Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Polysomnography
2.3. Heart Rate Variability
2.4. Questionnaires
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
OSA | Obstructive sleep apnea |
HRV | Heart rate variability |
PSG | Polysomnography |
REM | Rapid eye movement |
AHI | Apnea–hypopnea index |
LF | Low-frequency band power |
HF | High-frequency band power |
VLF | Very low-frequency band power |
TP | Total power spectrum |
BDI-II | Beck Depression Inventory II |
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Depressed OSA (n = 695) | Nondepressed OSA (n = 1018) | p-Value | |
---|---|---|---|
Baseline characteristics | |||
Male, n (%) | 456 (65.6%) | 822 (80.7%) | <0.001 |
Age (years) | 51.3 ± 14.0 | 49.6 ± 13.1 | 0.012 |
BMI (kg/m2) | 27.8 ± 5.0 | 27.7 ± 4.3 | 0.842 |
Hypertension, n (%) | 326 (46.9%) | 498 (48.9%) | 0.413 |
Diabetes mellitus, n (%) | 109 (15.7%) | 149 (14.6%) | 0.552 |
Smoking, n (%) | 171 (24.6%) | 87 (8.5%) | <0.001 |
Neck circumference | 38.2 ± 4.0 | 39.1 ± 3.6 | <0.001 |
Epworth sleepiness scale | 8.4 ± 4.9 | 7.2 ± 4.1 | <0.001 |
Insomnia severity index | 15.3 ± 6.3 | 10.1 ± 6.0 | <0.001 |
Beck Depression Inventory-II | 21.8 ± 6.5 | 7.1 ± 3.8 | <0.001 |
PSQI | 10.2 ± 4.2 | 7.0 ± 3.6 | <0.001 |
PSG parameters | |||
Total sleep time (min) | 335.6 ± 63.7 | 347.9 ± 50.8 | <0.001 |
Sleep efficiency (%) | 80.5 ± 15.2 | 84.1 ± 12.2 | <0.001 |
WASO (min) | 65.7 ± 55.8 | 54.3 ± 46.0 | <0.001 |
N1 (min) | 111.9 ± 53.1 | 115.7 ± 49.3 | 0.128 |
N2 (min) | 126.5 ± 53.9 | 131.1 ± 48.7 | 0.069 |
N3 (min) | 13.1 ± 22.0 | 13.1 ± 22.7 | 0.994 |
REM (min) | 84.2 ± 37.3 | 88.1 ± 32.1 | 0.026 |
Apnea–hypopnea index | 28.5 ± 23.6 | 30.1 ± 23.0 | 0.162 |
Arousal index | 45.6 ± 22.5 | 45.4 ± 21.6 | 0.880 |
LF (ms2) | 10,744.7 ± 7171.2 | 11,746.4 ± 7725.7 | 0.007 |
HF (ms2) | 5238.2 ± 2908.8 | 5576.3 ± 3028.9 | 0.021 |
VLF (ms2) | 16,746.6 ± 11,169.2 | 18,218.3 ± 12,551.1 | 0.011 |
TP (ms2) | 33,557.8 ± 18,391.2 | 36,420.7 ± 20,139.7 | 0.003 |
LF/HF | 2.5 ± 2.5 | 2.8 ± 8.6 | 0.347 |
Variables | ln LF | ln HF | ln VLF | ln TP | ln LF/HF |
---|---|---|---|---|---|
Age | −0.46 *** (−0.56, −0.36) | −0.61 *** (−0.71, −0.52) | −0.15 * (−0.26, −0.04) | −0.31 *** (−0.39, −0.22) | 0.16 ** (0.05, 0.26) |
Male sex | 0.50 *** (0.43, 0.57) | 0.12 *** (0.05, 0.19) | 0.38 *** (0.30, 0.46) | 0.37 *** (0.31, 0.43) | 0.38 *** (0.31, 0.45) |
BMI | 0.26 * (0.06, 0.46) | 0.46 *** (0.23, 0.68) | 0.32 *** (0.15, 0.49) | 0.30 ** (0.10, 0.50) | |
Hypertension | −0.15 *** (−0.20, −0.09) | 0.06 (−0.01, 0.13) | 0.00 (−0.05, 0.05) | 0.09 ** (0.03, 0.15) | |
