Triggering of Nocturnal Arrhythmias by Sleep-Disordered Breathing Events

Objectives This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in patients with sleep-disordered breathing (SDB). Background SDB is associated with an increased risk of atrial fibrillation and nonsustained ventricular tachycardia (NSVT) as well as a predilecti...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology 2009-11, Vol.54 (19), p.1797-1804
Main Authors: Monahan, Ken, MD, Storfer-Isser, Amy, MS, Mehra, Reena, MD, MS, Shahar, Eyal, MD, MPH, Mittleman, Murray, MD, DrPH, Rottman, Jeff, MD, Punjabi, Naresh, MD, PhD, Sanders, Mark, MD, Quan, Stuart F., MD, Resnick, Helaine, PhD, Redline, Susan, MD, MPH
Format: Article
Language:English
Subjects:
Aged
arrhythmia
Arrhythmias, Cardiac - etiology
Arrhythmias, Cardiac - physiopathology
Biological and medical sciences
Body Mass Index
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Case-Control Studies
Confounding Factors (Epidemiology)
Cross-Over Studies
Electrocardiography
Female
Heart
Heart attacks
Humans
Internal Medicine
Male
Mathematical Computing
Medical sciences
Middle Aged
obesity
Obesity - complications
Obesity - physiopathology
Pneumology
Polysomnography
Respiratory system : syndromes and miscellaneous diseases
Risk Assessment
Risk Factors
sleep
Sleep Apnea Syndromes - complications
Sleep Apnea Syndromes - etiology
Sleep Apnea Syndromes - physiopathology
Studies
Surveys and Questionnaires
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in patients with sleep-disordered breathing (SDB). Background SDB is associated with an increased risk of atrial fibrillation and nonsustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. Methods Overnight polysomnograms from the Sleep Heart Health Study (n = 2,816) were screened for paroxysmal atrial fibrillation and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of paroxysmal atrial fibrillation or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. Polysomnograms were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-s hazard period preceding each arrhythmia or control period. Results Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia after a respiratory disturbance were nearly 18 times (odds ratio: 17.5; 95% confidence interval: 5.3 to 58.4) the odds of an arrhythmia occurring after normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia per 40,000 respiratory disturbances). Neither hypoxia nor electroencephalogram-defined arousals alone increased arrhythmia risk. Conclusions Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2009.06.038