Sympathetic-Nerve Activity during Sleep in Normal Subjects

Background: The early hours of the morning after awakening are associated with an increased frequency of events such as myocardial infarction and ischemic stroke. The triggering mechanisms for these events are not clear. We investigated whether autonomic changes occurring during sleep, particularly rapid-eye-movement (REM) sleep, contribute to the initiation of such events. Methods: We measured blood pressure, heart rate, and sympathetic-nerve activity (using microneurography, which provides direct measurements of efferent sympathetic-nerve activity related to muscle blood vessels) in eight normal subjects while they were awake and while in the five stages of sleep. Results: The mean (±SE) amplitude of bursts of sympathetic-nerve activity and levels of blood pressure and heart rate declined significantly (P<0.001), from 100 ±9 percent, 90 ±4 mm Hg, and 64 ±2 beats per minute, respectively, during wakefulness to 41 ±9 percent, 80 ±4 mm Hg, and 59 ±2 beats per minute, respectively, during stage 4 of non-REM sleep. Arousal stimuli during stage 2 sleep elicited high-amplitude deflections on the electroencephalogram (called “K complexes”), which were frequently associated with bursts of sympathetic-nerve activity and transient increases in blood pressure. During REM sleep, sympathetic-nerve activity increased significantly (to 215 ±11 percent; P<0.001) and the blood pressure and heart rate returned to levels similar to those during wakefulness. Momentary restorations of muscle tone during REM sleep (REM twitches) were associated with cessation of sympathetic-nerve discharge and surges in blood pressure. Conclusions: REM sleep is associated with profound sympathetic activation in normal subjects, possibly linked to changes in muscle tone. The hemodynamic and sympathetic changes during REM sleep could play a part in triggering ischemic events in patients with vascular disease., The early morning hours after awakening (approximately 6 to 11 a.m.) are associated with a higher-than-expected incidence of cardiovascular events, such as myocardial infarction and ischemic stroke¹–³. The relation between sleep and these events is not clear. Ischemic events can occur during sleep, especially in patients with severe coronary artery disease⁴ and vasospastic angina⁵. REM, or rapid-eye-movement, sleep is especially associated with myocardial ischemia⁴,⁵. In animals with coronary-artery stenosis, REM sleep causes further decreases in coronary-artery blood flow,⁶ possibly due to sympathetic activation during this sleep stage. Surprisingly, although there have been extensive investigations in…