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Clinical Investigations: CARDIOLOGY |

Cardiac Rhythm Disturbances and ST-Segment Depression Episodes in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome and Its Mechanisms*

Alberto Alonso-Fernández, PhD; Francisco García-Río, PhD; Miguel A. Racionero, PhD; José M. Pino, PhD; Fernando Ortuño, MD; Isabel Martínez, MD; José Villamor, PhD
Author and Funding Information

*From Servicios de Neumología (Drs. Alonso-Fernández, García-Río, Pino, and Villamor), Cardiología (Dr. Ortuño), and Laboratorio de Bioquímica (Dr. Martínez), Hospital Universitario La Paz; and Sección de Neumología (Dr. Racionero), Hospital de Alcorcón, Alcorcón, Madrid, Spain.

Correspondence to: Alberto Alonso-Fernández, PhD, Marte 32, 28760 Tres Cantos. Madrid, Spain; e-mail: aaf_97@hotmail.com



Chest. 2005;127(1):15-22. doi:10.1378/chest.127.1.15
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Study objectives: To compare the frequency of daytime and nocturnal cardiac arrhythmias and ST-segment depression episodes among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), snoring subjects, and healthy subjects, and to analyze the relationship between the cardiac disturbances, sleep characteristics, and sympathetic tone in patients with OSAHS.

Patients and interventions: Twenty-one consecutive patients with OSAHS, 12 snorers without hypersomnolence, and 15 healthy subjects were selected. Polysomnography, 24-h Holter ECG recording, and urinary catecholamine determination were simultaneously performed on all subjects.

Results: Patients with OSAHS had more daytime and nocturnal episodes of sinus and supraventricular arrhythmias and couplets than the snoring and control groups. Moreover, nocturnal ST-segment depression episodes were more frequent in the OSAHS group than in control subjects (0.565 ± 0.826/h vs 0 ± 0/h [mean ± SD]). In patients with OSAHS, arousal index and daytime epinephrine levels were related to daytime and nocturnal ST-segment depression episodes, whereas minimum arterial oxygen saturation was related to nocturnal sinus bradycardia and supraventricular tachycardia. Epinephrine and norepinephrine urinary concentrations correlated with sinus and supraventricular arrhythmias.

Conclusions: Patients with OSAHS have a higher frequency of cardiac rhythm disturbances and ST-segment depression episodes than snoring and control subjects. Moreover, ST-segment changes are related to sympathetic tone and sleep fragmentation, whereas most of the rhythm disturbances in patients with OSAHS are associated with sleep fragmentation, nocturnal hypoxemia, and sympathetic tone.

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