Nighttime instabilities of neurophysiological, cardiovascular, and respiratory activity: integrative modeling and preliminary results

Vladimir Shusterman; William C Troy; Medhat Abdelmessih; Stacy Hoffman; Jan Nemec; Patrick J Strollo; Barry London; Rachel Lampert

doi:10.1016/j.jelectrocard.2015.08.017

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Nighttime instabilities of neurophysiological, cardiovascular, and respiratory activity: integrative modeling and preliminary results

Journal article

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Nighttime instabilities of neurophysiological, cardiovascular, and respiratory activity: integrative modeling and preliminary results

Vladimir Shusterman, William C Troy, Medhat Abdelmessih, Stacy Hoffman, Jan Nemec, Patrick J Strollo, Barry London and Rachel Lampert

Journal of electrocardiology, Vol.48(6), pp.1010-1016

11/2015

DOI: 10.1016/j.jelectrocard.2015.08.017

PMCID: PMC4624504

PMID: 26341647

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Abstract

Unstable (cyclical alternating pattern, or CAP) sleep is associated with surges of sympathetic nervous system activity, increased blood pressure and vasoconstriction, heightened baroreflex sensitivity, and unstable heart rhythm and breathing. In susceptible persons, CAP sleep provokes clinically significant events, including hypertensive crises, sleep-disordered breathing, and cardiac arrhythmias. Here we explore the neurophysiology of CAP sleep and its impact on cardiovascular and respiratory functions. We show that: (i) an increase in neurophysiological recovery rate can explain the emergence of slow, self-sustained, hypersynchronized A1 CAP-sleep pattern and its transition to the faster A2-A3 CAP-sleep patterns; (ii) in a two-dimensional, continuous model of cardiac tissue with heterogeneous action potential duration (APD) distribution, heart rate accelerations during CAP sleep may encounter incompletely recovered electrical excitability in cell clusters with longer APD. If the interaction between short cycle length and incomplete, spatially heterogeneous repolarization persists over multiple cycles, irregularities and asymmetry of depolarization front may accumulate and ultimately lead to a conduction block, retrograde conduction, breakup of activation waves, reentrant activity, and arrhythmias; and (iii) these modeling results are consistent with the nighttime data obtained from patients with structural heart disease (N=13) that show clusters of atrial and ventricular premature beats occurring during the periods of unstable heart rhythm and respiration that accompany CAP sleep. In these patients, CAP sleep is also accompanied by delayed adaptation of QT intervals and T-wave alternans.

Sleep

Computational modeling

Baroreflex

Cardiac electrophysiology

Arrhythmias

Neurophysiology

Details

Title: Subtitle: Nighttime instabilities of neurophysiological, cardiovascular, and respiratory activity: integrative modeling and preliminary results
Creators: Vladimir Shusterman - University of Iowa, Iowa City, IA
William C Troy - University of Pittsburgh, Pittsburgh, PA
Medhat Abdelmessih - Yale University, New Haven, CT
Stacy Hoffman - PinMed, Inc., Pittsburgh, PA
Jan Nemec - University of Pittsburgh, Pittsburgh, PA
Patrick J Strollo - University of Pittsburgh, Pittsburgh, PA
Barry London - University of Iowa, Iowa City, IA
Rachel Lampert - Yale University, New Haven, CT
Resource Type: Journal article
Publication Details: Journal of electrocardiology, Vol.48(6), pp.1010-1016
DOI: 10.1016/j.jelectrocard.2015.08.017
PMID: 26341647
PMCID: PMC4624504
NLM abbreviation: J Electrocardiol
ISSN: 0022-0736
eISSN: 1532-8430
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000009, name: National Institutes of Health, award: NHLBI R43HL114277
Language: English
Date published: 11/2015
Academic Unit: Molecular Physiology and Biophysics; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984025375102771

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