title: Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs.
abstract: BACKGROUND
  Sleep apnea (SA) is associated with sudden cardiac death. Compared to central apneas, obstructive apneas are associated with negative intrathoracic pressure swings inducing autonomic imbalance, which may disturb ventricular repolarisation resulting in arrhythmias.
  
  
  OBJECTIVE
  To identify the influence of obstructive apneas versus central apneas on ventricular repolarisation.
  
  
  METHODS
  In 14 patients with SA, duration (RT-intervals) and dispersion of ventricular repolarisation [Tpeak-to-Tend-interval (TpTe)] were determined during central apneas compared to obstructive apneas. To identify mechanisms, hypoxia alone or hypoxia with applied negative thoracic pressure was applied in a pig model for SA before and after atropine (n = 7), atenolol (n = 5) and sympathetic renal denervation (RDN, n = 7).
  
  
  RESULTS
  In patients with SA, obstructive apneas during sleep were always associated with a prolongation of RT- as well as TpTe intervals. By contrast central apneas did not affect ventricular repolarisation significantly in the same patients. In the pig model for SA, 2 min of acute tracheal occlusion with applied negative thoracic pressure resulted in a prolongation in RT- and TpTe-interval. These changes in ventricular repolarisation could be inhibited by atenolol as well as by RDN and were not influenced by parasympathetic blockade by atropine. By contrast hypoxia alone did not affect ventricular repolarisation.
  
  
  CONCLUSIONS
  Intrathoracic pressure swings during obstructive apneas contribute to changes in ventricular repolarisation, which are not observed with central apneas. These changes are mainly driven by sympathetic activation and may represent mechanisms for increased occurrence of sudden cardiac death in obstructive SA.
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany. dominik.linz@uks.eu.
authors.forename: Dominik
authors.initials: D
authors.lastname: Linz
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Alisa
authors.initials: A
authors.lastname: Denner
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Illing
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Hohl
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ewen
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Reil
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Wirth
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000200:Action Potentials / Q000187:drug effects; D058671:Adrenergic beta-1 Receptor Antagonists / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D004195:Disease Models, Animal; D004562:Electrocardiography; D006339:Heart Rate; D006352:Heart Ventricles / Q000294:innervation*; D006801:Humans; D000860:Hypoxia / Q000150:complications; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000494:pharmacology; D020182:Sleep Apnea, Central / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013552:Swine; D013562:Sympathectomy; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D018727:Muscarinic Antagonists
keywords: Central sleep apnea; Heart failure; Obstructive sleep apnea; Ventricular arrhythmias; Ventricular repolarisation
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