Actigraphy-based sleep disruption and diurnal biomarkers of autonomic function in paroxysmal atrial fibrillation.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-04-22 DOI:10.1007/s11325-025-03293-4

Sepideh Khazaie, Lu Wang, Farhad Kaffashi, Mina K Chung, Catherine M Heinzinger, David R Van Wagoner, Kenneth A Loparo, Harneet K Walia, Reena Mehra

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引用次数: 0

Abstract

Introduction: Sleep architectural disruption is associated with atrial fibrillation (AF); however, associated autonomic influences remain unclear and it is unknown if this detriment persists during wakefulness. We hypothesize sleep disruption and autonomic dysfunction have diurnal patterning in patients with paroxysmal AF.

Methods: We analyzed data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study designed to examine paroxysmal AF and sleep apnea, including simultaneous collection of continuous electrocardiogram monitoring (Heartrak Telemetry^®) and actigraphy (Actiwatch GTX) for 7-21 days. Heart rate variability (HRV) measures in time-domain (standard deviation of normal-to-normal (NN) intervals (SDNN), coefficient of variation (CV)) and frequency-domain (low frequency power (LFP), high frequency power (HFP)) were used as surrogates of autonomic function and averaged per sleep/wake per day. A linear mixed-effects model assuming compound symmetry correlation structure was used to assess the relationship of HRV with actigraphy-derived sleep data.

Results: The analytic sample (age 60.1 ± 12.0 years, body mass index 32.6 ± 6.7 kg/m2, 36% female, 75% White) included 100 participants with paroxysmal AF. Longer sleep latency was associated with lower HFP during wakefulness (coefficient - 0.0501, p = 0.031). Higher sleep efficiency was associated with increased SDNN (coefficient 0.0007, p = 0.014) and CV (coefficient 0.0167, p = 0.047). Higher arousal index was associated with increased CV (coefficient 0.0166, p = 0.007) and LFP (coefficient 0.0232, p = 0.003). During sleep, longer average awakenings duration was associated with increased LFP/HFP ratio (coefficient 0.1977, p < 0.001) and reduced HFP (coefficient - 0.1338, p < 0.001). Significant sleep-wake interactions were observed for sleep latency with HFP (p = 0.024), sleep efficiency with SDNN and CV (both p < 0.01), WASO with SDNN, CV, and LFP (all p < 0.05), and frequency of awakenings with CV and LFP (both p < 0.05).

Conclusions: Actigraphy-based measures of sleep disruption were associated with autonomic function alterations exhibiting diurnal variability in paroxysmal AF. Greater overall HRV and parasympathetic modulation were related to better sleep quality. Increased sympathetic activation was associated with sleep fragmentation. Results provide insights into differential autonomic dysfunction related to sleep disruption that may contribute to atrial arrhythmogenesis.

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阵发性心房颤动中基于活动图的睡眠中断和自主神经功能的昼夜生物标志物。

导论：睡眠结构紊乱与心房颤动（AF）有关；然而，相关的自主神经影响尚不清楚，也不清楚这种损害是否在清醒期间持续存在。我们假设睡眠中断和自主神经功能障碍在阵发性房颤患者中具有昼夜模式。方法：我们分析了来自睡眠呼吸暂停和房颤生物标志物和电生理心房触发器（SAFEBEAT）研究的数据，该研究旨在检查阵发性房颤和睡眠呼吸暂停，包括同时收集7-21天的连续心电图监测（hearttrak Telemetry®）和活动描记（Actiwatch GTX）。心率变异性（HRV）测量在时域（正常到正常（NN）间隔的标准差（SDNN），变异系数（CV））和频域（低频功率（LFP），高频功率（HFP））被用来代替自主神经功能和平均每天每次睡眠/觉醒。采用假设复合对称相关结构的线性混合效应模型来评估HRV与活动记录仪衍生睡眠数据的关系。结果：分析样本（年龄60.1±12.0岁，体重指数32.6±6.7 kg/m2，女性36%，白人75%）包括100名阵发性房颤患者。睡眠潜伏期较长与清醒时HFP较低相关（系数- 0.0501,p = 0.031）。较高的睡眠效率与增加的SDNN（系数0.0007,p = 0.014）和CV（系数0.0167,p = 0.047）相关。高唤醒指数与CV（系数0.0166,p = 0.007）和LFP（系数0.0232,p = 0.003）升高相关。在睡眠期间，较长的平均觉醒时间与LFP/HFP比值增加相关（系数0.1977,p）。结论：基于活动图的睡眠中断测量与自主神经功能改变有关，在阵发性房颤中表现出昼夜变异性。更大的总体HRV和副交感神经调节与更好的睡眠质量有关。交感神经激活增加与睡眠分裂有关。结果提供了与睡眠中断相关的不同自主神经功能障碍可能导致心房心律失常的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.