Cardiac Rhythm Disturbances in the Obstructive Sleep Apnea Syndrome: Effects of Nasal Continuous Positive Airway Pressure Therapy

doi:10.1378/chest.118.3.591

Chest

Volume 118, Issue 3, September 2000, Pages 591-595

https://doi.org/10.1378/chest.118.3.591 Get rights and content

Study objectives

A high incidence of nocturnal cardiacrhythm disturbances among patients with obstructive sleep apnea (OSA)syndrome has been described in some reports, but not in others. Wewished to examine the prevalence of significant cardiac rhythmdisturbance in patients with established moderate to severe OSAsyndrome and , in particular, to assess the impact of nasal continuouspositive airway pressure (nCPAP) therapy.

Design and setting

A prospective study of consecutive eligible patients ina dedicated sleep disorders unit of a university teachinghospital.

Measurements and results

Holter monitoringwas performed for 18 h in 45 patients with previously diagnosed, OSA syndrome (mean [SD] apnea/hypopnea frequency [AHI] of 50[23]/h) and repeated within 2 to 3 days after institution of n, CPAPtherapy. Investigators were blinded to the patients’ treatmentsduring data analysis. Thirty-five patients were found to have somecardiac rhythm disturbance, but only 8 had pathologically significantdisturbances (ventricular tachycardia or fibrillation, complexventricular ectopy, new-onset supraventricular tachycardia other thansinus tachycardia, pauses of > 2 s, and second- or third-degree heartblock). Significant rhythm disturbances occurred only during thenighttime, and there was a significant correlation between OSA severityand the severity of rhythm disturbance (p = 0.04,r = 0.301). No significant correlation was found between, OSA severity and any other anthropometric parameter measured. n, CPAPtherapy resulted in abolition of rhythm disturbance in seven of theseeight patients; the eighth patient was found to have coexistingsevere aortic valve disease requiring valve replacement.

Conclusion

The data indicate that OSA syndrome predisposesto clinically significant cardiac rhythm disturbances that can besuccessfully controlled by n, CPAP therapy.

Section snippets

Materials and Methods

The study included 45 consecutive patients (41 men, 4women) with previously diagnosed moderate to severe OSAS (diagnosed bystandard overnight polysomnography¹⁹) who were beingevaluated in the hospital for n, CPAP therapy. Prior to institution ofn, CPAP, 18-h, four-lead, two-channel ambulatory ECG recordings wereperformed (from 6:00 pm to 12:00 am the nextmorning) on each patient using a Holter monitor (Tracker 2 Holter Monitor; Reynolds Medical; Hertford, UK) with concurrent overnightoximetry

Results

Anthropometric and clinical details are given in Table 1. The study population included a broad spectrum of OSAS severity, although most patients had severe disorders. The mean fastingcholesterol was just above the upper limit of normal for our laboratory(5.8 mmol/L), indicating a high incidence of hypercholesterolemia inthe study population. Following tape analysis, the patients wereclassified into three groups: group 0, those with no rhythmdisturbances; group 2, those with significant rhythm

Discussion

The present findings indicate that cardiac rhythm disturbances are common during sleep among patients with OSAS, but they are largelyabolished following the institution of n, CPAP therapy. The exclusivenocturnal nature of the rhythm disturbances in these patients contrastswith the more common pattern of rhythm disturbances in patients withcardiac disease, where rhythm disturbances are less frequent duringsleep than during wakefulness.²¹ An interesting finding ofthe present study is that

