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Association of Nocturnal Arrhythmias with Sleep-disordered Breathing

The Sleep Heart Health Study

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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