Association of Nocturnal Arrhythmias with Sleep-disordered Breathing: The Sleep Heart Health Study

• Published in: American journal of respiratory and critical care medicine Vol. 173; no. 8; pp. 910 - 916
• Main Authors: Mehra, Reena, Benjamin, Emelia J, Shahar, Eyal, Gottlieb, Daniel J, Nawabit, Rawan, Kirchner, H. Lester, Sahadevan, Jayakumar, Redline, Susan
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 15.04.2006; American Lung Association; American Thoracic Society
• Subjects: Adult and adolescent clinical studies; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anxiety disorders. Neuroses; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Biological and medical sciences; Circadian Rhythm - physiology; Electrocardiography; Emergency and intensive respiratory care; F. Sleep and Control of Ventilation; Female; Follow-Up Studies; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Odds Ratio; Polysomnography; Post-traumatic stress disorder; Prevalence; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk Factors; Severity of Illness Index; Sleep - physiology; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - physiopathology; Nervous system diseases; Sleep apnea syndrome; Intensive care; Arrhythmia; Respiratory disease; Heart disease; Cohort study; cohort studies; Cardiovascular disease; sleep apnea syndromes; Epidemiology; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200509-1442OC

Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development. We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing. The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index>or=30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5). Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p=0.003) for atrial fibrillation; 5.3 versus 1.2% (p=0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5% (p=0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.03-15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95% CI, 1.03-11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95% CI, 1.11-2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p<0.0003) considered as a continuous outcome. Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.