title: The Association between Nocturnal Cardiac Arrhythmias and Sleep-Disordered Breathing: The DREAM Study.
abstract: To determine whether sleep-disordered breathing (SDB) is associated with cardiac arrhythmia in a clinic-based population with multiple cardiovascular comorbidities and severe SDB.
  
  
  
  This was a cross-sectional analysis of 697 veterans who underwent polysomnography for suspected SDB. SDB was categorized according to the apnea-hypopnea index (AHI): none (AHI < 5), mild (5 ≥ AHI < 15), and moderate-severe (AHI ≥ 15). Nocturnal cardiac arrhythmias consisted of: (1) complex ventricular ectopy, (CVE: non-sustained ventricular tachycardia, bigeminy, trigeminy, or quadrigeminy), (2) combined supraventricular tachycardia, (CST: atrial fibrillation or supraventricular tachycardia), (3) intraventricular conduction delay (ICD), (4) tachyarrhythmias (ventricular and supraventricular), and (5) any cardiac arrhythmia. Unadjusted, adjusted logistic regression, and Cochran-Armitage testing examined the association between SDB and cardiac arrhythmias. Linear regression models explored the association between hypoxia, arousals, and cardiac arrhythmias.
  
  
  
  Compared to those without SDB, patients with moderate-severe SDB had almost three-fold unadjusted odds of any cardiac arrhythmia (2.94; CI 95%, 2.01-4.30; p < 0.0001), two-fold odds of tachyarrhythmias (2.16; CI 95%,1.47-3.18; p = 0.0011), two-fold odds of CVE (2.01; 1.36-2.96; p = 0.003), and two-fold odds of ICD (2.50; 1.58-3.95; p = 0.001). A linear trend was identified between SDB severity and all cardiac arrhythmia subtypes (p value linear trend < 0.0001). After adjusting for age, BMI, gender, and cardiovascular diseases, moderate-severe SDB patients had twice the odds of having nocturnal cardiac arrhythmias (2.24; 1.48-3.39; p = 0.004). Frequency of obstructive respiratory events and hypoxia were strong predictors of arrhythmia risk.
  
  
  
  SDB is independently associated with nocturnal cardiac arrhythmias. Increasing severity of SDB was associated with an increasing risk for any cardiac arrhythmia.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Bernardo J
authors.initials: BJ
authors.lastname: Selim
authors.affiliation: Department of Neurology, Connecticut Veterans Affairs Health System, West Haven, CT.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Koo
authors.affiliation: Yale Center of Analytical Science (YCAS) Yale School of Epidemiology and Public Health, New Haven, CT.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.
authors.forename: Christine
authors.initials: C
authors.lastname: Won
authors.affiliation: Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Redeker
authors.affiliation: Department of Internal Medicine, Section of Cardiology/Electrophysiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Lampert
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.|Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT.
authors.forename: John P
authors.initials: JP
authors.lastname: Concato
authors.affiliation: Departments of Internal Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN.|Center of Excellence on Implementing Evidence-based Practice (CIEBP), Richard L. Roudebush VA Medical Center, Indianapolis IN.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.affiliation: Departments of Internal Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN.
authors.forename: Jared
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Kingman
authors.initials: K
authors.lastname: Strohl
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.|Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.|Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Andrey
authors.initials: A
authors.lastname: Zinchuk
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.|Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.|Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Henry K
authors.initials: HK
authors.lastname: Yaggi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology; D014728:Veterans / Q000706:statistics & numerical data
keywords: atrial fibrillation; autonomic nervous system; cardiac arrhythmias; hypoxemia; obstructive sleep apnea; sleep-disordered breathing; sudden cardiac death