Continuous positive airway pressure increases heart rate variability in congestive heart failure

Division of Cardiology, Toronto Hospital, Ontario, Canada.

OBJECTIVES. Our objective was to determine whether continuous positive airway pressure augments the low heart rate variability of congestive heart failure, a marker of poor prognosis. BACKGROUND. Nasal continuous positive airway pressure improves ventricular function in selected patients with heart failure. METHODS. In 21 sessions in 16 men (mean [+/- SE] age 56 +/- 2 years) with New York Heart Association functional class II to IV heart failure, we assessed the effects of 45 min with (n = 14) and without (as a time control, n = 7) nasal continuous positive airway pressure (10 cm of water) on heart rate variability and end-expiratory lung volume. Coarse-graining spectral analysis was used to derive total spectral power (PT), its nonharmonic component (fractal power [PF]) and the low (0.0 to 0.15 Hz [PL]) and high (0.15 to 0.50 Hz [PH]) frequency components of harmonic power. Standard deviation of the RR interval, high frequency power and the PH/PT ratio were used to estimate parasympathetic activity in the time and frequency domains, and the PL/PH ratio was used to estimate cardiac sympathetic activity in the frequency domain. RESULTS. Use of continuous positive airway pressure increased end-expiratory lung volume by 445 +/- 82 ml (p < 0.01) and both time (p < 0.006) and frequency domain indexes of heart rate variability: Total spectral power (p < 0.01), nonharmonic power (p < 0.023) and low (p < 0.04) and high (p < 0.05) frequency components of harmonic power all increased. Time alone had no effect on these variables. By comparison, the PH/PT ratio increased during nasal continuous positive airway pressure (p < 0.004), whereas the PL/PH ratio was unchanged. Breathing rate remained constant in both groups. CONCLUSIONS. Short-term application of nasal continuous positive airway pressure increases heart rate variability and time and frequency domain indexes of parasympathetic activity without influencing cardiac sympathetic activity. This increase may occur reflexively, through stimulation of pulmonary mechanoreceptor afferents.

This article has been cited by other articles:

				S. K. Frazier, D. K. Moser, R. Schlanger, J. Widener, L. Pender, and K. S. Stone Autonomic Tone in Medical Intensive Care Patients Receiving Mechanical Ventilation and During a CPAP Weaning Trial Biol Res Nurs, April 1, 2008; 9(4): 301 - 310. [Abstract] [PDF]

				K. Yoshinaga, I. G. Burwash, J. A. Leech, H. Haddad, C. B. Johnson, R. A. deKemp, L. Garrard, L. Chen, K. Williams, J. N. DaSilva, et al. The Effects of Continuous Positive Airway Pressure on Myocardial Energetics in Patients With Heart Failure and Obstructive Sleep Apnea J. Am. Coll. Cardiol., January 30, 2007; 49(4): 450 - 458. [Abstract] [Full Text] [PDF]

				M. R. Bonsignore, G. Parati, G. Insalaco, P. Castiglioni, O. Marrone, S. Romano, A. Salvaggio, G. Mancia, G. Bonsignore, and M. Di Rienzo Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP Eur. Respir. J., January 1, 2006; 27(1): 128 - 135. [Abstract] [Full Text] [PDF]

				J. A. Jo, A. Blasi, E. Valladares, R. Juarez, A. Baydur, and M. C. K. Khoo Determinants of heart rate variability in obstructive sleep apnea syndrome during wakefulness and sleep Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1103 - H1112. [Abstract] [Full Text] [PDF]

				T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part I: Obstructive Sleep Apnea Circulation, April 1, 2003; 107(12): 1671 - 1678. [Full Text] [PDF]

				J. A. Jo, A. Blasi, E. Valladares, R. Juarez, A. Baydur, and M. C. K. Khoo Model-based Assessment of Autonomic Control in Obstructive Sleep Apnea Syndrome during Sleep Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 128 - 136. [Abstract] [Full Text] [PDF]

				V. Belozeroff, R. B. Berry, C. S. H. Sassoon, and M. C. K. Khoo Effects of CPAP therapy on cardiovascular variability in obstructive sleep apnea: a closed-loop analysis Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H110 - H121. [Abstract] [Full Text] [PDF]

				A. T. Yan, T. D. Bradley, and P. P. Liu The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure Chest, November 1, 2001; 120(5): 1675 - 1685. [Abstract] [Full Text] [PDF]

				Y. Goso, H. Asanoi, H. Ishise, T. Kameyama, T. Hirai, T. Nozawa, S. Takashima, K. Umeno, and H. Inoue Respiratory Modulation of Muscle Sympathetic Nerve Activity in Patients With Chronic Heart Failure Circulation, July 24, 2001; 104(4): 418 - 423. [Abstract] [Full Text] [PDF]

				S Heindl, C Dodt, M Krahwinkel, G Hasenfuss, and S Andreas Short term effect of continuous positive airway pressure on muscle sympathetic nerve activity in patients with chronic heart failure Heart, February 1, 2001; 85(2): 185 - 190. [Abstract] [Full Text]

				S. K. Frazier, D. K. Moser, and K. S. Stone Heart Rate Variability and Hemodynamic Alterations in Canines with Normal Cardiac Function during Exposure to Pressure Support, Continuous Positive Airway Pressure, and a Combination of Pressure Support and Continuous Positive Airway Pressure Biol Res Nurs, January 1, 2001; 2(3): 167 - 174. [Abstract] [PDF]

				C. F. Notarius and J. S. Floras Limitations of the use of spectral analysis of heart rate variability for the estimation of cardiac sympathetic activity in heart failure Europace, January 1, 2001; 3(1): 29 - 38. [Abstract] [PDF]

				D. D. Sin, A. G. Logan, F. S. Fitzgerald, P. P. Liu, and T. D. Bradley Effects of Continuous Positive Airway Pressure on Cardiovascular Outcomes in Heart Failure Patients With and Without Cheyne-Stokes Respiration Circulation, July 4, 2000; 102(1): 61 - 66. [Abstract] [Full Text] [PDF]

				S. MEHTA, P. P. LIU, F. S. FITZGERALD, Y. K. ALLIDINA, and T. DOUGLAS BRADLEY Effects of Continuous Positive Airway Pressure on Cardiac Volumes in Patients with Ischemic and Dilated Cardiomyopathy Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 128 - 134. [Abstract] [Full Text]

				R. Tkacova, F. Rankin, F. S. Fitzgerald, J. S. Floras, and T. D. Bradley Effects of Continuous Positive Airway Pressure on Obstructive Sleep Apnea and Left Ventricular Afterload in Patients With Heart Failure Circulation, November 24, 1998; 98(21): 2269 - 2275. [Abstract] [Full Text] [PDF]