Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.
BACKGROUND
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>or=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.
Mehra
Reena
R
Department of Medicine and Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA. mehrar@ameritech.net
Benjamin
Emelia J
EJ
Shahar
Eyal
E
Gottlieb
Daniel J
DJ
Nawabit
Rawan
R
Kirchner
H Lester
HL
Sahadevan
Jayakumar
J
Redline
Susan
S
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology