REM sleep-related complete heart block: Is it a specific sleep-related disorder?

Osuna, Edgar; Patino, Gustavo

doi:10.1016/j.sleep.2005.11.010

Cited by 15 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thyroid functions were tested normal. However, all patients had a number of pauses that lasted far more than 2.5 s that were not associated with apnea or hypopnea events and that typically clustered during episodes of phasic REM sleep, a finding that was also reported by others [1][2][3][4].…”

Section: Discussionsupporting

confidence: 79%

“…On the other hand, the natural history of this disorder is essentially unknown, and no fatal cardiac arrests have been reported in patients with the REM sleep-related brady-arrhythmia syndrome. Six of the eight patients reported in literature ended up with pacemaker implantation [1][2][3][4][5], which was also the case for two of the three patients described here. With a follow-up of 6 and 1 year, respectively, both our patients remained symptomatic despite pacemaker implant.…”

Section: Discussionsupporting

confidence: 70%

“…They described a syndrome in four patients that was characterised by pathological sinus arrests during REM sleep, which could not be attributed to sleep apnea and which occurred in otherwise healthy individuals. Since then, only a few reports of this sleep-related rhythm disorder have been published [2][3][4][5]. Asystoles lasting longer than 2.5 s are considered pathological, as several studies have demonstrated that such arrests do rarely occur in asymptomatic healthy individuals [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

REM sleep-related brady-arrhythmia syndrome

et al. 2007

View full text Add to dashboard Cite

Rapid eye movement (REM) sleep-related brady-arrhythmia syndrome is a cardiac rhythm disorder characterised by asystoles lasting several seconds during REM sleep in otherwise healthy individuals. In contrast to arrhythmias associated with obstructive sleep apnea, REM sleep-related sinus arrests and atrioventricular (AV) blocks are not associated with episodes of apnea or hypopnea. In literature, only few cases have been published, suggesting that the prevalence of this nighttime rhythm disorder is very rare. In this paper, we report two new cases of REM sleep-related sinus arrests and one case of REM sleep-related total AV block. To explore the underlying mechanism, an analysis of heart rate variability was performed. In a matched control population, we observed a significant lower low-to-high frequency (LF/HF) ratio in slow wave sleep as compared to REM sleep (2.04 +/- 1.2 vs 4.55 +/- 1.82, respectively [Mann-Whitney U test p < 0.01]), demonstrating a global increase in sympathetic activity during REM. When using the same technique in two of three patients with REM-related arrhythmias, the shift to an increased LF/HF ratio from slow wave sleep to REM sleep tended to be lower. This may reflect an increased vagal activity (HF component) during REM sleep in these subjects. We, therefore, hypothesise that, in our patients with REM sleep-related arrhythmias, the overall dominance of sympathetic activity during REM is present but to a lesser extent and temporarily switches into vagal dominance when the bursts of REMs occur. As it was still unclear whether these REM sleep-related asystoles needed to be paced, we compared our treatment and these of previously reported cases with the current American College of Cardiology/American Heart Association guidelines for implantation of cardiac pacemakers.

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

REM sleep-related brady-arrhythmia syndrome

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Sleep-associated bradyarrhythmias were reported for the first time in 1984 by Guilleminault et al ( 3 ) as sinus arrest observed during REM sleep. Report of REM-associated AV blocks as well suggested that ANS imbalance observed during this period of sleep might be the etiological factor ( 10 , 11 ). Effect of ANS on heart varies according to circadian rhythm and sleep state cycle ( 2 ).…”

Section: Discussionmentioning

confidence: 96%

Sleep related bradyarrhythmic events and heart rate variability in apparently healthy individuals

Çi̇men

Sunman²,

Erat³

et al. 2016

Anatol J Cardiol

View full text Add to dashboard Cite

Objective:It is thought that abnormal cardiac impulses of the autonomic nervous system during sleep are responsible for sleep-related bradyarrhythmias. Despite a proposed common etiopathogenesis and having common name of “sleep-related bradyarrhythmias,” precise importance of sinoatrial or atrioventricular (AV) node involvement remains elusive. This study aimed to determine whether there is a difference in sleep-related bradyarrhythmias from the point of view of heart rate variability (HRV).Methods:Patients were evaluated using 24-hour Holter electrocardiogram monitor. After careful medical evaluation, apparently healthy individuals with sleep-related sinus pauses ≥2 seconds on at least 1 occasion or those in whom Mobitz type I AV block occurred were included. Frequency and time domain analyses were conducted for daytime, nighttime, and 24-hour period.Results:Total of 37 patients with sinus pause(s), 40 patients with Mobitz type I AV block(s), and 40 healthy controls were included. On HRV analyses, all time and frequency domain parameters were better in sinus pause group for daytime, nighttime, and 24-hour average (p<0.05 for all). Results of heart rate-corrected HRV analyses still showed significantly better total power (TP) and very low frequency (VLF) in the sinus pause group compared with AV block group (TP: 7.1×10-3 vs. 5.4×10-3, p=0.011; VLF: 4.9×10-3 vs. 3.7×10-3, p=0.007).Conclusion:Despite proposed common autonomic mechanisms, sleep-related sinus pause cases demonstrated better HRV profile in comparison with Mobitz type I AV block.

