Xu Yahui, Sun Lina, Li Linwei, Akpa Bimaje, Zhang Yahui, Xu Dexiang
Department of Respiratory and Critical Care Medicine II, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, China.
Division of Pulmonary, Critical Care & Sleep Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
J Thorac Dis. 2025 Jun 30;17(6):4210-4218. doi: 10.21037/jtd-2025-985. Epub 2025 Jun 26.
Human sleep is characterized by alternating cycles of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, with cardiovascular regulation differing across sleep stages. Sleep deprivation (SD) is prevalent in modern societies and can be associated with worsened cardiovascular outcomes. Previous research on SD has primarily focused on epidemiological concerns and the effects of total SD, while clinical data on the hemodynamic impact of selective SD during different sleep stages remain scarce. This study aimed to investigate the hemodynamic alterations in healthy volunteers undergoing acute selective SD of either REM or slow-wave sleep (SWS) under polysomnography guidance. Additionally, the cardiovascular stability of healthy individuals under selective SD and its potential correlation with cardiovascular diseases were examined.
A total of 30 healthy volunteers (male:female ratio =1:1; age 26.27±4.479 years) were enrolled in this study. Each participant underwent a 3-day experimental protocol: the first night involved normal sleep, the second night selective SD (either SWS or REM), and the third night recovery sleep. After an initial night of normal sleep, participants were randomly assigned to either the REMSD group (n=15) or the SWSSD group (n=15). During the SD night, participants were repeatedly awakened during REM or SWS sleep, with a total of three full-night deprivations. Hemodynamic parameters were recorded synchronously during SD interventions, with measurements taken 5 minutes before and after the first SD event, as well as before sleep onset and upon awakening. The hemodynamic parameters assessed included heart rate (), stroke volume index, cardiac index, cardiac power index, total peripheral resistance index, systolic blood pressure, and diastolic blood pressure.
In the SWSSD group, after SD, the heart rate significantly increased, while stroke volume index decreased (t=-4.37 to 2.21; P<0.05), whereas cardiac index, cardiac power index, and total peripheral resistance index showed no significant changes (P>0.05). In the REMSD group, heart rate, cardiac index, and cardiac power index increased, while total peripheral resistance index decreased (t=-5.91 to 2.39; P<0.05), with no significant changes in stroke volume index (P>0.05). Additionally, both groups had a significantly higher post deprivation DBP than a pre-SD diastolic blood pressure (t=-2.660; P<0.05).
Healthy individuals demonstrated resilience to minor hemodynamic fluctuations. However, abrupt awakening from SWS could elevate the risk of cardiovascular events. Since REM sleep is associated with heightened sympathetic nervous system activity as compared to NREM sleep, selective REMSD may exacerbate cardiovascular physiological vulnerability during SD.
Chinese Clinical Trial Registry identifier: ChiCTR1900020622.
人类睡眠的特征是快速眼动（REM）睡眠和非快速眼动（NREM）睡眠交替循环，心血管调节在不同睡眠阶段有所不同。睡眠剥夺（SD）在现代社会中很普遍，并且可能与心血管疾病恶化有关。先前关于睡眠剥夺的研究主要集中在流行病学问题和全睡眠剥夺的影响上，而关于不同睡眠阶段选择性睡眠剥夺的血流动力学影响的临床数据仍然很少。本研究旨在调查在多导睡眠图指导下，经历快速眼动或慢波睡眠（SWS）急性选择性睡眠剥夺的健康志愿者的血流动力学改变。此外，还研究了选择性睡眠剥夺下健康个体的心血管稳定性及其与心血管疾病的潜在相关性。
本研究共纳入30名健康志愿者（男女比例 =1:1；年龄26.27±4.479岁）。每位参与者接受为期3天的实验方案：第一个晚上为正常睡眠，第二个晚上为选择性睡眠剥夺（慢波睡眠或快速眼动睡眠），第三个晚上为恢复性睡眠。在正常睡眠的初始夜晚之后，参与者被随机分配到快速眼动睡眠剥夺组（n = 15）或慢波睡眠剥夺组（n = 15）。在睡眠剥夺的夜晚，参与者在快速眼动或慢波睡眠期间被反复唤醒，总共进行三个整夜的剥夺。在睡眠剥夺干预期间同步记录血流动力学参数，在第一次睡眠剥夺事件前5分钟和后、睡眠开始前和醒来时进行测量。评估的血流动力学参数包括心率、每搏量指数、心脏指数、心脏功率指数、总外周阻力指数、收缩压和舒张压。
在慢波睡眠剥夺组中，睡眠剥夺后心率显著增加，而每搏量指数下降（t = -4.37至2.21；P < 0.05），而心脏指数、心脏功率指数和总外周阻力指数无显著变化（P > 0.05）。在快速眼动睡眠剥夺组中，心率、心脏指数和心脏功率指数增加，而总外周阻力指数下降（t = -5.91至2.39；P < 0.05），每搏量指数无显著变化（P > 0.05）。此外，两组睡眠剥夺后的舒张压均显著高于睡眠剥夺前的舒张压（t = -2.660；P < 0.05）。
健康个体对轻微的血流动力学波动具有弹性。然而，从慢波睡眠中突然醒来可能会增加心血管事件的风险。由于与非快速眼动睡眠相比，快速眼动睡眠与交感神经系统活动增强有关，选择性快速眼动睡眠剥夺可能会加剧睡眠剥夺期间的心血管生理易损性。
中国临床试验注册标识符：ChiCTR1900020622。
