Heart Rate Variability as a Surrogate Marker of Severe Chronic Coronary Syndrome in Patients with Obstructive Sleep Apnea

Christopher Seifen; Maria Zisiopoulou; Katharina Ludwig; Johannes Pordzik; Muthuraman Muthuraman; Haralampos Gouveris

doi:10.3390/diagnostics13172838

Heart Rate Variability as a Surrogate Marker of Severe Chronic Coronary Syndrome in Patients with Obstructive Sleep Apnea

Diagnostics (Basel). 2023 Sep 1;13(17):2838. doi: 10.3390/diagnostics13172838.

Authors

Christopher Seifen¹, Maria Zisiopoulou², Katharina Ludwig¹, Johannes Pordzik¹, Muthuraman Muthuraman³, Haralampos Gouveris¹

Affiliations

¹ Sleep Medicine Center & Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany.
² Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60629 Frankfurt am Main, Germany.
³ Neural Engineering with Signal Analytics and Artificial Intelligence, Department of Neurology, University Medical Center Würzburg, 97080 Würzburg, Germany.

Abstract

Background and objectives: Obstructive sleep apnea (OSA) is a known risk factor for chronic coronary syndrome (CCS). CCS and OSA are separately associated with significant changes in heart rate variability (HRV). In this proof-of-concept study, we tested whether HRV values are significantly different between OSA patients with concomitant severe CCS, and OSA patients without known CCS.

Material and methods: The study comprised a retrospective assessment of the historical and raw polysomnography (PSG) data of 32 patients who presented to a tertiary university hospital with clinical complaints of OSA. A total of 16 patients (four females, mean age 62.94 ± 2.74 years, mean body mass index (BMI) 31.93 ± 1.65 kg/m²) with OSA (median apnea-hypopnea index (AHI) 39.1 (30.5-70.6)/h) and severe CCS were compared to 16 patients (four females, mean age 62.35 ± 2.06 years, mean BMI 32.19 ± 1.07 kg/m²) with OSA (median AHI 40 (30.6-44.5)/h) but without severe CCS. The short-long-term HRV (in msec) was calculated based on the data of a single-lead electrocardiogram (ECG) provided by one full-night PSG, using the standard deviation of the NN, normal-to-normal intervals (SDNN) and the heart rate variability triangular index (HRVI) methods, and compared between the two groups.

Results: A significant reduction (p < 0.05) in both SDNN and HRVI was found in the OSA group with CCS compared to the OSA group without CCS.

Conclusions: Severe CCS has a significant impact on short-long-term HRV in OSA patients. Further studies in OSA patients with less-severe CCS may shed more light onto the involved mechanistic processes. If confirmed in future larger studies, this physiologic metric has the potential to provide a robust surrogate marker of severe CCS in OSA patients.

Keywords: CCS; HRV; OSA; chronic coronary syndrome; heart rate variability; obstructive sleep apnea; surrogate marker.

Grants and funding

M.M. was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Project-ID 424778381-TRR 295 and the Fondazione Grigioni per il Morbo di Parkinson. All other authors received no external funding.