title: Association of smoking, sleep apnea, and plasma alkalosis with nocturnal ventricular arrhythmias in men with systolic heart failure.
abstract: BACKGROUND
  Excess sudden death due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiologic triggers to identify potential targets for therapy to reduce the persistently high incidence of sudden death in this population despite contemporary treatment.
  
  
  METHODS
  Eighty-six ambulatory male patients with stable low (≤ 45%) ejection fraction heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to the presence or absence of couplets (paired premature ventricular excitations) and ventricular tachycardia (VT) (at least three consecutive premature ventricular excitations) during sleep.
  
  
  RESULTS
  In multiple regression analysis, four variables (current smoking status, increased number of arousals, plasma alkalinity, and old age) were associated with VT and two variables (apnea-hypopnea index and low right ventricular ejection fraction) were associated with couplets during sleep.
  
  
  CONCLUSIONS
  We speculate that cessation of smoking, effective treatment of sleep apnea, and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of sudden death, which remains high despite the use of β blockades.
authors.affiliation: Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH. Electronic address: javaheri@snorenomore.com.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Javaheri
authors.affiliation: Departments of Medicine and Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
authors.affiliation: Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH.
authors.forename: Laura
authors.initials: L
authors.lastname: Wexler
mesh_terms: D000367:Age Factors; D000368:Aged; D000471:Alkalosis / Q000097:blood* / Q000503:physiopathology*; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012044:Regression Analysis; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000503:physiopathology*; D012907:Smoking / Q000009:adverse effects*; D013599:Systole / Q000502:physiology; D018754:Ventricular Dysfunction / Q000503:physiopathology*