Cardiac autonomic control in Brugada syndrome patients during sleep: The effects of sleep disordered breathing

Eleonora Tobaldini, Josep Brugada, Begona Benito, Irma Molina, Josep Montserrat, Tomas Kara, Pavel Leinveber, Alberto Porta, Paula G. Macedo, Nicola Montano, Virend Somers

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and is also associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. Methods We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n = 9), without SDB (BRU, n = 9), in controls (CON, n = 8) and in non-Brugada patients with SDB (n = 6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. Results Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. Conclusion Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.

Original languageEnglish (US)
Pages (from-to)3267-3272
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number4
DOIs
StatePublished - Oct 9 2013

Fingerprint

Brugada Syndrome
Sleep Apnea Syndromes
Sleep
Sudden Cardiac Death
Wakefulness
Entropy
Comorbidity
Cardiac Arrhythmias
Heart Rate
Sleep Stages
Apnea
Tachycardia
Electrocardiography

Keywords

  • Autonomic nervous system
  • Brugada syndrome
  • Heart rate variability
  • Non-linear analysis
  • Sleep
  • Sleep disordered breathing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac autonomic control in Brugada syndrome patients during sleep : The effects of sleep disordered breathing. / Tobaldini, Eleonora; Brugada, Josep; Benito, Begona; Molina, Irma; Montserrat, Josep; Kara, Tomas; Leinveber, Pavel; Porta, Alberto; Macedo, Paula G.; Montano, Nicola; Somers, Virend.

In: International Journal of Cardiology, Vol. 168, No. 4, 09.10.2013, p. 3267-3272.

Research output: Contribution to journalArticle

Tobaldini, E, Brugada, J, Benito, B, Molina, I, Montserrat, J, Kara, T, Leinveber, P, Porta, A, Macedo, PG, Montano, N & Somers, V 2013, 'Cardiac autonomic control in Brugada syndrome patients during sleep: The effects of sleep disordered breathing', International Journal of Cardiology, vol. 168, no. 4, pp. 3267-3272. https://doi.org/10.1016/j.ijcard.2013.04.137
Tobaldini, Eleonora ; Brugada, Josep ; Benito, Begona ; Molina, Irma ; Montserrat, Josep ; Kara, Tomas ; Leinveber, Pavel ; Porta, Alberto ; Macedo, Paula G. ; Montano, Nicola ; Somers, Virend. / Cardiac autonomic control in Brugada syndrome patients during sleep : The effects of sleep disordered breathing. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 4. pp. 3267-3272.
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abstract = "Aims Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and is also associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. Methods We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n = 9), without SDB (BRU, n = 9), in controls (CON, n = 8) and in non-Brugada patients with SDB (n = 6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. Results Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. Conclusion Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.",
keywords = "Autonomic nervous system, Brugada syndrome, Heart rate variability, Non-linear analysis, Sleep, Sleep disordered breathing",
author = "Eleonora Tobaldini and Josep Brugada and Begona Benito and Irma Molina and Josep Montserrat and Tomas Kara and Pavel Leinveber and Alberto Porta and Macedo, {Paula G.} and Nicola Montano and Virend Somers",
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T1 - Cardiac autonomic control in Brugada syndrome patients during sleep

T2 - The effects of sleep disordered breathing

AU - Tobaldini, Eleonora

AU - Brugada, Josep

AU - Benito, Begona

AU - Molina, Irma

AU - Montserrat, Josep

AU - Kara, Tomas

AU - Leinveber, Pavel

AU - Porta, Alberto

AU - Macedo, Paula G.

AU - Montano, Nicola

AU - Somers, Virend

PY - 2013/10/9

Y1 - 2013/10/9

N2 - Aims Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and is also associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. Methods We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n = 9), without SDB (BRU, n = 9), in controls (CON, n = 8) and in non-Brugada patients with SDB (n = 6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. Results Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. Conclusion Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.

AB - Aims Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and is also associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. Methods We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n = 9), without SDB (BRU, n = 9), in controls (CON, n = 8) and in non-Brugada patients with SDB (n = 6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. Results Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. Conclusion Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.

KW - Autonomic nervous system

KW - Brugada syndrome

KW - Heart rate variability

KW - Non-linear analysis

KW - Sleep

KW - Sleep disordered breathing

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