Association between QRS Duration and Obstructive Sleep Apnea

Gupta, Shuchita; Cepeda-Valery, Beatriz; Romero‐Corral, Abel; Shamsuzzaman, Abu; Somers, Virend K.; Pressman, Gregg S.

doi:10.5664/jcsm.2256

Cited by 27 publications

(18 citation statements)

References 27 publications

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“…[ 25 ] Desai et al reported that QRS duration was a significant and independent predictor of cardiovascular mortality in general medical population. [ 26 ] Similar to the previous one,[ 27 ] our study also found that OSAS patients had prolonged QRS duration. Another point to be considered was the higher numbers of male patients in the OSA group.…”

Section: Discussionsupporting

confidence: 89%

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Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome

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Altuntaş²,

Aktop

et al. 2015

Chinese Medical Journal

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Background:Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients.Methods:Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated.Results:Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = −0.231, P = 0.203).Conclusions:In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.

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Section: Discussionsupporting

confidence: 89%

“…While OSA patients revealed longer QT durations similar to our study in literature,[ 29 ] in the study of Gupta et al mentioned above, there was no significant lengthening in QRS duration. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome

Sayın

Altuntaş²,

Aktop

et al. 2015

Chinese Medical Journal

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“…The lack of association between SDB and QRS duration is in line with the finding of Gupta et al in which severity of sleep apnea was associated with prolonged QRS in women, but not in men [33]. Since prolonged QTc is a well-known ECG marker for cardiovascular risk including sudden cardiac death [34, 35], an association of SDB with QTc prolongation might be a mechanism underlying the reported associations of SDB with adverse cardiovascular outcome and sudden cardiac death [36, 37].…”

Section: Discussionsupporting

confidence: 87%

Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men

et al. 2016

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Purpose Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities. Methods We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, β-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications. Results Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00–3.40), and median AHI was 7.06 (IQR 2.55–15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32–0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08–0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29–15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters. Conclusions Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.

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“…QRS duration) is a significant clinical marker in terms of the ventricular arrhythmic risk in OSA patients. [ 21 ] In fact, data from our study might support a potential autonomic mechanism given that PAF patients (of whom 82% were on beta-blockers) were less susceptible to simulated OSA manoeuvres in Pd and P-wave duration. In addition, augmented oxidative stress has been suggested to increase the risk of cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 68%

Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion

et al. 2016

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BackgroundA high P-wave duration and dispersion (Pd) have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF), a condition linked to obstructive sleep apnea (OSA). We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF.Methods12-lead-electrocardiography (ECG) was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM), obstructive hypopnea (inspiration through a threshold load, ITH), central apnea (AP), and during normal breathing (BL) in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis.ResultsP-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1ms and +13.8ms during MM; +11.7ms and +12.9ms during ITH; p<0.001 for all comparisons). In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05).ConclusionIntrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF.

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Association between QRS Duration and Obstructive Sleep Apnea

Abstract: QRS duration and OSA were significantly associated. Severity of OSA independently predicted prolonged QRS in women but not men. Nevertheless, prolongation of QRS duration in either sex may potentiate arrhythmic risks associated with OSA.

Cited by 27 publications

References 27 publications

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome

Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men

Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion

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