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Published ahead of print on January 19, 2006, doi:10.1164/rccm.200509-1442OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 8, April 2006, 910-916

A more recent version of this article appeared on April 15, 2006
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Submitted on September 14, 2005
Accepted on January 17, 2006

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

Reena Mehra1*, Emelia J Benjamin2, Eyal Shahar3, Daniel J Gottlieb2, Rawan Nawabit1, H. Lester Kirchner1, Jayakumar Sahadevan1, and Susan Redline1

1 Department of Pulmonary and Critical Care, Case Western Reserve University, Cleveland, OH, USA, 2 Department of Cardiology, Boston University School of Medicine, Boston, MA, USA, 3 Department of Epidemiology, University of Minnesota, Minneapolis, MN, USA

* To whom correspondence should be addressed. 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: a) 228 subjects with sleep-disordered breathing (respiratory disturbance index≥30); and b) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5). Results: Atrial fibrillation, non-sustained ventricular tachycardia, and complex ventricular ectopy (non-sustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep- disordered breathing compared to those without sleep- disordered breathing: 4.8% vs. 0.9% (p=0.003 for atrial fibrillation; 5.3% vs. 1.2% (p=0.004) for non-sustained ventricular tachycardia; 25.0% vs. 14.5% (p=0.002) for complex ventricular ectopy. Compared to those without sleep-disordered breathing; 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 (OR 4.02; 95% CI 1.03-15.74), three times the odds of non-sustained 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/hour (p<0.0003) considered as a continuous outcome. Conclusions: Individuals with severe sleep-disordered breathing have a 2 to 4 fold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.
Key words: Arrhythmia, Sleep Apnea Syndromes, Cohort Studies, Epidemiology




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