PURPOSE: Sleep Disordered Breathing (SDB) is associated physiologic stresses (e.g. hypoxia, hyperadrenergic activity) that may predispose to arrhythmias. We examined whether SDB was associated with nocturnal cardiac arrhythmias and whether increase severity of SDB is associated with increased risk of nocturnal cardiac arrhythmias.
METHODS: From a total of 309 consecutive veterans referred for overnight PSG for suspected SDB between 2000 and 2002, Polysomnographic (PSG), clinical and PSG-EKG information were collected. We used logistic regression to examine the association between SDB and nocturnal cardiac arrhythmias. We used chi-squared test for linear trend to examine a dose-response relationship between severity of SDB (AHI< 5; AHI 5-15; AHI>15) and the risk of having nocturnal cardiac arrhythmias.
RESULTS: Complex Ventricular Arrhythmias (bigeminy or trigeminy or quadrigeminy or nonsustained ventricular tachycardia) and Intraventricular Conduction Delays were more common in subjects with SDB compared with those without SDB (P-value 0.001) Patients with SDB had 2.7 times the odds of Complex Ventricular Arrhythmias (unadjusted OR 2.7, 95% CI 1.5-4.8) and 3 times the odds of Intraventricular Conduction Delays (unadjusted OR 3, 95%CI 1.6-5.8) than those without SDB. A linear trend was identified between the severity of SDB and nocturnal cardiac arrhythmias including Complex Ventricular Arrhythmias (P-value linear trend 0.001) and Complex Atrial Arrhythmias (P-value linear trend 0.01).
CONCLUSION: Our primary analysis demonstrates a significant association between nocturnal cardiac arrhythmias and SDB. There is a dose-response relationship between severity of SDB and the risk of having nocturnal cardiac arrhythmias.
CLINICAL IMPLICATIONS: The association of SDB with nocturnal arrhythmias may provide a potential explanation for the observed day-night pattern of sudden cardiac death in this population. The treatment of SDB may present a novel management approach to stabilize or reverse nocturnal arrhythmias in a population susceptible for other adverse cardiovascular events.
DISCLOSURE: Bernardo Selim, No Financial Disclosure Information; No Product/Research Disclosure Information