Clues to the Pathophysiology of Sudden Cardiac Death in Obstructive Sleep Apnea

Grishina, I. F.; Перетолчина, Т. Ф.; Solenskaia, Olga Georgievna; Ковтун, О. П.; Teplyakova, O.; Chernjadev, Sergey Aleksandrovich; Попов, А. А.; Kurmin, Viacheslav Valentinovich

doi:10.1159/000490308

Cited by 11 publications

(6 citation statements)

References 51 publications

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“…OSA results in intermittent hypoxia and oxygen desaturation during sleep, which may cause over-arousal of the central nervous system (CNS) in order to increase airflow. The complex relationship between the sympathetic nervous system (SNS) and autonomic nervous system (ANS) causes a brief increase in both systolic and diastolic blood pressure (BP) during apneas [42][43]. The repeated exposure to an elevated BP continuously stresses the body.…”

Section: Discussionmentioning

confidence: 99%

Sudden death in patients with sleep apnea: a systematic review and meta-analysis

Heilbrunn¹,

Ssentongo

Chinchilli³

et al. 2020

Preprint

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Background: Over 1 billion individuals across the globe experience some form of sleep apnea, and this number is steadily rising. OSA can negatively influence ones quality of life (QOL), while also increasing their risk of mortality from many causes. However, the association between OSA and mortality has not been comprehensively and thoroughly explored. This meta-analysis was conducted to conclusively estimate the risk of death for all-cause mortality and cardiovascular mortality in OSA patients. Study Design: 4,613 articles from databases including PUBMED, OVID & Joana Briggs, and SCOPUS were comprehensively assessed by two reviewers (AES & ESH) for inclusion criteria. 28 total articles were included, with 22 of them being used for quantitative analysis. Pooled effects of all-cause mortality, cardiac mortality, and sudden death were calculated by utilizing the metaprop function in R Statistical Software and the random-effects model with appropriate 95% confidence intervals. Results: Analysis on 42,032 individuals revealed that those with OSA were twice as likely to die from cardiac mortality compared to those without sleep apnea (HR= 1.94, 95%CI 1.39-2.70). Likewise, individuals with OSA were 1.7 times as likely to die from all-cause mortality compared to individuals without sleep apnea (HR= 1.74, 95%CI 1.40-2.10). Conclusions: Individuals with obstructive sleep apnea are at an increased risk for all-cause mortality and cardiac mortality. Further research related to appropriate interventions and treatments are necessary in order to reduce this risk and optimize survival in this population.

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Section: Discussionmentioning

confidence: 99%

Sudden death in patients with sleep apnea: a systematic review and meta-analysis

Heilbrunn¹,

Ssentongo

Chinchilli³

et al. 2020

Preprint

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“…Ventricular repolarisation is evaluated with QT interval corrected by heart rate (QTc) in electrocardiogram (ECG). A prolonged QTc is related to an increased risk of sudden cardiac death according to the arrhythmia 6 . It is known that hypothyroidism was related with QTc prolongation 7,8 .…”

Section: Introductionmentioning

confidence: 99%

“…A prolonged QTc is related to an increased risk of sudden cardiac death according to the arrhythmia. 6 It is known that hypothyroidism was related with QTc prolongation. 7,8 Besides, a study of patients with a mean age…”

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confidence: 99%

The assessment of Tp‐e interval and Tp‐e/QT ratio in patients with hyperthyroidism before and after thyroid surgery

Aydin¹,

Yayla

2021

Int J Clinical Practice

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Background Ventricular repolarisation is assessed using the Tp‐e interval and QT interval corrected by the heart rate (QTc) via an electrocardiogram (ECG). Prolonged Tp‐e/QTc is related with an increased risk of arrhythmias and cardiac mortality. Objective This study was conducted at a single centre in collaboration with general surgery and cardiology clinics. We aimed to appraise the assessment of Tp‐e interval and Tp‐e/QT ratio in patients with hyperthyroidism before and after thyroid surgery. Methods Totally 65 patients with hyperthyroidism before and after thyroid surgery were enrolled in our study. In presurgical hospitalisation and six months after the thyroid surgery, we measured the electrocardiographic parameters again on same patients. All subjects who were investigated in this study were in sinus rhythm. Tp‐e interval, Tp‐e/QT and Tp‐e/QTc ratios were measured from the 12‐lead electrocardiogram. Results Heart rate (P = .073), QT interval (P = .432) and QTc interval (P = .179) were similar before and after thyroid surgery. Tp‐e interval (84.6 ± 13.1 vs 77.2 ± 10.9; P = .031), Tp‐e/QT ratio (0.23 ± 0.04 vs 0.21 ± 0.04; P < .001), Tp‐e/QTc ratio (0.21 ± 0.04 vs 0.19 ± 0.03; P < .001) and QTc dispersion (52.4 ± 7.2 vs 48.4 ± 7.4; P < .001) were significantly different before and after thyroid surgery. In correlation analysis, there was a significant correlation between preprocedural Tp‐e/QTc ratio and preprocedural fT4 in patients with hyperthyroidism (r = 0.275, P = .026). Conclusion Our study demonstrated that Tp‐e interval, Tp‐e/QT and Tp‐e/QTc ratios were shortened in patients with hyperthyroidism after thyroid surgery than before procedure. This study is considerable to display that hyperthyroidism may have a negative effect on cardiac conduction system, which potentially may induce formation of ventricular arrhythmias.

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“…However, this association is not clearly understood and several pathophysiological mechanisms have been proposed to explain how OSA leads to arrhythmogenesis and SCD [7]. An intriguing question that has arisen is whether OSA may lead to SCD in the absence of established cardiovascular disease.…”

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confidence: 99%

“…In their review article, Roth et al [7] searched the literature for data reporting the impact of OSA on cardiac arrhythmias, and they aim to demonstrate the pathophysiological mechanisms associated with OSA and SCD (intermittent nocturnal hypoxia, autonomic function, ion channel remodeling, electrolyte shifts, and others). The authors conclude that OSA should be included in the risk assessment for SCD by the Russian National Society of Arrhythmology as an independent risk factor.…”

mentioning

confidence: 99%