Diabetes mellitus | −0.24 *** (−0.33, −0.15) | −0.29 *** (−0.37, −0.20) | −0.16 ** (−0.25, −0.06) | −0.19 *** (−0.26, −0.11) | |
AHI | 0.14 *** (0.10, 0.18) | −0.09 *** (−0.13, −0.05) | 0.17 *** (0.12, 0.21) | 0.12 *** (0.08, 0.15) | 0.23 *** (0.19, 0.27) |
Arousal index | 0.003 *** (0.002, 0.005) | −0.005 *** (−0.006, −0.003) | 0.002 ** (0.001, 0.004) | 0.001 * (0.000, 0.003) | 0.008 *** (0.006, 0.009) |
BDI-II | −0.008 *** (−0.012, −0.005) | −0.005 ** (−0.008, −0.001) | −0.006 ** (−0.010, −0.002) | −0.006 *** (−0.009, −0.003) | |
PSQI |
Variables | ln LF | ln HF | ln VLF | ln TP | ln LF/HF |
---|---|---|---|---|---|
Age | −0.274 *** (−0.383, −0.166) | −0.587 *** (−0.689, −0.486) | 0.023 (−0.102, 0.147) | −0.162 *** (−0.254, −0.069) | 0.313 *** (0.205, 0.420) |
Male sex | 0.382 *** (0.307, 0.457) | 0.010 (−0.061, 0.080) | 0.321 *** (0.234, 0.407) | 0.280 *** (0.216, 0.344) | 0.372 *** (0.298, 0.447) |
BMI | −0.054 (−0.279, 0.170) | −0.065 (−0.276, 0.145) | 0.237 (−0.021, 0.495) | 0.094 (−0.097, 0.286) | 0.011 (−0.212, 0.234) |
Hypertension | −0.024 (−0.090, 0.041) | −0.011 (−0.072, 0.050) | 0.030 (−0.046, 0.105) | 0.011 (−0.045, 0.067) | −0.013 (−0.078, 0.052) |
Diabetes mellitus | −0.183 *** (−0.269, −0.097) | −0.192 *** (−0.273, −0.111) | −0.176 *** (−0.276, −0.077) | −0.166 *** (−0.240, −0.092) | 0.009 (−0.077, 0.095) |
AHI | 0.106 *** (0.051, 0.160) | 0.007 (−0.044, 0.058) | 0.145 *** (0.082, 0.208) | 0.110 *** (0.063, 0.156) | 0.099 *** (0.044, 0.153) |
Arousal index | 0.000 (−0.002, 0.002) | −0.005 *** (−0.006, 0.003) | −0.002 * (−0.004, 0.000) | −0.002 * (−0.003, 0.000) | 0.005 *** (0.003, 0.006) |
BDI-II | −0.005 * (−0.008, −0.001) | −0.004 * (−0.007, 0.000) | −0.003 (−0.008, 0.001) | −0.004 * (−0.007, −0.001) | −0.001 (−0.004, 0.003) |
PSQI | 0.096 ** (0.026, 0.167) | 0.040 (−0.026, 0.106) | 0.125 ** (0.044, 0.206) | 0.083 ** (0.022, 0.143) | 0.056 (−0.013, 0.126) |
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Shin, J.H.; Song, M.J.; Kim, J.H. Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea. J. Clin. Med. 2025, 14, 6978. https://doi.org/10.3390/jcm14196978
Shin JH, Song MJ, Kim JH. Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea. Journal of Clinical Medicine. 2025; 14(19):6978. https://doi.org/10.3390/jcm14196978
Chicago/Turabian StyleShin, Ji Hye, Min Ji Song, and Ji Hyun Kim. 2025. "Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea" Journal of Clinical Medicine 14, no. 19: 6978. https://doi.org/10.3390/jcm14196978
APA StyleShin, J. H., Song, M. J., & Kim, J. H. (2025). Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea. Journal of Clinical Medicine, 14(19), 6978. https://doi.org/10.3390/jcm14196978