Sympathetic overactivity based on heart-rate variability in patients with obstructive sleep apnea and cerebral small-vessel disease

Jangsup Moon, Kang Hyun Choi, Jung Hyun Park, Tae Jin Song, Yun Seo Choi, Ju Hee Kim, Hyeon Jin Kim, Hyang Woon Lee

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background and Purpose Obstructive sleep apnea (OSA) is associated with cerebral white-matter changes (WMC), but the underlying mechanisms are not completely understood. Our aim was to identify the cardiovascular autonomic characteristics during sleep that are associated with cerebral WMC in OSA patients. Methods We recruited subjects from our sleep-center database who underwent both polysomnography and brain MRI within a 1-year period. Sixty patients who had OSA with WMC (OSA+WMC), 44 patients who had OSA without WMC (OSA–WMC), and 31 control subjects who had neither OSA nor WMC were analyzed. Linear and nonlinear indices of heart-rate variability (HRV) were analyzed in each group according to different sleep stages and also over the entire sleeping period. Results Among the nonlinear HRV indices, the Poincaré ratio (SD12) during the entire sleep period was significantly increased in the OSA+WMC group, even after age adjustment. Meanwhile, detrended fluctuation analysis 1 during non-rapid-eye-movement sleep tended to be lowest in the OSA+WMC group. These indices were altered regardless of the presence of hypertension or diabetes. In the subgroup analysis of middle-aged OSA patients, approximate entropy during rapid-eye-movement sleep was significantly lower in OSA+WMC patients than in OSA– WMC patients. Overall, the nonlinear HRV indices suggest that sympathetic activity was higher in the OSA+WMC group than in the OSA–WMC and control groups. Conclusions Our findings suggest that dysregulation of HRV, especially overactivation of sympathetic tone, could be a pathophysiologic mechanism underlying the development of WMC in OSA patients.

Original languageEnglish
Pages (from-to)310-319
Number of pages10
JournalJournal of Clinical Neurology (Korea)
Issue number3
StatePublished - Jul 2018

Bibliographical note

Funding Information:
This study was supported by the RP-Grant 2015 (to J.M.) and RP-Grant 2014 (to K.H.C.) of Ewha Womans University, and by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2014-R1A2A1A11052103 and 2017-R1A2A2 A05069647) and Ministry of Education the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KH-IDI) funded by the Ministry of Health & Welfare (HI14C1989) (to H.W.L.).

Publisher Copyright:
© 2018 Korean Neurological Association.


  • Heart-rate variability
  • Nonlinear indices
  • Obstructive sleep apnea
  • Sympathetic overactivation
  • White-matter changes


Dive into the research topics of 'Sympathetic overactivity based on heart-rate variability in patients with obstructive sleep apnea and cerebral small-vessel disease'. Together they form a unique fingerprint.

Cite this