Published: 2019-10-24

A cross-sectional study to evaluate the effect of subjective sleep quality on autonomic functions in different age groups of adults

Rajani Bala Jasrotia, Arvind Kanchan, Nitin Ashok John, Manish Kumar Verma, Vibha Gangwar


Background: Poor sleep quality adversely affects the person’s homeostasis via combination of impairments to multiple physiological-mechanisms. Autonomic functions are important for different aspects of health and disease. Objective of study was to analyze the impact of subjective sleep quality on autonomic functions in different age groups of adults.

Methods: A total of 375 apparently healthy adults from community were randomly selected for this cross-sectional observational study. They were divided into three groups based on the age distributions: Group 1: 18-30 years (n = 146); Group 2: 31-45 years (n = 112); and Group 3: 46-60 years (n = 117). Following assessments were done in all the participants in three groups: Anthropometric measurements, Pittsburgh Sleep-quality Index (PSQI), Electrocardiography (ECG), Autonomic functions based on frequency domain heart rate variability (HRV).  Two-way analysis of variance followed by post hoc analysis was done for intergroup comparisons of all assessment characteristics. Spearman’s correlation was done to find the correlation coefficients between PSQI scoring and all other parameters mentioned above.

Results: BMI, GPSQIS, SSQS, SDS and SMS were observed more in group2 and 3 as compared to group1, whereas SD and SE were more in group1 as compared to group 2 and 3. HF, Total Power and RR were more in group 1 as compared to group 3, whereas VLF and HR were less in group 1 as compared to group 3. LF/HF ratio and HR were more in group 3 as compared to group 2, whereas HF was more in group 2 as compared to group 3. There was statistically significant negative correlation between GPSQI and Total power, SMS and HF, SIT and HF, SD and LF/HF ratio, whereas statistically significant positive correlation between SMS and LF, SMS and LF/HF ratio, SIT and LF, SIT and LF/HF ratio, SD and total power as well as SE and total power.

Conclusions: Ageing in adults affects the sleep-quality, reduces the sleep duration and decreases the sleep efficiency; these contribute to autonomic dysfunction as increased sympathetic activity and decreased parasympathetic activity in older adults as compared to younger adults.


Autonomic, Ageing, Sleep-quality, Heart rate variability

Full Text:



Heslop P, Smith GD, Metcalfe C, Macleod J, Hart C. Sleep duration and mortality: the effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Medicine. 2002 Jul 1;3(4):305-14.

Tamakoshi A, Ohno Y; JACC Study Group. Self-reported sleep duration as a predictor of all-cause mortality: results from the JACC study, Japan. Sleep. 2004 Feb 1;27(1):51-4.

Gosselin D, De Koninck J, Campbell K. Novel measures to assess the effects of partial sleep deprivation on sensory, working, and permanent memory. Frontiers in Psychol. 2017 Sep 28;8:1607.

Altevogt BM, Colten HR, editors. Sleep disorders and sleep deprivation: an unmet public health problem. National Academies Press; 2006 Oct 13.

Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: results from the National Health Interview Survey. Sleep. 2010 Aug 1;33(8):1037-42.

Trinder J, Kleiman J, Carrington M, Smith S, Breen S, Tan N, Kim Y. Autonomic activity during human sleep as a function of time and sleep stage. J sleep Resea. 2001 Dec 13;10(4):253-64.

Bersano C, Revera M, Vanoli E. Physiopathology of the autonomic nervous system activity during sleep. Ital Heart J Suppl. 2001;2(8):840-4.

Nano MM, Fonseca P, Vullings R, Aarts RM. Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review. PloS one. 2017 Oct 23;12(10):e0186716.

Tobaldini E, Nobili L, Strada S, Casali KR, Braghiroli A, Montano N. Heart rate variability in normal and pathological sleep. Frontiers in physiology. 2013 Oct 16;4:294.

Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social science and medicine. 2010 Sep 1;71(5):1027-36.

Bliwise DL, King AC, Harris RB, Haskell WL. Prevalence of self-reported poor sleep in a healthy population aged 50-65. Social Science and Medicine. 1992 Jan 1;34(1):49-55.

Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995 Aug 1;18(6):425-32.

Vitiello MV, Larsen LH, Moe KE. Age-related sleep change: gender and estrogen effects on the subjective–objective sleep quality relationships of healthy, noncomplaining older men and women. J Psycho Resea. 2004 May 1;56(5):503-10.

Zeitlhofer J, Schmeiser‐Rieder A, Tribl G, Rosenberger A, Bolitschek J, Kapfhammer G, et al. Sleep and quality of life in the Austrian population. Acta Neurologica Scandinavica. 2000 Oct;102(4):249-57.

Bertel O, Bühler FR, Kiowski W, Lütold BE. Decreased Beta-adrenoreceptor responsiveness as related to age, blood pressure, and plasma catecholamines in patients with essential hypertension. Hypertension. 1980 Mar;2(2):130-8.

Iwase S, Mano T, Watanabe T, Saito M, Kobayashi F. Age-related changes of sympathetic outflow to muscles in humans. J Gerontol. 1991 Jan 1;46(1):M1-5.

Korkushko OV, Shatilo VB, Plachinda YI, ShatiloShatilo TV. Autonomic control of cardiac chronotropic function in man as a function of age: assessment by power spectral analysis of heart rate variability. J Autonomic Nervous System. 1991 Mar 1;32(3):191-8.

Poller U, Nedelka G, Radke J, Pönicke K, Brodde OE. Age-dependent changes in cardiac muscarinic receptor function in healthy volunteers. J Am College Cardiol. 1997 Jan 1;29(1):187-93.

Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, DeMeersman RE, Basner RC. Increased sympathetic and decreased parasympathetic cardiovascular modulation in ormal humans with acute sleep deprivation. J Appl Physiol. 2005 Jun;98(6):2024-32.

Franzen PL, Gianaros PJ, Marsland AL, Hall MH, Siegle GJ, Dahl RE, et al. Cardiovascular reactivity to acute psychological stress following sleep deprivation. Psychosomatic Medicine. 2011 Oct;73(8):679-82.

Yang H, Durocher JJ, Larson RA, DellaValla JP, Carter JR. Total sleep deprivation alters cardiovascular reactivity to acute stressors in humans. J Appl Physiol. 2012 Jul 19;113(6):903-8.

Takase B, Akima T, Satomura K, Mastui T, Ishihara M, Kurita A. Effects of chronic sleep deprivation on autonomic activity by examining heart rate variability, plasma catecholamine, and intracellular magnesium levels. Biomed and Pharmaco. 2004 Oct 1;58:S35-9.