Sleep apnea in heart failure increases heart rate variability and sympathetic dominance

Aims: Sleep disordered breathing (SDB) is common in heart failure and ventilation is known to influence heart rate. Our aims were to assess the influence of SDB on heart rate variability (HRV) and to determine whether central sleep apnea (CSA) and obstructive sleep apnea (OSA) produced different patterns of HRV. Methods and results: Overnight polysomnography was performed in 21 patients with heart failure and SDB. Two 10-minute segments each of SDB and stable breathing from each patient were visually identified and ECG signal exported for HRV analysis. SDB increased total power (TP) with very low frequency (VLF) power accounting for the greatest increase (1.89 +/- 0.54 vs 2.96 +/- 0.46 ms(2), P <0.001); LF/HF ratio increased during SDB (1.2 +/- 1.0 vs; 2.7 +/- 2.1, P <0.001). Compared to OSA, CSA was asso-ciated with lower absolute LF (2.10 +/- 0.47 vs 2.52 +/- 0.55 ms(2), P = 0.049) and HF power (1.69 +/- 0.41 vs 2.34 +/- 0.58 ms(2), P = 0.004), increased VLF% (78.9% +/- 13.4% vs 60.9% +/- 19.2%, P = 0.008), decreased HF% (6.9% +/- 7.8% vs 16.0%+/- 11.7%, P = 0.046) with a trend to higher LF/HF ratio. Conclusions: SDB increases HRV in the setting of increased sympathetic dominance. HRV in CSA and OSA have unique HRV patterns which are likely to reflect the different pathophysiological mechanisms involved.