Arrhythmias and conduction disturbance
Cardiac Arrhythmias in Obstructive Sleep Apnea (from the Akershus Sleep Apnea Project)

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Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. Of these, 271 patients were diagnosed with OSA (apnea–hypopnea index [AHI] ≥5, median AHI 16.8, quartiles 1 to 3 8.9 to 32.6). Mean nadir oxygen saturations were 82% and 89% in patients with and without OSA, respectively. Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.

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Methods

This is a substudy of the Akershus Sleep Apnea Project (ASAP). The recruitment protocol and main inclusion and exclusion criteria have been previously reported.6 In brief, the Berlin Questionnaire was mailed to 30,000 randomly selected patients 30 to 65 years of age (Figure 1). The Berlin Questionnaire includes questions on daytime sleepiness, snoring, and obesity/hypertension and is used to stratify patients for risk of OSA. Of the 16,302 responders, 1,772 subjects were further categorized in

Results

In total, 535 participants were included in the clinical phase of the study (Figure 1). Of these, 49 subjects were excluded because of unsatisfactory polysomnographic recordings or technical problems with Holter registration. Baseline characteristics of subjects with and without OSA are presented in Table 2. In general, subjects diagnosed with OSA were older, more obese, and more likely to be men compared to subjects without OSA. Subjects with OSA also exhibited a higher prevalence of

Discussion

The principal findings of this study are that OSA of mainly mild and moderate severity is associated with an increased prevalence of ventricular arrhythmias in middle-aged subjects and that high AHI is independently associated with frequent ventricular premature complexes in analyses that adjusted for relevant covariates.

Our results are in line with results previously reported for patients with severe OSA. The first reports of an association between OSA and cardiac arrhythmias were in patients

Acknowledgment

We thank the staff at Akershus University Hospital, Department Stensby, and the other researchers of the ASAP who contributed to the project.

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This study was supported by Grant 2004219 the South-Eastern Norway Regional Health Authority and the University of Oslo, Oslo, Norway.

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