title: Central sleep apnoea and inflammation are independently associated with arrhythmia in patients with heart failure.
abstract: OBJECTIVE
  We examined whether the severity of central sleep apnoea (CSA) and the level of C-reactive protein are associated with the prevalence and complexity of arrhythmias, and whether these factors contribute to increased risk of nocturnal sudden death.
  
  
  RESULTS
  We prospectively examined 178 patients (age 70 ± 1 years) who were admitted to our hospital due to worsening heart failure. We recorded a simultaneous overnight cardiorespiratory polygraph and Holter ECG. Obstructive sleep apnoea was excluded and patients were dichotomized based on the median value of the central apnoea index (CAI) of 7.5/h. The prevalence and complexity of arrhythmias were compared between daytime (06:00 h to 15:00 h) and night-time (21:00 h to 06:00 h). A multivariate logistic regression analysis revealed that the CAI was associated with prevalence of atrial fibrillation (AF) [odds ratio 1.03, 95% confidence interval (CI) 1.02-2.51)] and sinus pause during the night-time period (1.12, 95% CI 1.08-1.35). The CAI and C-reactive protein were independently associated with non-sustained ventricular tachycardia during both daytime (1.22, 95% CI 1.00-6.92; and 5.82, 2.58-56.1, respectively) and night-time periods (3.57, 95% CI 1.06-13.1; and 10.7, 3.30-44.4, respectively). During a mean follow-up period of 22 months, 30 (17%) patients had cardiovascular deaths and the CSA was an independent predictor (hazard ratio 1.29, 95% CI 1.16-2.32); only 5 (2.8%) of them died due to ventricular tachyarrhythmia, occurring during wakefulness.
  
  
  CONCLUSIONS
  We demonstrated that the severity of CSA and C-reactive protein levels are independently associated with the prevalence and complexity of arrhythmias. CSA was associated with increased mortality risk, but it was not related directly to nocturnal death due to ventricular tachyarrhythmia.
authors: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors: Kan
authors: K
authors: Sano
authors: Eiichi
authors: E
authors: Watanabe
authors: Junichiro
authors: J
authors: Hayano
authors: Yuuki
authors: Y
authors: Mieno
authors: Yoshihiro
authors: Y
authors: Sobue
authors: Mayumi
authors: M
authors: Yamamoto
authors: Tomohide
authors: T
authors: Ichikawa
authors: Hiroki
authors: H
authors: Sakakibara
authors: Kazuyoshi
authors: K
authors: Imaizumi
authors: Yukio
authors: Y
authors: Ozaki
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020182:Sleep Apnea, Central / Q000097:blood / Q000150:complications*
chemical_list: D002097:C-Reactive Protein
keywords: Arrhythmia; Electrocardiogram; Holter monitoring; Sleep; Sudden cardiac death