Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias

Abstract

Summary:This report documents how respiratory sleep disorders can adversely effect ischaemic heart disease. Three male patients (aged 60-67 years) with proven ischaemic heart disease are described. They illustrate a spectrum of nocturnal cardiac dysfunction, two with nocturnal angina and one with nocturnal arrhythmias. Full sleep studies were performed in a dedicated sleep laboratory on all patients, and one patient had 48 hours of continuous Holter monitoring. Two patients were found to have obstructive sleep apnoea with apnoea/hypopnoea indices of 57 and 36 per hour, respectively, the former with nocturnal arrhythmias and the latter with nocturnal angina. In both cases, nasal continuous positive airways pressure successfully treated the sleep apnoea, with an associated improvement in nocturnal arrhythmias and angina. The third patient who presented with nocturnal angina, did not demonstrate obstructive sleep apnoea (apnoea/hypopnoea index = 7.2) but had significant oxygen desaturation during rapid eye movement (REM) sleep. This patient responded to a combination of nocturnal oxygen and protriptyline, an agent known to suppresss REM sleep, and had no further nocturnal angina. All patients were considered to be an optimum cardiac medication and successful symptom resolution only occurred with the addition of specific therapy aimed at their sleep-related respiratory problem. We conclude that all patients with nocturnal angina or arrhythmias should have respiratory sleep abnormalities considered in their assessment.

Sleep Apnea and Cardiovascular Disease

“…[223][224][225] Nocturnal arrhythmias have been shown to occur in up to 50% of OSA patients. The most common arrhythmias during sleep include nonsustained ventricular tachycardia, sinus arrest, seconddegree atrioventricular conduction block, and frequent (Ͼ2 bpm) premature ventricular contractions.…”

Sleep Apnea and Cardiovascular Disease

“…Cardiac arrhythmias are reportedly more frequent in persons with OSA and increase with the number of apneic episodes and the severity of the associated hypoxemia (223)(224)(225). Nocturnal arrhythmias have been shown to occur in up to 50% of OSA patients.…”

The Role of Ganglionated Plexi in Apnea-Related Atrial Fibrillation

“…In the last few years, there have been an increasing number of clinical reports associating sleep apnea and atrial fibrillation (AF) (1)(2)(3)(4)(5)(6)(7)(8). Many possible mechanisms responsible for this relationship have been proposed, including hypoxemia, hypercapnea, pulmonary and systemic hypertension, autonomic factors, stretch-mediated channel activation, and pro-inflammatory factors such as C-reactive protein, among others (9).…”