Published ahead of print on January 19, 2006, doi:10.1164/rccm.200509-1442OC
American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 910-916, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200509-1442OC
Association of Nocturnal Arrhythmias with Sleep-disordered Breathing
The Sleep Heart Health Study
Reena Mehra,
Emelia J. Benjamin,
Eyal Shahar,
Daniel J. Gottlieb,
Rawan Nawabit,
H. Lester Kirchner,
Jayakumar Sahadevan and
Susan Redline
Departments of Medicine and Pediatrics, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota
Correspondence and requests for reprints should be addressed to Reena Mehra, M.D., M.S., Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail: mehrar{at}ameritech.net
Rationale: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development.
Objective: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing.
Methods: 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  30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index < 5).
Results: 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.
Conclusions: 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.
Key Words: arrhythmia • cohort studies • epidemiology • sleep apnea syndromes
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|
|
|
|
|
|
|
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|
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|
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|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
J Amit Benjamin and K E Lewis
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|
|
|
|
|
|
|
W. T. McNicholas
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293(4):
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|
|
|
|
|
|
|
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293(4):
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|
|
|
|
|
|
|
S. Garrigue, J.-L. Pepin, P. Defaye, F. Murgatroyd, Y. Poezevara, J. Clementy, and P. Levy
High Prevalence of Sleep Apnea Syndrome in Patients With Long-Term Pacing: The European Multicenter Polysomnographic Study
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|
|
|
|
|
|
|
R. L. Horner and T. D. Bradley
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March 1, 2007;
175(5):
426 - 431.
[Full Text]
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|
|
|
|
|
|
|
W. T. McNicholas, M. R. Bonsignore, and the Management Committee of EU COST ACTION B26
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January 1, 2007;
29(1):
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[Full Text]
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|
|
|
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