Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke.

Tobaldini, Eleonora; Proserpio, Paola; Oppo, Valentina; Figorilli, Michela; Fiorelli, Elisa M; Manconi, Mauro; Agostoni, Elio C; Nobili, Lino; Montano, Nicola; Horvath, Thomas; Bassetti, Claudio L. (2020). Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke. Journal of sleep research, 29(3), e12878. Wiley-Blackwell 10.1111/jsr.12878

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Ischaemic stroke is accompanied by important alterations of cardiac autonomic control, which have an impact on stroke outcome. In sleep, cardiac autonomic control oscillates with a predominant sympathetic modulation during REM sleep. We aimed to assess cardiac autonomic control in different sleep stages in patients with ischaemic stroke. Forty-five patients enrolled in the prospective, multicentre SAS-CARE study but without significant sleep-disordered breathing (apnea-hypopnea index < 15/hr) and without atrial fibrillation were included in this analysis. The mean age was 56 years, 68% were male, 76% had a stroke (n = 34, mean National Institutes of Health Stroke Scale [NIHSS] score of 5, 11 involving the insula) and 24% (n = 11) had a transitory ischaemic attack. Cardiac autonomic control was evaluated using three different tools (spectral, symbolic and entropy analysis) according to sleep stages on short segments of 250 beats in all patients. Polysomnographic studies were performed within 7 days and 3 months after the ischaemic event. No significant differences in cardiac autonomic control between sleep stages were observed in the acute phase and after 3 months. Predominant vagal modulation and decreased sympathetic modulation were observed across all sleep stages in ischaemic stroke involving the insula. Patients with ischaemic stroke and transitory ischaemic attack present a loss of cardiac autonomic dynamics during sleep in the first 3 months after the ischaemic event. This change could represent an adaptive phenomenon, protecting the cardiovascular system from the instabilities of autonomic control, or a risk factor for stroke, which precedes the ischaemic event.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Manconi, Mauro, Horvath, Thomas Nikolaus, Bassetti, Claudio L.A.


600 Technology > 610 Medicine & health








Chantal Kottler

Date Deposited:

14 Nov 2019 13:09

Last Modified:

02 Mar 2023 23:32

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

autonomic modulation brain ischaemia heart rate variability insula




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