Altered heart rate variability but preserved relationships with sleep stages in a patient with primary aldosteronism

Objective: In a previous study, we found oscillations in the autonomic nervous system activity - as estimated by spectral analysis of R-R intervals - strongly linked to the non-rapid-eye movement (NREM) - REM sleep cycles, with low sympathetic activity during NREM sleep and predominant sympathetic activity during REM sleep. In the present study we established the 5-min nighttime profiles in various measures of heart rate variability (HRV) in one patient with primary aldosteronism before and after successful surgery of Conn adenoma. Methods: One patient (female, 36 years old) with primary aldosteronism underwent two experimental nights a few weeks before and after surgery by coelioscopy in which sleep and cardiac recordings were made. Power spectral analysis was performed on ectopic-free R-R intervals with a fast Fourier transform. We calculated also the standard deviation of normal R-R intervals (SDNN) and the root mean square difference among successive R-R intervals (RMSSD). Results: While removal of adenoma resulted in a rapid complete normalization of blood pressure and classical signs and biological symptoms of aldosterone hypersecretion, HRV profile did not changed a few weeks after surgery. The overnight SDNN was low although not abnormal at 38 and 33 ms before and after surgery respectively vs 58 +/- 15 ms (33 to 83) in normal female controls. RMSSD was low although not abnormal at 33 and 31 ms before and after surgery respectively vs 60 +/- 20 ms (20 to 105). The total spectrum power was low although not abnormal at 2.3 and 1.8 ms' before and after surgery, respectively vs 3.2 +/- 1.1 ms(2) (1.4 to 4.9). One out of the 8 controls had comparable or lower SDNN (33 ms), RMSSD (20 ms) and total power (1.4 ms(2)) values. While LF/HF ratio was comparable, the VLF (0.003-0.04 Hz) and LF (0.04-0.15 Hz) relative power were decreased and increased respectively in the patient compared in controls. Despite this reduced HRV, the normal temporal relationship of spectral parameters with specific sleep stages was preserved. Conclusion: Altered HRV with normal temporal relationships with specific sleep stages was observed in a patient with primary hyperaldosteronism. This HRV profile did not changed 20 weeks after successful surgery i.e. complete remission of classical signs and symptoms of aldosterone hypersecretion.