Sleep stage-specific heart rate variability feature-driven clustering analysis: identifying cardiac autonomic endotypes with long-term cardiovascular predictive value.

Xiao Chen, Luqi Bai, Chong Li, Boda Zhou

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Article in European heart journal. Digital health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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4 authors.

Xiao ChenBeijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.ORCID https://orcid.org/0009-0005-4604-0002

Luqi BaiBeijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.

Chong LiSchool of Biomedical Engineering, Tsinghua University, Beijing 100084, China.

Boda ZhouBeijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.ORCID https://orcid.org/0000-0001-8207-7367

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: Cardiovascular risk assessment in obstructive sleep apnoea (OSA) has traditionally relied on the Apnea-Hypopnea Index (AHI). However, AHI primarily reflects respiratory event burden and may not adequately capture inter-individual heterogeneity in sleep-related cardiorespiratory regulation. This study aimed to identify sleep stage-specific heart rate variability (HRV) phenotypes and evaluate their associations with long-term cardiovascular outcomes. Methods and results: Data were obtained from the Sleep Heart Health Study (SHHS). After exclusion of participants with missing clinical covariates or outcome data, 4029 individuals were included. Linear and non-linear HRV features were extracted from stage-specific electrocardiographic segments during N2, N3, and rapid eye movement (REM) sleep. Conclusion: Incorporating sleep stage-specific HRV features into conventional clinical phenotyping provides complementary prognostic information beyond traditional respiratory severity metrics. HRV-informed phenotyping may improve long-term cardiovascular risk stratification in patients with OSA.

Indexed as

Autonomic regulationCardiovascular riskHeart rate variability (HRV)Obstructive sleep apnoeaRisk stratificationSleep stages

Identifiers

PMID42898431

DOI10.1093/ehjdh/ztag144

PMCPMC13677779

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.