Heart rate and heart rate variability in subjectively reported insomnia

According to epidemiological studies, insomnia is associated with cardiovascular mortality. However, it is yet to be determined whether this link is mediated by known cardiovascular risk factors. The current study aimed at investigating the association between primary insomnia, defined as subjectively reported sleep disturbance in the absence of any other pathology or substance intake, and alterations in polysomnographically determined nocturnal heart rate (HR) and heart rate variability (HRV). A total of 4 581 nocturnal short‐term electrocardiographic recordings (5 min each) from 104 participants (58 with primary insomnia, 46 healthy controls) were evaluated for HR as well as for time and frequency domain measures of HRV. In the primary insomnia group, we found a lower wake‐to‐sleep HR reduction and a lower standard deviation of RR intervals (SDNN) compared to healthy controls. However, between‐group differences in resting HR were not found, and previous results of an increase in sympathovagal balance and a decrease in parasympathetic nocturnal activity in objectively determined insomnia could not be confirmed in our sample of self‐report insomnia patients. When restricting our analyses to insomnia patients with objectively determined short sleep duration, we found reduced parasympathetic activity as indicated by decreased high frequency power of HRV, as well as decreased root mean square of successive RRI differences (RMSSD) and percentage of successive RRIs that differ by more than 50 ms (pNN50) values. A lower wake‐to‐sleep HR reduction and alterations in HRV variables might, at least partially, mediate the increased rates of cardiovascular morbidity and mortality observed in insomnia patients.

[1]  John Trinder,et al.  On the nature of cardiovascular activation at an arousal from sleep. , 2003, Sleep.

[2]  John Trinder,et al.  Sleep and circadian influences on cardiac autonomic nervous system activity. , 1997, American journal of physiology. Heart and circulatory physiology.

[3]  Paul Linkowski,et al.  Effects of Aging and Cardiac Denervation on Heart Rate Variability During Sleep , 2001, Circulation.

[4]  Duanping Liao,et al.  Insomnia with objective short sleep duration is associated with a high risk for hypertension. , 2009, Sleep.

[5]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[6]  T. Wehr,et al.  Serotonin 1A receptors, melatonin, and the proportional control thermostat in patients with winter depression. , 1998, Archives of general psychiatry.

[7]  C. Espie,et al.  The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review. , 2006, Sleep medicine reviews.

[8]  H. V. Van Dongen,et al.  Physiologic indexes in chronic insomnia during a constant routine: evidence for general hyperarousal? , 2005, Sleep.

[9]  D. Kripke,et al.  Mortality associated with sleep duration and insomnia. , 2002, Archives of general psychiatry.

[10]  T. Roth,et al.  Heart rate changes in chronic insomnia , 1994 .

[11]  J. Montplaisir,et al.  Nighttime blood pressure in normotensive subjects with chronic insomnia: implications for cardiovascular risk. , 2009, Sleep.

[12]  Cheryl C. H. Yang,et al.  Asymmetry in sympathetic and vagal activities during sleep-wake transitions. , 2008, Sleep.

[13]  S. Haynes,et al.  The effects of presleep stress on sleep-onset insomnia. , 1981, Journal of abnormal psychology.

[14]  Ulrich Voderholzer,et al.  Primary insomnia: a risk factor to develop depression? , 2003, Journal of affective disorders.

[15]  Steven B. Heymsfield,et al.  Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey , 2006, Hypertension.

[16]  H. Stanley,et al.  Endogenous circadian rhythm in human motor activity uncoupled from circadian influences on cardiac dynamics , 2007, Proceedings of the National Academy of Sciences.

[17]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[18]  B. Feige,et al.  The hyperarousal model of insomnia: a review of the concept and its evidence. , 2010, Sleep medicine reviews.

[19]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[20]  Jan H. Houtveen,et al.  Circadian variation in base rate measures of cardiac autonomic activity , 2004, European Journal of Applied Physiology.

[21]  S. Cole,et al.  Insomnia and heart disease: a review of epidemiologic studies. , 1999, Journal of psychosomatic research.

