Autonomic dysfunction and comorbid diseases in patients with obstructive sleep apnea.

Svetlana Rubina, Irina Makarova

Rubina S., Makarova I. Autonomic dysfunction and comorbid diseases in patients with obstructive sleep apnea. Journal of Clinical Physiology and Pathology (JISCPP) 2024; 3 (1): 9-18.

Purpose of the study. To reveal the features of heart rate variability (HRV) and comorbid pathology in patients with obstructive sleep apnea (OSA).

Material and methods. The study involved 113 patients who underwent anthropometric measurements, polysomnography, recording of heart rate variability (HRV) and questionnaires (Beck scale, HADS, Holmes-Rey stress, Spielberger-Khanin questionnaire). According to polysomnography data, 2 groups of subjects were identified: with OSA (n = 61) and without apnea (n = 52).

Results. We found that in patients with OSA, hypertension (HT) occurred in 86,9% (p=0,000), acute cerebrovascular accident (CVA) in 8,2% (p=0,035), and chronic cerebral ischemia (CCI) in 82% of patients (p=0,000). According to the results of our work, there were no significant differences in the indices of the scales of anxiety, anxiety and stress levels between the groups of examined individuals. The mean scores of asthenia on the VAS scale (p=0,001), depression on the HADS (p=0,001) and Beck (p=0,000) scales in patients with OSA were significantly higher than in the control group. Representative indicators of HRV in patients with apnea in orthostasis were low values of Cr (%), SDNN (ms), RMSSD (ms), DX (ms), CV (%) and IC (arb. units), FR (ms²), HF (ms²), LF (ms², %), VLF (ms²), and at rest — IC (arb. units), VPP (arb. units), HF (%) and VLF (%), which were higher than in the comparison group.

Conclusion. It has been established that for patients with OSA the most common comorbid pathology is obesity, HT, CVA, CCI and depression. In patients with moderate and severe severity of OSA, the influence of the central circuit of autonomic regulation on the heart rhythm increases, the total power of HRV decreases due to the parasympathetic department and the activity of the sympathetic department predominates, which can lead to depletion of the body’s regulatory systems, a decrease in the adaptation reserve and an increase in the risks of vascular diseases complications. It is necessary to continue studying the features of HRV in patients with OSA and determine the significance of changes in the autonomic nervous system (ANS) depending on the severity of apnea, as well as what place comorbid pathology and OSA occupy in ANS dysfunction.

obstructive sleep apnea, acute cerebrovascular accident, chronic cerebral ischemia, obesity, depression, anxiety, asthenia, autonomic nervous system, heart rate variability, polysomnography.