Morales-Ghinaglia Natasha, He Fan, Calhoun Susan L, Vgontzas Alexandros N, Liao Jiangang, Liao Duanping, Bixler Edward O, Fernandez-Mendoza Julio
Geisinger Commonwealth School of Medicine, Department of Medical Education, Scranton, PA, USA.
Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University, College of Medicine, Hershey, PA, USA.
Sleep. 2025 Jul 11;48(7). doi: 10.1093/sleep/zsaf015.
Although heart rate variability (HRV), a marker of cardiac autonomic modulation (CAM), is known to predict cardiovascular morbidity, the circadian timing of sleep is also involved in autonomic modulation. We examined whether circadian misalignment is associated with blunted HRV in adolescents as a function of entrainment to school or on-breaks.
We evaluated 360 subjects from the Penn State Child Cohort (median 16 years) who had at least 3-night at-home actigraphy (ACT), in-lab 9-h polysomnography, and 24-h Holter-monitoring HRV data. ACT-measured metrics of circadian misalignment included sleep midpoint (SM), sleep irregularity (SI), and social jetlag (SJL). Five 24-h, daytime, and nighttime frequency- and time-domain HRV indices were the primary outcomes. Linear regression models adjusted for sex, race/ethnicity, age, body mass index, apnea/hypopnea index, sleep duration, and its variability. These associations were also examined as a function of being in-school or on-break.
While on-break, a later SM on weekends was significantly associated with all five nighttime HRV indices. While in-school, greater SI on weekdays was significantly associated with three daytime and three nighttime HRV indices. Greater SJL was not associated with any HRV index. Longitudinal analyses confirmed the association of adolescent SM, SI, and SJL with change in nighttime HRV since childhood.
An irregular sleep phase during days of entrainment to social demands and a delayed sleep phase during ad libitum days are associated with blunted HRV in adolescents. Circadian misalignment contributes to increased cardiovascular risk via an altered CAM in youth.
尽管心率变异性（HRV）作为心脏自主神经调节（CAM）的一个指标，已知可预测心血管疾病的发病率，但睡眠的昼夜节律时间也参与自主神经调节。我们研究了昼夜节律失调是否与青少年HRV减弱有关，这取决于他们对学校作息或休息时间的适应情况。
我们评估了宾夕法尼亚州立大学儿童队列中的360名受试者（中位年龄16岁），他们至少有3个晚上的家庭活动记录仪（ACT）数据、9小时的实验室多导睡眠图数据以及24小时动态心电图监测的HRV数据。ACT测量的昼夜节律失调指标包括睡眠中点（SM）、睡眠不规则性（SI）和社交时差（SJL）。五个24小时、白天和夜间的频率域和时域HRV指数是主要结果。线性回归模型对性别、种族/民族、年龄、体重指数、呼吸暂停/低通气指数、睡眠时间及其变异性进行了调整。这些关联还根据在校或休息情况进行了研究。
在休息期间，周末较晚的SM与所有五个夜间HRV指数显著相关。在上学期间，工作日较高的SI与三个白天和三个夜间HRV指数显著相关。较高的SJL与任何HRV指数均无关联。纵向分析证实了青少年的SM、SI和SJL与自童年以来夜间HRV变化之间的关联。
在适应社会需求的日子里睡眠阶段不规律，以及在自由活动日睡眠阶段延迟，与青少年HRV减弱有关。昼夜节律失调通过改变年轻人的CAM导致心血管风险增加。