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Clinical outcomes and plaque characteristics in patients with coronary artery disease and concomitant sleep-disordered breathing treated by continuous positive airway pressure
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Sleep-disordered breathing (SDB) is a risk factor for recurrent adverse events in patients with coronary artery disease (CAD). However, the prognosis of continuous positive alveolar pressure (CPAP) treatment for SDB with CAD remains unknown.
A total of 281 consecutive patients with stable CAD requiring percutaneous coronary intervention (PCI) were included and classified into three groups according to the concomitance of SDB and CPAP treatment (untreated SDB group, n = 61; CPAP-SDB group, n = 24; and non-SDB group, n = 138). The incidence of major adverse cardiac and cerebrovascular events (MACCEs) within a year after PCI was compared between the three groups. The characteristics of the culprit plaques, including macrophage accumulation, were further assessed using optical coherence tomography.
The incidence of MACCEs was significantly different among the three groups (p = 0.037), with the highest incidence in the untreated-SDB group (22.9%) and 8.3% and 10.1% in the CPAP-SDB and non-SDB groups, respectively. The incidence of MACCEs at 1 year was significantly lower in patients with appropriate CPAP use than that in inadequately treated patients with SDB (0.0 vs. 22.5%, p = 0.048). Macrophage accumulation differed significantly among the three groups, with the highest accumulation in the untreated SDB group.
CPAP treatment for SDB may be associated with a lower incidence of MACCEs following PCI and a lower prevalence of macrophages in the culprit plaques.
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Citation Excerpt :
For this reason, the 2018 ACC/AHA/HRS guidelines give a Class I recommendation to screen for symptoms of OSA in patients with nocturnal bradycardia, with subsequent confirmatory testing as directed by clinical suspicion.10 If OSA is confirmed, a Class I recommendation is given for treatment directed specifically at OSA, since continuous positive airway pressure has been shown to effectively suppress these bradyarrhythmias during sleep.9,11 These same guidelines, however, give a Class III recommendation against pacing in patients with sleep-related sinus pauses unless other indications for pacing are present.
Prevalence, types and treatment of bradycardia in obstructive sleep apnea - A systematic review and meta-analysis
2022, Sleep Medicine
The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We sought to clarify the prevalence of comorbid OSA and bradycardia, and the effect of continuous positive airway pressure (CPAP) therapy on bradycardia outcomes.
We systematically searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) for randomized or observational studies reporting the co-prevalence of sleep apnea and bradycardia or evaluated the use of CPAP on the incidence of bradycardias. We used random-effects models in all meta-analyses and evaluated heterogeneity using I².
We included 34 articles from 7204 records, comprising 4852 patients. Among patients with OSA, the pooled prevalence of daytime and nocturnal bradycardia were 25% (95% CI: 18.6 to 32.7) and 69.8% (95% CI: 41.7 to 88.2) respectively. Among patients with bradycardia, the pooled prevalence of OSA was 56.8% (95% CI: 21.5 to 86.3). CPAP treatment, compared to those without, did not significantly reduce the risk of daytime (two randomized trials; RR: 0.50; 95% CI: 0.11 to 2.21) or nocturnal bradycardia (one randomized-controlled trial and one cohort study; RR: 0.76; 95% CI: 0.48 to 1.20).
This meta-analysis demonstrates a high comorbid disease burden between OSA and bradycardia. Future research should explore the treatment effect of CPAP on bradycardia incidence, as compared to placebo.
Obstructive Sleep Apnea and Cardiovascular Disease
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2021, Perioperative Medicine: Managing for Outcome, Second Edition
2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2019, Heart Rhythm

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Chest

Clinical InvestigationsSleepCardiac Rhythm Disturbances in the Obstructive Sleep Apnea Syndrome: Effects of Nasal Continuous Positive Airway Pressure Therapy

Study objectives

Design and setting

Measurements and results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Chest

Am J Cardiol

J Electrocardiol

Chest

Lancet

Am J Med

Clin Chest Med

Am J Cardiol

Am J Cardiol

Heart block in patients with sleep apnoea

Thorax

Heart block in patients with obstructive sleep apnea: pathogenetic factors and effects of treatment

Eur Respir J

Bradycardia during sleep apnea: characteristics and mechanism

J Clin Invest

Different heart rate patterns in obstructive sleep apnea during NREM sleep

Sleep

Heart rate during obstructive sleep apnea depends on individual hypoxic chemosensitivity of the carotid body

Circulation

Sleep apnea and complete heart block

Clin Cardiol

Atrial flutter associated with obstructive sleep apnea syndrome: a case report

Arch Intern Med

Clinical Investigations
Sleep
Cardiac Rhythm Disturbances in the Obstructive Sleep Apnea Syndrome: Effects of Nasal Continuous Positive Airway Pressure Therapy