Triggering of nocturnal arrhythmias by sleep-disordered breathing events.
OBJECTIVE
This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in patients with sleep-disordered breathing (SDB).


BACKGROUND
SDB is associated with an increased risk of atrial fibrillation and nonsustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias.


METHODS
Overnight polysomnograms from the Sleep Heart Health Study (n = 2,816) were screened for paroxysmal atrial fibrillation and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of paroxysmal atrial fibrillation or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. Polysomnograms were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-s hazard period preceding each arrhythmia or control period.


RESULTS
Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia after a respiratory disturbance were nearly 18 times (odds ratio: 17.5; 95% confidence interval: 5.3 to 58.4) the odds of an arrhythmia occurring after normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia per 40,000 respiratory disturbances). Neither hypoxia nor electroencephalogram-defined arousals alone increased arrhythmia risk.


CONCLUSIONS
Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.
Monahan
Ken
K
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Storfer-Isser
Amy
A
Mehra
Reena
R
Shahar
Eyal
E
Mittleman
Murray
M
Rottman
Jeff
J
Punjabi
Naresh
N
Sanders
Mark
M
Quan
Stuart F
SF
Resnick
Helaine
H
Redline
Susan
S
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000503:physiopathology*; D015992:Body Mass Index; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D018592:Cross-Over Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D017286:Polysomnography; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires