A pilot study investigating the effects of continuous positive airway pressure treatment and weight-loss surgery on autonomic activity in obese obstructive sleep apnea patients

• Published in: Journal of electrocardiology 2014-05, Vol.47 (3), p.364-373
• Main Authors: Bakker, Jessie P., PhD, Campana, Lisa M., PhD, Montesi, Sydney B., MD, Balachandran, Jayshankar, MD, DeYoung, Pamela N., BS, Smales, Erik, BS, Patel, Sanjay R., MD, Malhotra, Atul, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Autonomic Nervous System - physiopathology; Bariatric Surgery; Cardiovascular; Combined Modality Therapy; Continuous Positive Airway Pressure; Electrocardiography - methods; Female; Heart Rate; Heart rate variability; Humans; Male; Middle Aged; Obesity; Obesity Hypoventilation Syndrome - diagnosis; Obesity Hypoventilation Syndrome - physiopathology; Obesity Hypoventilation Syndrome - therapy; Obstructive sleep apnea; Pilot Projects; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Weight-loss surgery; Young Adult
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2014.02.008

Abstract Background We have previously demonstrated that severity of obstructive sleep apnea (OSA) as measured by the apnea–hypopnea index (AHI) is a significant independent predictor of readily-computed time-domain metrics of short-term heart rate variability (HRV). Methods We aimed to assess time-domain HRV measured over 5-min while awake in a trial of obese subjects undergoing one of two OSA therapies: weight-loss surgery ( n = 12, 2 males, median and interquartile range (IQR) for BMI 43.7 [42.0, 51.4] kg/m2 , and AHI 18.1 [16.3, 67.5] events/h) or continuous positive airway pressure (CPAP) ( n = 15, 11 males, median BMI 33.8 [31.3, 37.9] kg/m2 , and AHI 36.5 [24.7, 77.3] events/h). Polysomnography was followed by electrocardiography during wakefulness; measurements were repeated at 6 and 12–18 months post-intervention. Results Despite similar measurements at baseline, subjects who underwent surgery exhibited greater improvement in short-term HRV than those who underwent CPAP ( p = 0.04). Conclusions Our data suggest a possible divergence in autonomic function between the effects of weight loss resulting from bariatric surgery, and the amelioration of obstructive respiratory events resulting from CPAP treatment. Randomized studies are necessary before clinical recommendations can be made.