[22]  P. Tsai,et al.  Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results. , 2008, Journal of psychosomatic research.

[23]  Anna Blasi,et al.  Cardiovascular variability after arousal from sleep: time-varying spectral analysis. , 2003, Journal of applied physiology.

[24]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[25]  Ian G. Harnik.  Heart-rate profile during exercise as a predictor of sudden death. , 2005, The New England journal of medicine.

[26]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[27]  S. Sidney,et al.  Short sleep duration and incident coronary artery calcification. , 2008, JAMA.

[28]  Katsumi Yoshida,et al.  Persistent Insomnia is a Predictor of Hypertension in Japanese Male Workers , 2003, Journal of occupational health.

[29]  D. Levy,et al.  Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. , 1996, Circulation.

[30]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[31]  M H Bonnet,et al.  Heart Rate Variability in Insomniacs and Matched Normal Sleepers , 1998, Psychosomatic medicine.

[32]  Frederic Roche,et al.  Cardiac variability and heart-rate increment as a marker of sleep fragmentation in patients with a sleep disorder: a preliminary study. , 2007, Sleep.

[33]  D. Mannino,et al.  Does insomnia kill? , 2005, Sleep.

[34]  M. Irwin,et al.  Sex differences in cardiac sympathovagal balance and vagal tone during nocturnal sleep. , 2008, Sleep medicine.

[35]  R. Freedman,et al.  Physiological and psychological factors in sleep-onset insomnia. , 1982, Journal of abnormal psychology.

[36]  B. Feige,et al.  Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients , 2008, Journal of sleep research.

[37]  A. Jordan,et al.  Cardiac changes during arousals from non-REM sleep in healthy volunteers. , 2007, American journal of physiology. Regulatory, integrative and comparative physiology.

[38]  D. Mannino,et al.  Do insomnia complaints cause hypertension or cardiovascular disease? , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[39]  R. Mcevoy,et al.  Noninvasive cardiovascular markers of acoustically induced arousal from non-rapid-eye-movement sleep. , 2002, Sleep.

[40]  D. Dawson,et al.  The relationship between slow-wave activity, body temperature, and cardiac activity during nighttime sleep. , 2001, Sleep.

[41]  P. van de Borne,et al.  The impact of chronic primary insomnia on the heart rate – EEG variability link , 2009, Clinical Neurophysiology.

[42]  Michael Bursztyn,et al.  Blunted heart rate dip during sleep and all-cause mortality. , 2007, Archives of internal medicine.

[43]  Jean-Claude Tardif,et al.  Resting heart rate in cardiovascular disease. , 2007, Journal of the American College of Cardiology.

[44]  F. Zitman,et al.  Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). , 2008, Archives of general psychiatry.

[45]  R. Bootzin,et al.  Psychophysiological insomnia: the behavioural model and a neurocognitive perspective , 1997, Journal of sleep research.

[46]  G. Berglund,et al.  Sleep disturbance in association with elevated pulse rate for prediction of mortality – consequences of mental strain? , 2001, Journal of internal medicine.

[47]  A. Folsom,et al.  Low Heart Rate Variability in a 2-Minute Rhythm Strip Predicts Risk of Coronary Heart Disease and Mortality From Several Causes: The ARIC Study , 2000, Circulation.

[48]  P. Enright,et al.  Insomnia did not predict incident hypertension in older adults in the cardiovascular health study. , 2009, Sleep.

[49]  E. Wolpert.  A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[50]  J. Goldberger,et al.  Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. , 2008, Journal of the American College of Cardiology.

[51]  J. Broman,et al.  Sleep complaints predict coronary artery disease mortality in males: a 12‐year follow‐up study of a middle‐aged Swedish population , 2002, Journal of internal medicine.

[52]  C. Guilleminault,et al.  EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. , 1992, Sleep.

[53]  L. J. Monroe.  Psychological and physiological differences between good and poor sleepers. , 1967, Journal of abnormal psychology.

[54]  K. Asayama,et al.  Predictive value of ambulatory heart rate in the Japanese general population: the Ohasama study , 2008, Journal of hypertension.