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      The Association of Sleep Duration and Quality with Heart Rate Variability and Blood Pressure

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          Abstract

          Background:

          The current study was conducted to evaluate the relation of sleep duration and quality with blood pressure (BP) and heart rate variability (HRV).

          Materials and Methods:

          This cross-sectional study was carried out in 2017 among 260 staff of a university hospital in Isfahan, Iran. They were selected by multi-stage random method from different wards. Time domain spectral analysis was used to measure a number of HRV parameters. The long-term components of the HRV were estimated using the standard deviation of the normal-to-normal interval (SDNN). The square root of the mean squared differences of successive NN intervals (RMSSD) was calculated by statistical time domain measurements; SNN50, and PNN50 were measured. Pittsburg sleep quality index (PSQI) questionnaire was used to assess sleep quality.

          Results:

          Higher PSQI score correlated with lower SDANN rise (OR=0.92). Fairly bad to very good subjective sleep quality had association with lower SDANN (OR=0.43). Very high sleep latency to very low sleep latency ratio had association with lower SDANN (OR=0.39) and lower PNN50 (OR= 0.44). Sleep duration and HRV parameters had no significant association. Fairly bad sleep efficiency to very good sleep efficiency ratio was correlated with lower SDANN (OR= 0.29). Very high daytime dysfunction to very low daytime dysfunction ratio had correlation with lower SDANN (OR=0.35). Very bad compared to very good subjective sleep quality had significant correlation with higher Heart rate (HR) (B=0.03). Very high sleep latency compared to no sleep latency was associated with higher HR (B=4.74). Very high compared to very low amount of sleep disturbances correlated with higher SBP levels (B=15.2). Using sleep medication less than once a week compared with no history of taking such drugs was associated with higher HR (B=16.4).

          Conclusion:

          Our findings showed that poor sleep quality are adversely associated with HRV, HR and BP. This finding should be considered in clinical and preventive recommendations.

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          Most cited references32

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          Sympathetic-nerve activity during sleep in normal subjects.

          The early hours of the morning after awakening are associated with an increased frequency of events such as myocardial infarction and ischemic stroke. The triggering mechanisms for these events are not clear. We investigated whether autonomic changes occurring during sleep, particularly rapid-eye-movement (REM) sleep, contribute to the initiation of such events. We measured blood pressure, heart rate, and sympathetic-nerve activity (using microneurography, which provides direct measurements of efferent sympathetic-nerve activity related to muscle blood vessels) in eight normal subjects while they were awake and while in the five stages of sleep. The mean (+/- SE) amplitude of bursts of sympathetic-nerve activity and levels of blood pressure and heart rate declined significantly (P < 0.001), from 100 +/- 9 percent, 90 +/- 4 mm Hg, and 64 +/- 2 beats per minute, respectively, during wakefulness to 41 +/- 9 percent, 80 +/- 4 mm Hg, and 59 +/- 2 beats per minute, respectively, during stage 4 of non-REM sleep. Arousal stimuli during stage 2 sleep elicited high-amplitude deflections on the electroencephalogram (called K complexes), which were frequently associated with bursts of sympathetic-nerve activity and transient increases in blood pressure. During REM sleep, sympathetic-nerve activity increased significantly (to 215 +/- 11 percent; P < 0.001) and the blood pressure and heart rate returned to levels similar to those during wakefulness. Momentary restorations of muscle tone during REM sleep (REM twitches) were associated with cessation of sympathetic-nerve discharge and surges in blood pressure. REM sleep is associated with profound sympathetic activation in normal subjects, possibly linked to changes in muscle tone. The hemodynamic and sympathetic changes during REM sleep could play a part in triggering ischemic events in patients with vascular disease.
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            Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation.

