Objective: To explore the differences in heart rate variability (HRV) across awake-sleep stages between patients with synucleinopathies and elderly controls without parkinsonism

Background: A complex interplay exists between the autonomic nervous system (ANS) and synucleinopathies. While many studies have examined HRV in synucleinopathies, few have assessed circadian variations of HRV in these patients

Method: Five-minute artifact-free electrocardiograms (ECGs), recorded as part of a polysomnography study during wakefulness, NREM, and REM, were selected for analysis. Both time and frequency HRV domains were analyzed using Python® software. Missing data were replaced with imputed values calculated by the multiple imputation method. Baseline characteristics and HRV values (overall, during wakefulness, NREM, and REM) were compared between groups. To assess the effect of patient condition (i.e., synucleinopathies vs. controls) on variations in significant HRV values, quantile regression was employed

Results: Sixty patients were included in the analysis: 25 with synucleinopathies (13 with idiopathic Parkinson’s disease [PD], 10 with multiple system atrophy [MSA], and 2 with dementia with Lewy bodies [DLB]) and 35 elderly controls without parkinsonism. The corresponding mean ages were 67.40 (SD 7.87) years for the patient group and 63.14 (SD 10.37) years for the control group (p = 0.090). A higher prevalence of male participants and REM sleep behavioral disorder (RBD) was noted in the synucleinopathy group. Only the pNN50 value, both overall and during NREM, was significantly different between the groups. However, when adjusting for gender and RBD, the effect of the disease condition (synucleinopathies) remained significant only for the prediction of the pNN50 value during NREM

Conclusion: Our findings demonstrate circadian variations in HRV values in patients with synucleinopathies. A lower pNN50 value compared with controls was most pronounced during NREM, suggesting dysregulation of parasympathetic activity during sleep in these patients. This dysregulation may increase their risk of lethal cardiovascular events at night. Risk-modifying therapies aimed at improving nighttime HRV may be of great interest to help reduce these risks

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-cardiac-autonomic-dysfunction-in-synucleinopathies-with-parkinsonism-across-awake-sleep-stages/