Heart rate turbulence in obstructive sleep apnea syndrome: The effect of short-term CPAP therapy

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Patients affected by obstructive sleep apnea (OSA) present an increased risk of cardiovascular (CV) events [1]. This is likely due to the imbalance in the autonomic nervous system, with cardiac sympathetic hyperactivity and reduced baro-reflex sensitivity [2]. Cardiac autonomic activity is usually measured non-invasively by means of the heart rate variability (HRV), which is an important nega-tive prognostic factor, being strongly associated with increased risk of total and CV mortality [3]. HRV assessment in patients with sleep disordered breathing (SDB) has been debated because these patients often exhibit breathing pattern alterations and cardiac arrhythmias - including ventricular premature beat (VPB) - all of which are able to interfere with the rhythmical os-cillations of HRV [4]. The heart rate turbulence (HRT) has been suggested as another non- invasive tool to assess the level of autonomic traffic to the heart [5] and is a powerful predictor of mortality. HRT expresses the short-time variability of the sinus node induced by a VPB, resulting from a baroreflex-mediated biphasic reaction of the sinus node (early acceler-ation and late deceleration of heart rate) in response to the lower stroke volume following a VPB. Two numeric parameters are descriptors of HRT: turbulence onset (TO) and turbulence slope (TS) [6]. TO reflects the acceleration phase, while TS the deceleration phase of heart beat after a VPB. It has been reported that HRT is altered in OSA patients and, importantly, the degree of the disorder in the autonomic system is related to the severity of the disease, as expressed by apnea-hypopnea index (AHI)
Original languageEnglish
Pages (from-to)111-114
Number of pages4
JournalEuropean Journal of Internal Medicine
Publication statusPublished - Apr 2021


  • Continuous Positive Airway Pressure
  • Heart Rate
  • Humans
  • Sleep Apnea, Obstructive/therapy


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