            Cardiovascular autonomic modulation during 36 h of total sleep deprivation (SD) was assessed in 18 normal subjects (16 men, 2 women, 26.0 +/- 4.6 yr old). ECG and continuous blood pressure (BP) from radial artery tonometry were obtained at 2100 on the first study night (baseline) and every subsequent 12 h of SD. Each measurement period included resting supine, seated, and seated performing computerized tasks and measured vigilance and executive function. Subjects were not supine in the periods between measurements. Spectral analysis of heart rate variability (HRV) and BP variability (BPV) was computed for cardiac parasympathetic modulation [high-frequency power (HF)], sympathetic modulation [low-frequency power (LF)], sympathovagal balance (LF/HF power of R-R variability), and BPV sympathetic modulation (at LF). All spectral data were expressed in normalized units [(total power of the components/total power-very LF) x 100]. Spontaneous baroreflex sensitivity (BRS), based on systolic BP and pulse interval powers, was also measured. Supine and sitting, BPV LF was significantly increased from baseline at 12, 24, and 36 h of SD. Sitting, HRV LF was increased at 12 and 24 h of SD, HRV HF was decreased at 12 h SD, and HRV LF/HF power of R-R variability was increased at 12 h of SD. BRS was decreased at 24 h of SD supine and seated. During the simple reaction time task (vigilance testing), the significantly increased sympathetic and decreased parasympathetic cardiac modulation and BRS extended through 36 h of SD. In summary, acute SD was associated with increased sympathetic and decreased parasympathetic cardiovascular modulation and decreased BRS, most consistently in the seated position and during simple reaction-time testing.
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              Heart rate variability in normal and pathological sleep

              Sleep is a physiological process involving different biological systems, from molecular to organ level; its integrity is essential for maintaining health and homeostasis in human beings. Although in the past sleep has been considered a state of quiet, experimental and clinical evidences suggest a noteworthy activation of different biological systems during sleep. A key role is played by the autonomic nervous system (ANS), whose modulation regulates cardiovascular functions during sleep onset and different sleep stages. Therefore, an interest on the evaluation of autonomic cardiovascular control in health and disease is growing by means of linear and non-linear heart rate variability (HRV) analyses. The application of classical tools for ANS analysis, such as HRV during physiological sleep, showed that the rapid eye movement (REM) stage is characterized by a likely sympathetic predominance associated with a vagal withdrawal, while the opposite trend is observed during non-REM sleep. More recently, the use of non-linear tools, such as entropy-derived indices, have provided new insight on the cardiac autonomic regulation, revealing for instance changes in the cardiovascular complexity during REM sleep, supporting the hypothesis of a reduced capability of the cardiovascular system to deal with stress challenges. Interestingly, different HRV tools have been applied to characterize autonomic cardiac control in different pathological conditions, from neurological sleep disorders to sleep disordered breathing (SDB). In summary, linear and non-linear analysis of HRV are reliable approaches to assess changes of autonomic cardiac modulation during sleep both in health and diseases. The use of these tools could provide important information of clinical and prognostic relevance.
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                Author and article information

                Journal
                Tanaffos
                Tanaffos
                Tanaffos
                Tanaffos
                Tanaffos
                National Research Institute of Tuberculosis and Lung Disease
                1735-0344
                2345-3729
                November 2020
                : 19
                : 2
                : 135-143
                Affiliations
                [1 ]Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,
                [2 ]Medical Student, Isfahan University of Medical Sciences, Isfahan, Iran,
                [3 ]Center of Sleep Medicine, Charite e Universitatsmedizin€ Berlin, Berlin, Germany,
                [4 ]Charite e Universitatsmedizin€ Berlin, Department of Cardiology and Pulmonology, Center of Sleep Medicine, Berlin, Germany,
                [5 ]Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran,
                [6 ]Department of Pulmonology, Bamdad Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Correspondence to: Amra B, Address: Department of Pulmonology, Bamdad Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Email address: amrababak@ 123456gmail.com
                Article
                Tanaffos-19-135
                7680518
                33262801
                d528bdf7-03f0-463f-8b80-4f70f4d32334
                Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 February 2019
                : 29 November 2019
                Categories
                Original Article

                sleep duration,sleep quality,heart rate variability,blood pressure

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