Interdisciplinary Center of Sleep Medicine, Charité -Universitätsmedizin Berlin, Berlin, Germany.
Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
PLoS One. 2020 May 7;15(5):e0232589. doi: 10.1371/journal.pone.0232589. eCollection 2020.
Insomnia has been associated with increased cardiovascular (CV) risk, which may be linked to sympathetic activation. Non-invasive overnight pulse wave analysis may be a useful tool to detect early signs of autonomic changes during sleep in insomniacs. Fifty-two participants (26 men, 37±13 years, BMI: 24±5 kg/m2, 26 insomniacs/ 26 controls) underwent overnight polysomnography with pulse oximetry and pulse wave analysis including pulse rate, vascular stiffness (pulse propagation time, PPT), and a composite cardiac risk index based on autonomic function and overnight hypoxia. We identified two subgroups of insomniacs, with and without objectively disturbed sleep (sleep efficiency SE≤80%, n = 14 vs. SE>80%, n = 12), and observed increased pulse rate and vascular stiffness in insomnia cases when diagnosis was based on both, subjective and objective criteria. Both insomnia groups were associated with higher overnight pulse rate than controls (median/ IQR: low-SE (low sleep efficiency): 67/ 58-70bpm; high-SE: 66/ 63-69bpm; controls: 58/ 52-63bpm; p = 0.01). Vascular stiffness was higher (reduction of PPT) in low-SE insomniacs compared with high-SE insomniacs and controls (169/ 147-232ms; 237/ 215-254ms; 244/ 180-284ms; p = 0.01). The cardiac risk index was increased in low-SE insomniacs (0.2/ 0.0-0.7; 0.0/ 0.0-0.4; 0.0/ 0.0-0.3; p = 0.05). Our results suggest a hyperarousal state in young and otherwise healthy insomniacs during sleep. The increased pulse rate and vascular stiffness in insomniacs with low SE suggest early signs of rigid vessels and potentially, an elevated CV risk. Overnight pulse wave analysis may be feasible for CV risk assessment in insomniacs and may provide a useful tool for phenotyping insomnia in order to provide individualized therapy.
失眠与心血管（CV）风险增加有关，这可能与交感神经激活有关。非侵入性的夜间脉搏波分析可能是一种有用的工具，可以检测失眠患者睡眠期间自主变化的早期迹象。52 名参与者（26 名男性，37±13 岁，BMI：24±5kg/m2，26 名失眠症患者/26 名对照组）接受了夜间多导睡眠图检查，同时进行脉搏血氧测定和脉搏波分析，包括脉搏率、血管僵硬度（脉搏传播时间，PPT）以及基于自主功能和夜间缺氧的复合心脏风险指数。我们确定了两组失眠症患者，一组伴有和不伴有客观睡眠障碍（睡眠效率 SE≤80%，n=14 与 SE>80%，n=12），并观察到根据主观和客观标准诊断为失眠症时，脉搏率和血管僵硬度增加。两组失眠症患者的夜间脉搏率均高于对照组（中位数/ IQR：低 SE（低睡眠效率）：67/58-70bpm；高 SE：66/63-69bpm；对照组：58/52-63bpm；p=0.01）。与高 SE 失眠症患者和对照组相比，低 SE 失眠症患者的血管僵硬度更高（PPT 降低）（169/147-232ms；237/215-254ms；244/180-284ms；p=0.01）。低 SE 失眠症患者的心脏风险指数升高（0.2/0.0-0.7；0.0/0.0-0.4；0.0/0.0-0.3；p=0.05）。我们的结果表明，在睡眠期间，年轻且其他方面健康的失眠症患者处于过度唤醒状态。低 SE 失眠症患者的脉搏率和血管僵硬度增加表明血管僵硬的早期迹象，并可能存在升高的心血管风险。夜间脉搏波分析可能适用于失眠症患者的心血管风险评估，并可能为失眠症患者的表型分析提供有用的工具，以提供个体化治疗。
