Original Article

Comparison of Abnormal Heart Rate and Nocturnal Arrhythmia in Patients with Obstructive Sleep Apnea and Normal Subjects

Abstract

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder and an important risk factor for cardiovascular diseases (CVDs). This study aimed to compare abnormal heart rate and arrhythmias among patients with OSA and normal subjects.
Materials and Methods: This case-control study was conducted on patients with OSA who were attending Imam Khomeini Hospital Sleep Lab, Tehran, Iran, to undergo a full-night polysomnography (PSG). Apnea-Hypopnea Index (AHI) was measured for study participants. Those with AHI < 5/h were considered as control (normal) and those with AHI > 15/h were considered as case (OSA) group. We compared abnormal heart rate and nocturnal arrhythmia during PSG between the two study groups.
Results: A total of 60 patients (30 cases and 30 controls) were included in this study. Abnormal heart rate (bradycardia and tachycardia) and nocturnal arrhythmia were compared between the two study groups. Twenty-eight percent of patients with moderate to severe OSA developed arrhythmia including sinus arrest, premature atrial contraction (PAC), atrial fibrillation (AF), and bigeminy premature ventricular contraction (PVC). Multiple PVC episodes were observed in 6.7% of subjects without OSA. Nocturnal arrhythmia was more common in cases; however, there was no significant difference. Mean heart rate in cases was 45 beat/minute in comparison with 68/minute in controls (P = 0.0001).
Conclusion: Different arrhythmias are observed in patients with OSA due to autonomic disorders. Bradycardia was more prevalent among patients with OSA. Regarding the association between OSA and nocturnal arrhythmias, treatment of OSA is important to prevent cardiac mortality.

1. Kasper DL, Fauci AS, Hauser SL, et al. Harrison's principles of internal medicine. 19th. New York, NY: McGraw-Hill Education; 2016. p. 1723-6.
2. Verrier RL, Josephson ME. Impact of sleep on ar-rhythmogenesis. Circ Arrhythm Electrophysiol 2009; 2: 450-9.
3. Guilleminault C, Pool P, Motta J, et al. Sinus arrest during REM sleep in young adults. N Engl J Med 1984; 311: 100610.
4. Kong TQ, Goldberger JJ, Parker M, et al. Circadian variation in human ventricular refractoriness. Circulation 1995; 92: 1507-16.
5. Svatikova A, Wolk R, Shamsuzzaman AS, et al. Serum amyloid A in obstructive sleep apnea. Circulation 2003; 108: 1451-4.
6. Sabharwal R, Zhang Z, Lu Y, et al. Receptor activity-modifying protein 1 increases baroreflex sensitivity and attenuates Angiotensin induced hypertension. Hypertension 2010; 55: 627-35.
7. Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589-94.
8. Parati G, Lombardi C, Narkiewicz K. Sleep apnea: Epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Phys-iol 2007; 293: R1671-R1683.
9. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.
10. Wolk R, Kara T, Somers VK. Sleep disordered breathing and cardiovascular disease. Circulation 2003; 108: 9-12.
11. Hoffstein V, Mateika S. Cardiac arrhythmias, snoring, and sleep apnea. Chest 1994; 106: 466-71.
12. Shepard JW, Garrison MW, Grither DA, et al. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 1985; 88: 335-40.
13. Wit AL, Rosen AR. After depolarization triggered activity in: Fozzard HA, Haber E, Jenning RB, et al, editors. The heart and cardiovascular system. New York, NY: Raven Press; 1986. p. 1449-90.
14. Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 1996; 7: 475-8.
15. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52: 490-4.
16. Koehler U, Fus E, Grimm W, et al. Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment. Eur Respir J 1998; 11: 434-9.
17. Grimm W, Koehler U, Fus E, et al. Outcome of patients with sleep apnea associated severe brady arrhythmias after continuous positive airway pressure therapy. Am J Cardiol 2000; 86: 688-92, A9.
Files
IssueVol 4 No 3-4 (2019): Summer-Autumn QRcode
SectionOriginal Article(s)
Keywords
Thermography; Thyroid gland; Sleep
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Rahimi B, Tavoosi A, Sadeghi T, Arjmand R, Edalatifard M. Comparison of Abnormal Heart Rate and Nocturnal Arrhythmia in Patients with Obstructive Sleep Apnea and Normal Subjects. J Sleep Sci. 2020;4(3-4):59-62.