show abstract

“…Den Ergebnissen eigener Untersuchungen sowie aktuellerer Literaturdaten zufolge ist von einer Prävalenz von 5-20% bradykarder apnoeassoziierter Herzrhythmusstörungen auszugehen [14,10,23]. Die Prävalenzdaten der Bradyar rhythmien entsprechen in etwa der Häufigkeit schlafbezogener bradykarder Herzrhythmusstörungen bei jungen gesunden Probanden.…”

Section: Bradykarde Herzrhythmusstörungenunclassified

Autonome Regulation und nächtliche Arrhythmien bei Patienten mit schlafbezogener Atmungsstörung

et al. 2011

View full text Add to dashboard Cite

Das autonome Nervensystem ist an den akuten und chronischen Funktionsabläufen bei SBAS maßgeblich beteiligt. Die enge pathophysiologische Verknüpfung der Regelkreise Atmung, kardiovaskulä-res System sowie zentrales Nervensystem lässt sich anhand der OSA beispielhaft darstellen. Die komplexe Verschaltung mechanischer, hämodynamischer, humoraler und reflektorischer Mechanismen kann die Patienten akut und chronisch gefährden. So ist bei Patienten mit obstruktiver Schlafapnoe primär im Schlaf, später aber auch am Tage eine Überak-tivierung des adrenergen Systems zu objektivieren. Die Überfunktion des adrenergen Systems kann langfristig v. a. über den Hauptrisikofaktor arterielle Hypertonie zu kardialen, zerebralen und renalen Folgeschäden führen [22, 30, 33]. Das Auftreten von tachykarden Arrhythmien, hypertensiven Blutdruckwerten sowie myokardialen und zerebralen Ischämien wird durch den erhöhten Sympathikotonus begünstigt. Als ursächlich für bradykarde apnoeassoziierte Herzrhythmusstörungen wird ein vagal vermittelter kardioinhibitorischer Reflex angesehen [17]. Autonomes Nervensystem und Atemregulation Über das autonome oder auch vegetative Nervensystem werden zur Aufrechterhaltung der inneren Homöostase des Kör-pers die Vitalfunktionen wie Atmung, Blutdruck, Herzfrequenz, Verdauung und Stoffwechsel geregelt. Die Autonomie bezieht sich in erster Linie auf biologische Anpassungs-und Regulationsvorgänge, die nicht vom Menschen willentlich beeinflusst werden können. Das autonome Nervensystem wird nach funktionellen Gesichtspunkten in ein sympathisches und parasympathisches sowie ein enteritisches unterteilt. Der Sympathikus, der als Katalysator einer erhöhten kardiovaskulä-ren Morbidität und Mortalität angesehen werden muss, kann auf der Ebene der Endorganantwort (Herzfrequenz, Blutdruck, Muskel-und Hautdurchblutung), anhand der Plasmakatecholamine oder direkt als elektrische Aktivität in Haut oder Muskeln mit der Mikroneurographie bestimmt werden. Er gilt als wichtiger prognostischer Faktor, zumal er das Auftreten von Arrhythmien, arterieller Hypertonie, Herzinsuffizienz und Arteriosklerose begünstigt (. Abb. 1). Die Atmung ist eine komplex geregelte Größe. Die Aktivierung des neuronalen respiratorischen Netzwerks erfolgt in erster Linie über chemische und vigilanzabhängige Mechanismen. Der Atemrhythmus wird durch ein neuronales Netzwerk respiratorischer Neurone in Medulla oblongata und Pons generiert [24]. Die Aktivierung des neuronalen Netzwerks erfolgt über Antriebsmechanismen, die sowohl aus der Körperperipherie als auch von übergeordneten Hirnregionen stammen. Der chemische Atmungsantrieb wird in Abhängigkeit von Sauerstoff-und Kohlendioxidpartialdruck sowie dem pH-Wert des arteriellen Blutes und des Liquor cerebrospinalis geregelt. Periphere Chemorezeptoren in den Glomera carotica sowie die im Hirnstamm lokalisierten zentralen Chemorezeptoren fungieren als Sensoren, die den Rhythmusgenerator antreiben oder hemmen und so Einfluss auf die Variabilität der Herzfrequenz nehmen können. Schlaf und Wachsein können mo...

show abstract

REM sleep-related complete heart block: Is it a specific sleep-related disorder?

Cited by 15 publications

References 3 publications

REM sleep-related brady-arrhythmia syndrome

REM sleep-related brady-arrhythmia syndrome

Sleep related bradyarrhythmic events and heart rate variability in apparently healthy individuals

Autonome Regulation und nächtliche Arrhythmien bei Patienten mit schlafbezogener Atmungsstörung

Contact Info

Product

Resources

About