Sleep-disordered breathing in patients with the Brugada syndrome.
We investigated breathing patterns and the occurrence of arrhythmias and ST-segment changes during sleep in patients with Brugada syndrome. Patients with Brugada syndrome are more likely to die from ventricular arrhythmias during sleep. ST-segment changes have been correlated with risk of sudden cardiac death. Whether sleep disturbances may contribute to arrhythmogenesis is unknown. Patients with Brugada syndrome underwent overnight polysomnography with simultaneous 12-lead electrocardiographic recording. A control group matched by age, gender, and body mass index (BMI) also underwent polysomnography. Twenty patients were included (50 ± 15 years old, 75% men). Despite their normal BMI (24.7 ± 2.7 kg/m(2)), 45% had sleep-disordered breathing (SDB), with a mean apnea-hypopnea index of 17.2 ± 14 events/hour. In patients with a high risk of arrhythmias, 5 (63%) had SDB. In the control group, 27% had SDB. Atrial or ventricular arrhythmias were not observed. Spontaneous ST-segment changes occurred in 2 patients over 45 different time points. Most ST-segment changes were observed during rapid eye movement sleep (31%) or within 1 minute of arousals (44%). Regarding respiratory events, 25 (56%) of ST-segment changes were related to occurrence of apnea or hypopnea. In conclusion, patients with Brugada syndrome have a high prevalence of SDB even in the setting of normal BMI. The higher incidence of nocturnal death in patients with Brugada syndrome may be conceivably related to co-morbid SDB. Moreover, autonomic instability encountered in rapid eye movement sleep and arousals could potentiate the risk of arrhythmias.
Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA.
Paula G
PG
Macedo
Josep
J
Brugada
Pavel
P
Leinveber
Begoña
B
Benito
Irma
I
Molina
Fatima
F
Sert-Kuniyoshi
Taro
T
Adachi
Jan
J
Bukartyk
Christelle
C
van der Walt
Tomas
T
Konecny
Shantal
S
Maharaj
Tomas
T
Kara
Josep
J
Montserrat
Virend
V
Somers
D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
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