Abstract
Various cardiac arrhythmias frequently occur in patients with sleep apnea, but complex analysis of the relationship between their severity and the probable arrhythmogenic risk factors is conflicting. The question is what cardiovascular risk factors and how strongly they are associated with the severity of cardiac arrhythmias in sleep apnea. Adult males (33 with and 16 without sleep apnea), matched for cardiovascular co-morbidity were studied by polysomnography with simultaneous ECG monitoring. Arrhythmia severity was evaluated for each subject by a special 7-degree scoring system. Laboratory, clinical, echocardiographic, carotid ultrasonographic, ambulatory blood pressure, and baroreflex sensitivity values were also assessed. Moderate sleep apnea patients had benign, but more exaggerated cardiac arrhythmias than control subjects (2.53 ± 2.49 vs. 1.13 ± 1.64 degrees of cumulative severity, p < 0.05). We confirmed strong correlations between the arrhythmia severity and known arrhythmogenic risk factors (left ventricular ejection fraction and dimensions, right ventricular diameter, baroreflex sensitivity, carotid intima-media thickness, age, previous myocardial infarction, and also apnea-hypopnea index). In multivariate modelling only the apnea-hypopnea index indicating the sleep apnea intensity remained highly significantly correlated with the cumulative arrhythmia severity (beta = 0.548, p < 0.005). In conclusion, sleep apnea modifying cardiovascular risk factors and structures or functions provoked various nocturnal arrhythmias. The proposed scoring system allowed a complex analysis of the contribution of various triggers to arrhythmogenesis and confirmed the apnea-hypopnea index as an independent risk for nocturnal cardiac arrhythmia severity in sleep apnea.
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References
Alonso-Fernandez, A., Garcia-Rio, F., Racionero, M. A., Pino, J. M., Ortuño, F., Martínez, I., & Villamor, J. (2005). Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive sleep apnea-hypopnea syndrome and its mechanisms. Chest, 127, 15–22.
ASDA-American Sleep Disorders Association Report. (1999). Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep, 22, 667–689.
Blomström-Lundqvist, C., Scheinman, M. M., Aliot, E. M., Alpert, J. S., Calkins, H., Camm, A. J., Campbell, W. B., Haines, D. E., Kuck, K. H., Lerman, B. B., Miller, D. D., Shaeffer, C. W., Jr., Stevenson, W. G., Tomaselli, G. F., Antman, E. M., Smith, S. C., Jr., Alpert, J. S., Faxon, D. P., Fuster, V., Gibbons, R. J., Gregoratos, G., Hiratzka, L. F., Hunt, S. A., Jacobs, A. K., Russell, R. O., Jr., Priori, S. G., Blanc, J. J., Budaj, A., Burgos, E. F., Cowie, M., Deckers, J. W., Garcia, M. A., Klein, W. W., Lekakis, J., Lindahl, B., Mazzotta, G., Morais, J. C., Oto, A., Smiseth, O., Trappe, H. J., American College of Cardiology, American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines, & Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias: A report of the ACC/AHA Task Force on Practice Guidelines and ESC Committee for Practice Guidelines. Circulation, 108, 1871–1909.
Brusoni, B., Sanne, G., Bettini, R., Fonda, F., Pagnoni, F., Santoro, G. M., & Sartori, F. (1983). Malignant ventricular hyperkinetic arrhythmias. Classificational criteria: Review of Lown’s classification. Giornale Italiano di Cardiologia, 13, 253–259.
Camm, A. J., Kirchhof, P., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I. C., Al-Attar, N., Hindricks, G., Prendergast, B., Heidbuchel, H., Alfieri, O., Angelini, A., Atar, D., Colonna, P., De Caterina, R., De Sutter, J., Goette, A., Gorenek, B., Heldal, M., Hohloser, S. H., Kolh, P., Le Heuzey, J. Y., Ponikowski, P., & Rutten, F. H. (2010). Guidelines for the management of atrial fibrillation. The task force of the ESC. European Heart Journal, 31, 2369–2429.
Fox, K., Garcia, M. A. A., Ardissino, D., Buszman, P., Camici, P. G., Crea, F., Daly, C., De Backer, G., Hjemdahl, P., Lopez-Sendon, J., Marco, J., Morais, J., Pepper, J., Sechtem, U., Simoons, M., Thygesen, K., Priori, S. G., Blanc, J. J., Budaj, A., Camm, J., Dean, V., Deckers, J., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J., Zamorano, J. L., Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology, & ESC Committee for Practice Guidelines (CPG). (2006). European guidelines on management of stable angina pectoris. The task force of the ESC. European Heart Journal, 27, 1341–1381.
Franz, M. R., & Bode, F. (2003). Mechano-electrical feedback underlying arrhythmias: The atrial fibrillation case. Progress in Biophysics and Molecular Biology, 82, 163–174.
