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Heart rate variability analysis in comorbid insomnia and sleep apnea (COMISA)
Adrián Martín-Montero1,2, Fernando Vaquerizo-Villar1,2, Clara García-Vicente3,4
1Biomedical Engineering Group, University of Valladolid, Av. Ramón y Cajal, 7, Valladolid, 47003, Spain.
Scientific Reports
|May 21, 2025
Summary
Comorbid insomnia and sleep apnea (COMISA) causes unique overnight autonomic nervous system (ANS) dysfunction, with less parasympathetic activity during wakefulness and more sympathetic activity during sleep. This differs from isolated insomnia or obstructive sleep apnea (OSA).
Area of Science:
- Cardiology
- Sleep Medicine
- Neuroscience
Background:
- Obstructive sleep apnea (OSA) and insomnia are common sleep disorders.
- Comorbid insomnia and sleep apnea (COMISA) describes their co-occurrence.
- Autonomic nervous system (ANS) dysfunction is linked to OSA and insomnia individually, but COMISA's specific impact is unknown.
Purpose of the Study:
- To characterize nocturnal ANS alterations in COMISA using heart rate variability (HRV) analysis.
- To differentiate COMISA-related ANS changes from those in isolated insomnia or OSA.
Main Methods:
- Analysis of 5,335 electrocardiograms from the Sleep Heart Health Study (SHHS) dataset.
- Participants categorized into No-OSA, Insomnia, OSA, or COMISA groups based on polysomnography and questionnaires.
- Time and frequency domain HRV features computed for wakefulness and sleep periods.
Main Results:
- COMISA exhibits reduced parasympathetic activity during wakefulness and heightened sympathetic activation during sleep.
- Recurrent apneic events in OSA and COMISA affect HRV frequency features.
- Insomnia uniquely alters mean heart rate during sleep, distinguishing it from OSA.
Conclusions:
- COMISA induces specific nocturnal ANS dysfunction.
- Further HRV research is needed to understand COMISA's cardiovascular implications.
- Targeted interventions for COMISA may improve ANS regulation and cardiovascular health.
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