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. 2021 Mar 1;17(3):461-469.
doi: 10.5664/jcsm.8934.

Association of heart rate variability with REM sleep without atonia in idiopathic REM sleep behavior disorder

Jeong Hun Yang  1 , Sang Ho Choi  2 , Mi Hyun Lee  3 , Seong Min Oh  4 , Jae-Won Choi  5 , Jee Eun Park  6 , Kwang Suk Park  7   8 , Yu Jin Lee  3
Affiliations

Association of heart rate variability with REM sleep without atonia in idiopathic REM sleep behavior disorder

Jeong Hun Yang et al. J Clin Sleep Med. .

Abstract

Study objectives: Idiopathic rapid eye movement sleep behavior disorder (iRBD), characterized by rapid eye movement sleep without atonia (RSWA) and dream-enactment behavior, has been suggested to be a predictor of α-synucleinopathies. Autonomic instability, represented by heart rate variability, is a common characteristic of both iRBD and α-synucleinopathies. Previous studies reported that RSWA was associated with autonomic dysfunction and was a possible predictor of phenoconversion. Therefore, we sought to compare heart rate variability between iRBD and control groups and explore the relationship between heart rate variability and RSWA in patients with iRBD.

Methods: Nocturnal polysomnographic data on 47 patients (28 men, 19 women) diagnosed with iRBD based on video-polysomnography and 26 age-matched and sex-matched controls were reviewed. The first 5-minute epoch with a stable electrocardiogram lead II on video-polysomnography was selected from stage N2, wake, and rapid eye movement. For quantification of RSWA, tonic activity was analyzed from the submentalis electromyogram and phasic activity from the submentalis and bilateral anterior tibialis electromyogram channels.

Results: Compared to the control group, the iRBD group showed significant reductions in the standard deviation of the R-R intervals, the root mean square of successive R-R interval differences, and high-frequency values. Quantified tonic activity was inversely correlated with normalized low-frequency values and low-frequency/high-frequency ratios and positively correlated with normalized high-frequency values.

Conclusions: This study implied decreased cardiac autonomic function in patients with iRBD, which showed parasympathetic predominance. Heart rate variability of the patients with iRBD in this study was associated with quantified tonic RSWA, which was previously reported to be a possible predictor of phenoconversion.

Keywords: REM sleep behavior disorder; autonomic nervous system; heart rate variability.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the Seoul National University Hospital, Seoul, Korea. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Box plots of HRV parameters across sleep stages in iRBD group and control group.
The values of the first and third quartiles are shown in boxes. Values showing a difference of more than 10 times the IQR from the average value are marked with * as outliers. HF = high frequency, HRV = heart rate variability, iRBD = idiopathic rapid eye movement sleep disorder, LF, low frequency, REM = rapid eye movement, RMSSD = root mean square difference of successive R-R intervals, SDNN = standard deviation of R-R intervals.
See this image and copyright information in PMC

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