After 4 yr: HR suddenly continues at 78 without immediate ramp down to base 60 (in sleep after motion)

I'm so pleased to have found this site again. I hope someone here can identify what I recently began seeing in my bio-data graphs of sleep metrics and brought me to looking for this site again for help.

I soon will have an appointment with my vascular cardiologist who has been unresponsive to requests for his reaction to the graphs I put into his hands--apparently because they are incidental to sleep apnea treatment. I hope that means he knows and sees the new pattern as one to be dealt with on a routine basis by my elecrophysiologist who implanted the PM. The HR elevation is not that much..

My Subject condition is episodic part of the night in about the last 20 of the last 60 nights. It occurs moslty in later hours of sleep and tends to dominate the remaining sleep period after it begins. Period of each elevation  can range from 1 to 30 minutes. I call their shape "bars"or "square waves" both are nearly flat on top, almost always below the 80 bpm rate. It is a bit unnerving to see last night  and one night earlier an extremely dense series of these elevated HR period and them getting more frequent.

From sleep apnea machine, oximeter and accelerometer data graphs for four years:  upon movements or some gasps in sleep, the HR would spike almost straight up to 70-80 even 90 from a base of 60 and then  immediately begin sharply ramping downward to become asymptotic to the 60 baseline. I call these shapes "shark fins" given their likeness to a shark's dorsal fin..

The PM has performed well, allowing intense, never-miss exercise, well 5+ met level exercise, for nearly 4 years before the Covid interruption in March. Confession: I've not exercised since. 

I take Eliquis and Repathat shots (both beginning after a ?TIA? in 12/2019 and take Clopidigrel( =Plavix) too now, as always. Additionally, I take Valsartan w/HCTZ and Propranolol. The Eliquis and Repatha are newest to me and until a recent 3rd stent I went off Clopidegrel when I started them. Repatha was started after my long refusal of statins.

I have well treated sleep apnea that was virtually all Obstructive sleep apnea: 6 month AHI is 0.1 after beginning at nearly 60 in 2015.

I've learned a lot, but know little. Tendency is to lay all the cards out for assessment and dump TMI.

Thanks in advance to any who read all this and may comment.







Variation of heart rate with sleep

by Selwyn - 2020-08-04 16:04:33

This all sound perfectly normal.


You would expect your heart rate to fall with any apnoeic attack, followed by a rebound increase on breathing. There is an increase chance of an arrhythmia associated with apnoeic attacks.


I trust someone is keeping an eye on your electrolytes/kidney function - disturbance of this can cause arrhythmias.

Clearly, the breathing and circulation are linked. You would expect a sustained increase in heart rate if your breathing was not good. 

It is also worth checking your blood pressure at night ( 24hr monitoring) as some folk have night time spikes, especially important as you have had a TIA. You should also have had investigations of your arterial supply to your brain before something more major comes about!





After 4 yr: HR suddenly continues at 78 without immediate ramp down to base 60 (in sleep after motion)

by HikerDave - 2020-08-20 04:58:16

Interrogation of PM Wednesday, 8/19, showed it was not at fault. Apparently the oximeter has been failing intermittently.

Consistent with that findng, there were few to no hints of correlations of the new unusual HR-burst, with rectangular waveform contour, to either changes in SpO2 levels or bodily motions. So I now can comfortably dismiss the erroneous HR graphs until I get a replacement oximeter. It works fine, correlating well when it works, that is, when it shows the longstanding HR spike and reversed-J descent to become asymptotic to the base HR axis.

Thank you Selwyn for your helpful suggestions, including the reference.


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