Sleep Heart Rate Spikes in Kidney and Heart Disease Patients

Irregular sleep detected with heart rate exceeding 100 beats per minute?

Hello Doctor, I am a dialysis patient and also have ischemic heart disease.
Last year, I was examined for the degree of coronary artery blockage, which showed 40% in one artery and 50% in another.
I also have sleep apnea due to mild arrhythmia.
Over the past few months, I have been using a heart rate and blood oxygen monitoring device while sleeping, and I have noticed that for several days each month, my heart rate exceeds 100 beats per minute, sometimes reaching over 120, during sleep (notably, this only occurs once, specifically rising for about 3 to 5 minutes before returning to normal).
After that, my heart rate does not exceed 100 for the remainder of the sleep period.
I have attached the monitoring graph: https://imgur.com/a/rCg96kL.
Even when not exceeding 100, my heart rate generally stays between 80 and 90.
Since I am taking Concor, my heart rate rarely exceeds 80 during the day, and when resting, it can even drop to the low 50s.
The episodes of exceeding 100 only occur while I am asleep.
When awake, a heart rate in the 70s is considered high.
Interestingly, my average blood pressure and highest blood pressure during sleep are higher than when I am awake and active.
I would like to ask what could be the reason for this? I have Googled and am concerned it might be due to myocardial ischemia or left heart dysfunction.

Gao Xiansheng, 40~49 year old female. Ask Date: 2023/11/05

Dr. He Dongjin reply Cardiology

Hello, the imaging results are not conclusive.
Last year, there was a 40% blockage in one artery and a 50% blockage in another, which should be manageable.
Sleep apnea could potentially cause autonomic instability during sleep, leading to a heart rate exceeding 100, even reaching 120.
I believe this does not resemble myocardial ischemia or left heart dysfunction.
I recommend scheduling a 24-hour Holter monitor to further investigate any arrhythmias.
Take care, and Changhua Hospital is concerned about your well-being.

Reply Date: 2023/11/05

More Info

Understanding sleep heart rate spikes in patients with kidney and heart disease is crucial, especially for those like yourself who have a complex medical history involving renal failure, ischemic heart disease, and sleep apnea. Your observations of heart rate spikes during sleep, particularly reaching over 100 beats per minute (bpm), can be concerning, but they can also be explained through various physiological mechanisms.

Firstly, it is important to recognize that sleep is not a uniform state; it consists of different stages, including REM (Rapid Eye Movement) and non-REM sleep. During REM sleep, the body experiences increased brain activity, which can lead to fluctuations in heart rate and blood pressure. For individuals with underlying heart conditions, such as ischemic heart disease, these fluctuations may be more pronounced. The autonomic nervous system, which regulates heart rate, can become unstable during sleep, particularly in patients with sleep apnea. This instability can lead to episodes of tachycardia (elevated heart rate) during sleep.

In your case, the presence of sleep apnea is particularly relevant. Sleep apnea can cause intermittent hypoxia (low oxygen levels) and increased sympathetic nervous system activity, which can lead to spikes in heart rate. When breathing stops during sleep, the body may respond by increasing heart rate to maintain blood flow and oxygen delivery to vital organs. This could explain the isolated episodes of elevated heart rate you are experiencing during sleep.

Additionally, your history of ischemic heart disease, with coronary artery blockages of 40% and 50%, may contribute to your heart's response during sleep. The heart may struggle to meet the demands of the body, especially during periods of stress or low oxygenation, leading to temporary increases in heart rate. However, it is reassuring that these episodes are brief and followed by a return to normal heart rate.

The medications you are taking, such as Concor (a beta-blocker), typically help to manage heart rate and blood pressure. However, individual responses to medication can vary, and it may be worth discussing with your healthcare provider whether your current regimen is optimal for your condition. If your heart rate remains elevated during sleep, it may be beneficial to undergo further monitoring, such as a 24-hour Holter monitor, to assess for any underlying arrhythmias or other cardiac issues.

It is also essential to consider lifestyle factors that could be influencing your heart rate during sleep. Stress, anxiety, caffeine intake, and irregular sleep patterns can all contribute to heart rate variability. Implementing relaxation techniques, maintaining a regular sleep schedule, and avoiding stimulants before bedtime may help mitigate these spikes.

In conclusion, while your concerns regarding potential ischemic heart disease or left heart dysfunction are valid, the spikes in heart rate during sleep may be more closely related to the interplay of sleep apnea, autonomic nervous system instability, and your existing heart condition. Continuous monitoring and open communication with your healthcare provider are key to managing your health effectively. If symptoms persist or worsen, further evaluation may be necessary to ensure that your heart is functioning optimally and to rule out any significant underlying issues.

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