Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive sleep apnea-hypopnea syndrome and its mechanisms.
OBJECTIVE
To compare the frequency of daytime and nocturnal cardiac arrhythmias and ST-segment depression episodes among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), snoring subjects, and healthy subjects, and to analyze the relationship between the cardiac disturbances, sleep characteristics, and sympathetic tone in patients with OSAHS.


METHODS
Twenty-one consecutive patients with OSAHS, 12 snorers without hypersomnolence, and 15 healthy subjects were selected. Polysomnography, 24-h Holter ECG recording, and urinary catecholamine determination were simultaneously performed on all subjects.


RESULTS
Patients with OSAHS had more daytime and nocturnal episodes of sinus and supraventricular arrhythmias and couplets than the snoring and control groups. Moreover, nocturnal ST-segment depression episodes were more frequent in the OSAHS group than in control subjects (0.565 +/- 0.826/h vs 0 +/- 0/h [mean +/- SD]). In patients with OSAHS, arousal index and daytime epinephrine levels were related to daytime and nocturnal ST-segment depression episodes, whereas minimum arterial oxygen saturation was related to nocturnal sinus bradycardia and supraventricular tachycardia. Epinephrine and norepinephrine urinary concentrations correlated with sinus and supraventricular arrhythmias.


CONCLUSIONS
Patients with OSAHS have a higher frequency of cardiac rhythm disturbances and ST-segment depression episodes than snoring and control subjects. Moreover, ST-segment changes are related to sympathetic tone and sleep fragmentation, whereas most of the rhythm disturbances in patients with OSAHS are associated with sleep fragmentation, nocturnal hypoxemia, and sympathetic tone.
Alonso-Fernández
Alberto
A
Servicios de Neumología, Hospital Universitario La Paz, Spain. aaf_97@hotmail.com
García-Río
Francisco
F
Racionero
Miguel A
MA
Pino
José M
JM
Ortuño
Fernando
F
Martínez
Isabel
I
Villamor
José
J
D001143:Arousal; D001146:Arrhythmia, Sinus / Q000453:epidemiology; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000453:epidemiology*; D001794:Blood Pressure; D002395:Catecholamines / Q000097:blood; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000453:epidemiology*; D012913:Snoring / Q000453:epidemiology*
D002395:Catecholamines