Triggering of Nocturnal Arrhythmias by Sleep-Disordered Breathing Events

Abstract

Objectives This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in those with sleep-disordered breathing (SDB). Background SDB is associated with increased risk of atrial fibrillation (AF) and non-sustained 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 (PSGs) from the Sleep Heart Health Study (n = 2816) were screened for paroxysmal atrial fibrillation (PAF) and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of PAF or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. PSGs were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-second 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 following a respiratory disturbance were nearly 18-times (OR 17.5; 95% CI 5.3–58.4) the odds of an arrhythmia occurring following normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia/40000 respiratory disturbances). Neither hypoxia nor EEG-defined arousals alone increased arrhythmia risk. Conclusions Although the absolute arrhythmia rate is low, the relative risk of PAF 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.

Effects of obstructive sleep apnoea on heart rhythm

“…VPCs were observed mainly during the night at the end of apnoeas, and when oxygen desaturations were most pronounced [90]. Recently, two studies investigated the time of VPCs occurrence during the night and revealed an increased onset during the apnoeic phase and shortly after events of disturbed breathing when compared with normal breathing periods, thus supporting possible direct effects of OSA on the inducibility of arrhythmias [91,92].…”

Síndrome da Apneia Obstrutiva do Sono e Doenças Cardiovasculares

“…Mais de 50% dos portadores de SAOS apresentam arritmias noturnas e a frequência das arritmias aumenta com o IAH e a gravidade da hipoxemia 44 . O risco de episódio de fibrilação atrial (FA) ou de taquicardia ventricular não-sustentada 90 minutos após um episódio de apneia/hipopneia é 18 vezes maior em relação aos perío-dos de respiração normal.44 A prevalência de taquicardia ventricular não sustentada é maior em indivíduos com SAOS em relação aos indivíduos normais 45 .…”

Sleep-Related Breathing Disorders and Cardiac Arrhythmia

“…The purported decrease in vagus nerve activity and unopposed cardiac sympathetic nerve activity in these patients may foster development of ventricular tachycardia and fibrillation (Verrier & Josephson, 2009). The surge in arterial blood pressure and sympathetic nerve activity that occur with apneas may explain the temporal association between the apnea and the onset of nonsustained ventricular tachycardia (Monahan et al, 2009;Somers et al, 1995;Somers et al, 2008). In one sub-study from the Sleep Heart Health Study, polysomnograms from 57 patients with 62 episodes of paroxysmal atrial fibrillation or nonsustained vetricular tachycardia (NSVT) were reviewed (Monahan et al, 2009).…”

“…The surge in arterial blood pressure and sympathetic nerve activity that occur with apneas may explain the temporal association between the apnea and the onset of nonsustained ventricular tachycardia (Monahan et al, 2009;Somers et al, 1995;Somers et al, 2008). In one sub-study from the Sleep Heart Health Study, polysomnograms from 57 patients with 62 episodes of paroxysmal atrial fibrillation or nonsustained vetricular tachycardia (NSVT) were reviewed (Monahan et al, 2009). Respiratory disturbances (apneas or hypopneas) occurring during hazard periods defined as the 90s intervals preceding an AF event were compared with those occurring during referent control periods in the same subject.…”