ESC Congress 2026 Abstract · Oct 26, 2026
Very low frequency power of heart rate variability characterized by sleep apnoea-related heart rate fluctuation and recurrent major adverse cardiovascular events in hypertensive patients
By Ruan H, Wang L, Lu X et al.
Background and Aims: Marked heart rate fluctuation (ΔHR) after sleep apnoea (SA) events represents a high-risk phenotype of obstructive sleep apnoea (OSA). However, it remains unclear whether SA-related very-low-frequency (VLF) power of heart rate variability (HRV) is associated with recurrent major adverse cardiovascular events (MACE) in hypertensive patients. Methods: A total of 1867 hypertensive patients (mean age 58.4 ± 11.2 years; 422 females, 22.6%) underwent nocturnal Holter electrocardiography and type Ⅲ home SA testing (HSAT). The total duration of SA-related respiratory-cardiac effect (SA-ΔHR duration), hypoxic burden (HB), and time- and frequency-domain HRV indices were analyzed overnight. The VLF5m ratio was defined as VLF power in the first 5 minutes after sleep onset divided by that in the 15 minutes before sleep. The primary endpoint was MACEs. Multivariate Cox proportional hazards models was performed to evaluate the association between variables and MACE. Results: During a median follow-up of 37 months, 286 patients (15.3%) developed MACE. SA-ΔHR duration ranged from 11 to 150 s, with ΔHR of 15.3 ± 9.5 bpm. SA-ΔHR duration, ΔHR, HB, and time-domain HRV indices were not associated with MACEs. In contrast, VLFn power (2675.8 ± 632.3) was independently associated to MACEs risk (adjusted Hazard Ratio: 0.83; 95% confidence intervals: 0.72–0.96; P = 0.011). A VLF5m ratio > 1.28 predicted SA with an area under the curve (AUC) of 0.962. Conclusions: SA-related VLFn power of HRV is associated with recurrent MACEs in hypertensive patients and may serve as a useful prognostic marker.Characteristics of patientsPrognostic regression analysis