Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea

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Abstract

Background and purpose: Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea (OSA), reportedly as a consequence of the autonomic effects of recurrent apnea with subsequent oxygen desaturation. We have investigated whether different patterns of OSA are associated with specific arrhythmia during sleep. Patients and methods: Electrocardiographic (ECG) data recorded during polysomnography (PSG) were analysed in 257 consecutive OSA patients to determine the prevalence of cardiac rhythm disturbances, and to relate these to breathing pattern (normal, apnea/hypopnea, recovering ventilation, snoring) and oxygen saturation. Results: Arrhythmias were found in 18.5% of patients. Patients with nocturnal bradyarrhythmia (BA) had higher values of ventilatory disturbance (apnea-hypopnea index [AHI] 58.8 ± 36.8 vs 37.2 ± 30.3, p = 0.02), mean desaturation amplitude (8.9 ± 4 vs 5.9 ± 3.4%, p = 0.03), and a lower SaO2 nadir (69% vs 77%, p = 0.003) than those without arrhythmia. The prevalence of BA in patients with AHI ≥ 30/h was significantly higher than that observed in those with AHI <30/h (7.8% vs 1.5%, respectively; χ2 = 5.61, p = 0.01). In contrast, patients with tachyarrhythmia (TA) had no significant differences in AHI, mean desaturation amplitude or SaO2 nadir than those without arrhythmia. No associations were found between arrhythmia and the presence of comorbidity or concomitant medical therapy, except for an association between tachyarrhythmia and chronic obstructive pulmonary disease (COPD) (odds ratio 2.53; 95% confidence intervals 1.1-5.8, p = 0.03). Conclusions: We conclude that while BA during sleep is associated with OSA severity, concomitant COPD or β2-treatment may play a role in the development of TA during sleep.

Original languageEnglish
Pages (from-to)475-480
Number of pages6
JournalSleep Medicine
Volume9
Issue number5
DOIs
Publication statusPublished - Jul 2008

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Obstructive Sleep Apnea
Apnea
Cardiac Arrhythmias
Bradycardia
Tachycardia
Sleep
Chronic Obstructive Pulmonary Disease
Autonomic Agents
Oxygen
Snoring
Polysomnography
Ventilation
Comorbidity
Respiration
Odds Ratio
Confidence Intervals
Therapeutics

Keywords

  • Cardiac arrhythmia
  • COPD
  • Hypoxemia
  • OSAS
  • Sleep apnea

ASJC Scopus subject areas

  • Dentistry(all)
  • Ophthalmology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

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title = "Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea",
abstract = "Background and purpose: Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea (OSA), reportedly as a consequence of the autonomic effects of recurrent apnea with subsequent oxygen desaturation. We have investigated whether different patterns of OSA are associated with specific arrhythmia during sleep. Patients and methods: Electrocardiographic (ECG) data recorded during polysomnography (PSG) were analysed in 257 consecutive OSA patients to determine the prevalence of cardiac rhythm disturbances, and to relate these to breathing pattern (normal, apnea/hypopnea, recovering ventilation, snoring) and oxygen saturation. Results: Arrhythmias were found in 18.5{\%} of patients. Patients with nocturnal bradyarrhythmia (BA) had higher values of ventilatory disturbance (apnea-hypopnea index [AHI] 58.8 ± 36.8 vs 37.2 ± 30.3, p = 0.02), mean desaturation amplitude (8.9 ± 4 vs 5.9 ± 3.4{\%}, p = 0.03), and a lower SaO2 nadir (69{\%} vs 77{\%}, p = 0.003) than those without arrhythmia. The prevalence of BA in patients with AHI ≥ 30/h was significantly higher than that observed in those with AHI <30/h (7.8{\%} vs 1.5{\%}, respectively; χ2 = 5.61, p = 0.01). In contrast, patients with tachyarrhythmia (TA) had no significant differences in AHI, mean desaturation amplitude or SaO2 nadir than those without arrhythmia. No associations were found between arrhythmia and the presence of comorbidity or concomitant medical therapy, except for an association between tachyarrhythmia and chronic obstructive pulmonary disease (COPD) (odds ratio 2.53; 95{\%} confidence intervals 1.1-5.8, p = 0.03). Conclusions: We conclude that while BA during sleep is associated with OSA severity, concomitant COPD or β2-treatment may play a role in the development of TA during sleep.",
keywords = "Cardiac arrhythmia, COPD, Hypoxemia, OSAS, Sleep apnea",
author = "Francesca Olmetti and {La Rovere}, {Maria Teresa} and Elena Robbi and Taurino, {Anna Eugenia} and Francesco Fanfulla",
year = "2008",
month = "7",
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language = "English",
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T1 - Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea

