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Sleep, cardiac autonomic function, and carotid atherosclerosis in patients with cardiovascular risks: HSCAA study
Manabu Kadoya1, Hidenori Koyama1, Masafumi Kurajoh1
1Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Insights
Cardiac autonomic dysfunction, indicated by heart rate variability (HRV), is linked to carotid atherosclerosis, independent of sleep quality. This association is stronger in individuals with cardiovascular risk factors.
Area of Science:
- Cardiology
- Sleep Medicine
- Autonomic Nervous System Research
Background:
- Behavioral and psychosocial factors are increasingly recognized for their impact on cardiovascular diseases.
- Understanding the interplay between sleep, autonomic function, and atherosclerosis is crucial for cardiovascular health.
Purpose of the Study:
- To evaluate sleep conditions, cardiac autonomic function, and carotid atherosclerosis.
- To investigate the association between sleep, heart rate variability (HRV), and carotid atherosclerosis markers.
Main Methods:
- Cross-sectional study of 330 patients without prior cardiovascular disease.
- Assessed sleep efficiency, apnea-hypopnea index (AHI), HRV parameters, carotid intima-media thickness (IMT), and plaque presence/score.
- Utilized multivariate logistic regression to identify independent associations.
Main Results:
- Lower sleep efficiency and HRV parameters were negatively associated with IMT and plaque scores.
- Higher AHI was positively associated with IMT and plaque scores.
- Heart rate variability (specifically rMSSD) was independently associated with carotid plaque, irrespective of sleep conditions or traditional risk factors.
Conclusions:
- Cardiac autonomic nervous dysfunction is independently associated with carotid atherosclerosis.
- The link between autonomic dysfunction and atherosclerosis is more pronounced in patients with cardiovascular risk factors.
- Sleep conditions alone did not independently predict carotid atherosclerosis in this cohort.
Objectives:
Behavioral and psychosocial factors have been gaining increased attention in regard to cardiovascular diseases. We evaluated sleep conditions, cardiac autonomic function, and carotid atherosclerosis in subjects who participated in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) Study.
Methods:
This cross-sectional study included 330 serial patients registered in the HSCAA study who were free from past cardiovascular diseases, and prescribing α- or β-blockers. In addition to clinical background and classical cardiovascular risk factors, sleep efficiency, apnea hypopnea index (AHI), awake physical activity, heart rate variability (HRV), carotid intima-media thickness (IMT), presence of plaque and plaque score were determined.
Results:
Sleep efficiency (r = -0.183) and all HRV parameters (SDNN: r = -0.202; rMSSD: r = -0.234; pNN50: r = -0.277) were significantly (p < 0.01) and negatively associated with IMT, while AHI (r = 0.220, p < 0.001) was positively associated with IMT. Similarly, sleep efficiency (r = -0.129), HRV parameters (SDNN: r = -0.170; rMSSD: r = -0.217; pNN50: r = -0.260) and AHI (r = 0.184) were also significantly (p < 0.05) associated with plaque scores. Multivariate logistic regression analyses showed that rMSSD, but not sleep efficiency or AHI, was significantly associated with carotid plaque (OR 0.74, 95% CI 0.56-0.98, p = 0.037), independent of classical risk factors. The association of rMSSD with carotid plaque remained significant even after adjustment for sleep efficiency or AHI. A comparison of risk factors in specific subgroups showed that the association of lower HRV with carotid plaque was more prominent in patients with cardiovascular risk factors including male gender, hypertension, dyslipidemia and diabetes mellitus.
Conclusion:
Cardiac autonomic nervous dysfunction was independently associated with carotid atherosclerosis, independent of sleep condition. Moreover, that association was more prominent in specific subgroups with cardiovascular risk factors.
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