Heart rate response to cortical arousals in patients with isolated obstructive sleep apnea and with comorbid insomnia (COMISA)

Comorbid insomnia often occurs in patients with obstructive sleep apnea (OSA), referred to as COMISA. Cortical arousals manifest as a common feature in both OSA and insomnia, often accompanied by elevated heart rate (HR). Our objective was to evaluate the heart rate response to nocturnal cortical arousals in patients with COMISA and patients with OSA alone. We analyzed data from patients with COMISA and from patients with OSA matched for apnea-hypopnea index. Sleep staging and analysis of respiratory events and cortical arousals were performed using the Philips Somnolyzer automatic scoring system. Beat-by-beat HR was analyzed from the onset of the cortical arousal to 30 heartbeats afterwards. HR responses were divided into peak and recovery phases. Cortical arousals were separately evaluated according to subtype (related to respiratory events and spontaneous) and duration (3–6 s, 6–10 s, 10–15 s). A total of 72 patients with COMISA and 72 patients with OSA were included in this study. There were no overall group differences in the number of cortical arousals with and without autonomic activation. No significant differences were found for spontaneous cortical arousals. The OSA group had more cortical arousals related to respiratory events (21.0 [14.8–30.0] vs 16.0 [9.0–27.0], p = 0.016). However, the COMISA group had longer cortical arousals (7.2 [6.4–7.8] vs 6.7 [6.2–7.7] s, p = 0.024) and the HR recovery phase was prolonged (52.5 [30.8–82.5] vs 40.0 [21.8–55.5] beats/min, p = 0.017). Both the peak and the recovery phase for longer cortical arousals with a duration of 10–15 s were significantly higher in patients with COMISA compared to patients with OSA (47.0 [27.0–97.5] vs 34.0 [21.0–71.0] beats/min, p = 0.032 and 87.0 [47.0–132.0] vs 71.0 [43.0–103.5] beats/min, p = 0.049, respectively). The HR recovery phase after cortical arousals related to respiratory events is prolonged in patients with COMISA compared to patients with OSA alone. This response could be indicative of the insomnia component in COMISA.