Gami, A. S., Pressman, G., Caples, S. M., Kanagala, R., Gard, J. J., Davison, D. E., Malouf, J. F., Ammash, N. M., Friedman, P. A., & Somers, V. K. (2004). Association of atrial fibrillation and obstructive sleep apnea. Circulation, 110, 364–367.
Gami, A. S., Howard, D. E., Olson, E. J., & Somers, V. K. (2005). Day-night pattern of sudden death in obstructive sleep apnea. The New England Journal of Medicine, 352, 1206–1214.
Gami, A. S., Hodge, D. O., Herges, R. M., Olson, E. J., Nykodym, J., Kara, T., & Somers, V. K. (2007). Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. Journal of the American College of Cardiology, 49, 565–571.
Grimm, W., Hoffmann, J., Menz, V., Köhler, U., Heitmann, J., Peter, J. H., & Maisch, B. (1996). Electrophysiologic evaluation of sinus node function and atrio-ventricular conduction in patients with prolonged ventricular asystolia during obstructive sleep apnea. The American Journal of Cardiology, 77, 1310–1314.
Gula, L. J., Krahn, A. D., Skanes, A. C., Yee, R., & Klein, G. J. (2004). Clinical relevance of arrhythmias during sleep: Guidance for clinicians. Heart, 90, 347–352.
Hall, M. J., Ando, S., Floras, J. S., & Bradley, T. D. (1998). Magnitude and time course of hemodynamic responses to Mueller manoeuvres in patients with congestive heart failure. Journal of Applied Physiology, 85, 1476–1484.
Harbison, J., O’Reilly, P., & McNicholas, W. T. (2000). Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: Effects of nasal continuous positive airway pressure therapy. Chest, 118, 591–595.
Hedner, J., & Grote, L. (1998). Cardiovascular consequences of obstructive sleep apnea. In W. T. McNicholas (Ed.), European Respiratory Monograph 10: Respiratory disorders during sleep (pp. 227–265). Sheffield: European Respiratory Society.
Javaheri, S. (2000). Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure. Circulation, 101, 392–397.
Kanagala, R., Murali, N. S., Friedman, P. A., Ammash, N. M., Gersh, B. J., Ballman, K. V., Shamsuzzaman, A. S., & Somers, V. K. (2003). Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation, 107, 2589–2594.
Kohler, M., Pepperell, J. C. T., Casadei, B., Craig, S., Crosthwaite, N., Stradling, J. R., & Davies, R. J. (2008). CPAP and measures of cardiovascular risk in males with OSAS. European Respiratory Journal, 32, 1488–1496.
Koshino, Y., Satoh, M., Katayose, Y., Yasuda, K., Tanigawa, T., Takeyasu, N., Watanabe, S., Yamaguchi, I., & Aonuma, K. (2008). Association of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure. The American Journal of Cardiology, 101, 882–886.
La Rovere, M. T., Bigger, J. T., Jr., Marcus, F. I., Mortara, A., & Schwartz, P. J. (1998). Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. (Autonomic Tone and Reflexes After Myocardial Infarction – ATRAMI). Lancet, 351, 478–484.
Lown, B., & Wolf, M. (1971). Approaches to sudden death from coronary heart disease. Circulation, 44, 130–142.
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005). Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet, 365, 1046–1053.
Mancia, G., De Backer, G., Diominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., Narkiewicz, K., Ruilope, L., Rynkiewicz, A., Schmieder, R. E., Struijker-Boudier, H. A., Zanchetti, A., Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Kjeldsen, S. E., Erdine, S., Narkiewicz, K., Kiowski, W., Agabiti-Rosei, E., Ambrosioni, E., Cifkova, R., Dominiczak, A., Fagard, R., Heagerty, A. M., Laurent, S., Lindholm, L. H., Mancia, G., Manolis, A., Nilsson, P. M., Redon, J., Schmieder, R. E., Viigimaa, M., Filippatos, G., Adamopoulos, S., Agabiti-Rosei, E., Ambrosioni, E., Bertomeu, V., Clement, D., Erdine, S., Farsang, C., Gaita, D., Kiowski, W., Lip, G., Mallion, J. M., Manolis, A. J., Nilsson, P. M., O’Brien, E., Ponikowski, P., Redon, J., Ruschitzka, F., Tamargo, J., van Zwieten, P., Viigimaa, M., Waeber, B., Williams, B., & Zamorano, J. L. (2007). Guidelines for the management of arterial hypertension. European Heart Journal, 28, 1462–1536.
Mehra, R., Benjamin, E. J., Shahar, E., Gottlieb, D. J., Nawabit, R., Kirchner, H. L., Sahadevan, J., Redline, S., & Sleep Heart Health Study. (2006). Association of nocturnal arrhythmias with sleep-disordered breathing. The sleep heart health study. American Journal of Respiratory and Critical Care Medicine, 173, 910–916.
