Sleep-Disordered Breathing in Patients With the Brugada Syndrome

Macedo, Paula; Brugada, Josep; Leinveber, Pavel; Benito, Begoña; Molina, Irma; Kuniyoshi, Fatima H. Sert; Adachi, Taro; Bukartyk, Jan; Walt, Christelle van der; Konečný, Tomáš; Maharaj, Shantal; Kára, Tomáš; Montserrat, Josep M.; Somers, Virend K.

doi:10.1016/j.amjcard.2010.10.046

Cited by 23 publications

(21 citation statements)

References 32 publications

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“…1a, b. Sleep has been also reported to be associated with an increased incidence of VF in patients with Br-S [12]. Previous study showed that circadian distribution of VF episodes in Br-S was highest during the night time [17].…”

Section: T-wave Alternansmentioning

confidence: 95%

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Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

et al. 2015

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The prognostic value of T-wave alternans (TWA) during the night time in patients with Brugada syndrome (Br-S) remains unknown. We assessed TWA for risk stratification using 24-h multichannel Holter electrocardiogram (24-M-ECG) in Br-S. We enrolled 129 patients with Br-S [grouped according to histories of ventricular fibrillation (VF), n = 16; syncope, n = 10; or no symptoms (asymptomatic), n = 103] and 11 controls. Precordial electrodes were attached to the third (3L-V1, 3L-V2) and fourth (4L-V1, 4L-V2 and 4L-V5) intercostal spaces. We measured the values of maximum TWA (max-TWA) during the night time (12 a.m.-6 a.m.) and the day time (12 p.m.-6 p.m.) and calculated parameters of heart rate variability. Compared to the asymptomatic and control groups, the VF and syncope groups showed significantly greater 3L-V2 max-TWA during the night time. The cutoff value for the 3L-V2 max-TWA during the night time was determined as 20 µV (sensitivity 94 % and specificity 48 %; p = 0.01). Multivariate analysis revealed that 3L-V2 max-TWA during the night time ≥20 µV and previous VF episodes were independent predictors of future VF episodes. During a mean follow-up period of 68 ± 37 months, 16 patients experienced VF episodes. The incidence of VF episodes was the highest during the night time (p < 0.001). The 3L-V2 max-TWA during the night time may be a useful predictor for VF episodes in patients with Br-S.

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Section: T-wave Alternansmentioning

confidence: 95%

“…The Br-S is also influenced by the autonomic system. Previous reports showed that vagal tone activity was increasing rapidly before arrhythmic events in Br-S [11] and sleep has been reported to be associated with an increased incidence of VF in patients with Br-S [12].…”

Section: Introductionmentioning

confidence: 97%

Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

et al. 2015

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“…Patients and control subjects are the same as in the study of Macedo et al [20]. Subject characteristics have been previously reported.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Macedo and colleagues showed that the prevalence of SDB is higher in Brugada patients compared to controls (45% vs 27% respectively) [20]. …”

Section: Introductionmentioning

confidence: 99%

Cardiac autonomic control in Brugada syndrome patients during sleep: The effects of sleep disordered breathing

Tobaldini

Brugada

Benito

et al. 2013

International Journal of Cardiology

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Aims Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and it is associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. Methods We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n=9), without SDB (BRU, n= 9), in controls (CON, n=8) and in non-Brugada patients with SDB (n=6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. Results Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. Conclusion Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.

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“…66 However, SDB was a highly prevalent comorbidity in patients at risk for SCD such as Brugada syndrome, hypertrophic cardiomyopathy, or in implantable cardioverter-defibrillator (ICD) recipients. [67][68][69] One cohort facing an enhanced risk of malignant arrhythmic events are patients with chronic heart failure (CHF). 70 SDB is common in CHF and is associated with an impaired prognosis.…”

Section: Ventricular Tachycardiamentioning

confidence: 99%