHRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated ΔHRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the ΔHRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations).
The attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or mild or no OSA. This is at least partly explained by sympathetic hyperactivity. |
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AbstractList | The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment.
Cross-sectional study.
We studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) ≥ 15 events/h in MetS + OSA (n = 30, 49 ± 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 ± 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 ± 1.7 y).
Polysomnography, microneurography, cardiopulmonary exercise test.
We evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. ΔHRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated ΔHRR at first, second, and at fourth minute than did C, and attenuated ΔHRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated ΔHRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the ΔHRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations).
The attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or mild or no OSA. This is at least partly explained by sympathetic hyperactivity. STUDY OBJECTIVESThe attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment.DESIGNCross-sectional study.PARTICIPANTSWe studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) ≥ 15 events/h in MetS + OSA (n = 30, 49 ± 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 ± 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 ± 1.7 y).INTERVENTIONSPolysomnography, microneurography, cardiopulmonary exercise test.MEASUREMENTS AND RESULTSWe evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. ΔHRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated ΔHRR at first, second, and at fourth minute than did C, and attenuated ΔHRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated ΔHRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the ΔHRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations).CONCLUSIONSThe attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or mild or no OSA. This is at least partly explained by sympathetic hyperactivity. |
Author | Maki-Nunes, Cristiane Cepeda, Felipe X Lorenzi-Filho, Geraldo Negrao, Carlos E Alves, Maria Janieire N N Braga, Ana Maria F W Martinez, Daniel G Rondon, Maria Urbana P B Toschi-Dias, Edgar Drager, Luciano F Trombetta, Ivani C |
Author_xml | – sequence: 1 givenname: Felipe X surname: Cepeda fullname: Cepeda, Felipe X organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 2 givenname: Edgar surname: Toschi-Dias fullname: Toschi-Dias, Edgar organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 3 givenname: Cristiane surname: Maki-Nunes fullname: Maki-Nunes, Cristiane organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 4 givenname: Maria Urbana P B surname: Rondon fullname: Rondon, Maria Urbana P B organization: School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil – sequence: 5 givenname: Maria Janieire N N surname: Alves fullname: Alves, Maria Janieire N N organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 6 givenname: Ana Maria F W surname: Braga fullname: Braga, Ana Maria F W organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 7 givenname: Daniel G surname: Martinez fullname: Martinez, Daniel G organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 8 givenname: Luciano F surname: Drager fullname: Drager, Luciano F organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 9 givenname: Geraldo surname: Lorenzi-Filho fullname: Lorenzi-Filho, Geraldo organization: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil – sequence: 10 givenname: Carlos E surname: Negrao fullname: Negrao, Carlos E organization: School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil – sequence: 11 givenname: Ivani C surname: Trombetta fullname: Trombetta, Ivani C organization: Universidade Nove de Julho (UNINOVE), São Paulo, Brazil |
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CitedBy_id | crossref_primary_10_1590_s1980_6574201900010021 crossref_primary_10_3389_fnins_2021_680195 crossref_primary_10_5664_jcsm_9628 crossref_primary_10_1371_journal_pone_0217058 crossref_primary_10_1016_j_neubiorev_2019_10_018 crossref_primary_10_1097_HJH_0000000000002288 crossref_primary_10_3389_fphys_2017_00004 crossref_primary_10_1507_endocrj_EJ21_0589 crossref_primary_10_1183_13993003_02697_2017 crossref_primary_10_1161_HYPERTENSIONAHA_122_19288 crossref_primary_10_1111_jch_13060 crossref_primary_10_1016_j_smrv_2019_03_002 crossref_primary_10_1016_j_jjcc_2017_07_017 crossref_primary_10_3389_fcvm_2021_813280 |
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Snippet | The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS).... STUDY OBJECTIVESThe attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic... |
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SubjectTerms | Adult Cross-Sectional Studies Exercise - physiology Exercise Test Female Heart Rate - physiology Humans Male Metabolic Syndrome - complications Metabolic Syndrome - physiopathology Middle Aged OSA Impairs Sympathovagal Balance in Metabolic Syndrome Polysomnography Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - physiopathology Sympathetic Nervous System - physiopathology Vagus Nerve - physiology |
Title | Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome |
URI | https://www.ncbi.nlm.nih.gov/pubmed/25669187 https://search.proquest.com/docview/1695174868 https://pubmed.ncbi.nlm.nih.gov/PMC4481012 |
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