Mehra, R., Stone, K. L., & Varosy, P. D. (2009). Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men. Archives of Internal Medicine, 169, 1147–1155.
Morganroth, J. (1984). Premature ventricular complexes: Diagnosis and indications for therapy. Journal of the American Medical Association, 252, 673–676.
Narkiewicz, K., van de Borne, P. J., Cooley, R. L., Dyken, M. E., & Somers, V. K. (1998). Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation, 98, 772–776.
Pepperell, J. C. T., Casadei, B., Kohler, M., Craig, S., Crosthwaite, N., Stradling, J. R., & Davies, R. J. (2008). CPAP and measures of cardiovascular risk in males with OSAS. European Respiratory Journal, 32, 1488–1496.
Porthan, K. M., Melin, J. H., Kupila, J. T., Venho, K. K., & Partinen, M. M. (2004). Prevalence of sleep apnea syndrome in lone atrial fibrillation: A case–control study. Chest, 125, 879–885.
Quan, S. F., & Gersh, B. J. (2004). Cardiovascular consequences of sleep-disordered breathing: Past, present and future: Report of a workshop from the National Center on sleep disorders research and the National Heart, Lung, and Blood Institute. Circulation, 109, 951–957.
Roche, F., Xoung, A. N., Court-Fortune, I., Costes, F., Pichot, V., Duverney, D., Vergnon, J. M., Gaspoz, J. M., & Barthélémy, J. C. (2003). Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing and Clinical Electrophysiology, 26, 669–677.
Ryan, C. M., Usui, K., Flora, J. S., & Bradley, T. D. (2005). Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnea. Thorax, 60, 781–785.
Schafer, H., Hasper, E., Ewig, S., Koehler, U., Latzelsberger, J., Tasci, S., & Lüderitz, B. (1998). Pulmonary haemodynamics in obstructive sleep apnea: Time course and associated factors. European Respiratory Journal, 12, 679–684.
Sorajja, D., Gami, A. S., Somers, V. K., Behrenbeck, T. R., Garcia-Touchard, A., & Lopez-Jimenez, F. (2008). Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest, 133, 927–933.
Sovari, A. A., Kocheril, A. G., & Baas, A. S. (2010). Sudden cardiac death. http://emedicine.medscape.com/article/151907-Overview. Retrieved 21 Jan 2011.
Szaboova, E., Donic, V., Tomori, Z., & Koval, S. (1997). Obstructive sleep apnea as the cause of dysrhythmias and sudden cardiac death. Bratislava Medical Journal, 98, 448–453 (Article in Slovakian).
Szaboova, E., Tomori, Z., Donic, V., Petrovicová, J., & Szabó, P. (2007). Sleep apnea inducing hypoxemia is associated with early signs of carotid atherosclerosis in males. Respiratory Physiology & Neurobiology, 155, 121–127.
Vardas, P. E., Drexle, H., Ector, H., et al. (2007). Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force of the ESC. Europace, 9, 959–998.
Tomori, Z., Poliaček, I., Jakuš, J., Widdicombe, J., Donic, V., Benacka, R., & Gresova, S. (2010). Distinct generators for aspiration and expiration reflexes: Localisation, mechanisms and effects. Journal of Physiology and Pharmacology, 61, 5–12.
Zipes, D. P., Camm, A. J., Borgreffe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., Priori, S. G., Quinones, M. A., Roden, D. M., Silka, M. J., Tracy, C., Priori, S. G., Blanc, J. J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L., Smith, S. C., Jr., Jacobs, A. K., Adams, C. D., Antman, E. M., Anderson, J. L., Hunt, S. A., Halperin, J. L., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., American College of Cardiology, American Heart Association Task Force, European Society of Cardiology Committee for Practice Guidelines, European Heart Rhythm Association, & Heart Rhythm Society. (2006). ACC/AHA/ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace, 8, 746–857.
Zoni Berisso, M., Molini, D., Mela, G. S., & Vecchio, C. (1996). Value of programmed ventricular stimulation in predicting sudden death and sustained ventricular tachycardia in survivors of acute myocardial infarction. American Journal of Cardiology, 77, 673–680.
Acknowledgements
This study was supported by APVV grant no. 20.047705 and COST Action B26. Ing. M. Kundrík is gratefully acknowledged for technical assistance.
Conflicts of interest: The authors declare no conflicts of interest in relation to this article.
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Szaboova, E., Holoubek, D., Tomori, Z., Szabo, P., Donic, V., Stancak, B. (2013). Severity of Nocturnal Cardiac Arrhythmias Correlates with Intensity of Sleep Apnea in Men. In: Pokorski, M. (eds) Respiratory Regulation - Clinical Advances. Advances in Experimental Medicine and Biology, vol 755. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4546-9_21
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