AU - Olmetti, Francesca

AU - La Rovere, Maria Teresa

AU - Robbi, Elena

AU - Taurino, Anna Eugenia

AU - Fanfulla, Francesco

PY - 2008/7

Y1 - 2008/7

N2 - Background and purpose: Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea (OSA), reportedly as a consequence of the autonomic effects of recurrent apnea with subsequent oxygen desaturation. We have investigated whether different patterns of OSA are associated with specific arrhythmia during sleep. Patients and methods: Electrocardiographic (ECG) data recorded during polysomnography (PSG) were analysed in 257 consecutive OSA patients to determine the prevalence of cardiac rhythm disturbances, and to relate these to breathing pattern (normal, apnea/hypopnea, recovering ventilation, snoring) and oxygen saturation. Results: Arrhythmias were found in 18.5% of patients. Patients with nocturnal bradyarrhythmia (BA) had higher values of ventilatory disturbance (apnea-hypopnea index [AHI] 58.8 ± 36.8 vs 37.2 ± 30.3, p = 0.02), mean desaturation amplitude (8.9 ± 4 vs 5.9 ± 3.4%, p = 0.03), and a lower SaO2 nadir (69% vs 77%, p = 0.003) than those without arrhythmia. The prevalence of BA in patients with AHI ≥ 30/h was significantly higher than that observed in those with AHI <30/h (7.8% vs 1.5%, respectively; χ2 = 5.61, p = 0.01). In contrast, patients with tachyarrhythmia (TA) had no significant differences in AHI, mean desaturation amplitude or SaO2 nadir than those without arrhythmia. No associations were found between arrhythmia and the presence of comorbidity or concomitant medical therapy, except for an association between tachyarrhythmia and chronic obstructive pulmonary disease (COPD) (odds ratio 2.53; 95% confidence intervals 1.1-5.8, p = 0.03). Conclusions: We conclude that while BA during sleep is associated with OSA severity, concomitant COPD or β2-treatment may play a role in the development of TA during sleep.

AB - Background and purpose: Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea (OSA), reportedly as a consequence of the autonomic effects of recurrent apnea with subsequent oxygen desaturation. We have investigated whether different patterns of OSA are associated with specific arrhythmia during sleep. Patients and methods: Electrocardiographic (ECG) data recorded during polysomnography (PSG) were analysed in 257 consecutive OSA patients to determine the prevalence of cardiac rhythm disturbances, and to relate these to breathing pattern (normal, apnea/hypopnea, recovering ventilation, snoring) and oxygen saturation. Results: Arrhythmias were found in 18.5% of patients. Patients with nocturnal bradyarrhythmia (BA) had higher values of ventilatory disturbance (apnea-hypopnea index [AHI] 58.8 ± 36.8 vs 37.2 ± 30.3, p = 0.02), mean desaturation amplitude (8.9 ± 4 vs 5.9 ± 3.4%, p = 0.03), and a lower SaO2 nadir (69% vs 77%, p = 0.003) than those without arrhythmia. The prevalence of BA in patients with AHI ≥ 30/h was significantly higher than that observed in those with AHI <30/h (7.8% vs 1.5%, respectively; χ2 = 5.61, p = 0.01). In contrast, patients with tachyarrhythmia (TA) had no significant differences in AHI, mean desaturation amplitude or SaO2 nadir than those without arrhythmia. No associations were found between arrhythmia and the presence of comorbidity or concomitant medical therapy, except for an association between tachyarrhythmia and chronic obstructive pulmonary disease (COPD) (odds ratio 2.53; 95% confidence intervals 1.1-5.8, p = 0.03). Conclusions: We conclude that while BA during sleep is associated with OSA severity, concomitant COPD or β2-treatment may play a role in the development of TA during sleep.

KW - Cardiac arrhythmia

KW - COPD

KW - Hypoxemia

KW - OSAS

KW - Sleep apnea

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