Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome

Aytemir, Kudret; Deniz, Ali; Yavuz, Bünyamin; Demir, Ahmet Uğur; Şahiner, Levent; Çiftci, Orçun; Tokgözoğlu, Lâle; Can, İlknur; Şahin, Altan; Oto, Ali̇

doi:10.1016/j.rmed.2006.10.016

Cited by 41 publications

(56 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, in patients with OSA, QT dynamicity, a marker of augmented myocardial vulnerability to arrhythmias, has been found to be related to the severity of AHI [86].…”

Section: Observational Studiesmentioning

confidence: 99%

Effects of obstructive sleep apnoea on heart rhythm

2012

View full text Add to dashboard Cite

Symptomatic obstructive sleep apnoea (OSA) has been proven to be a risk factor for hypertension and vascular dysfunction, and has been proposed to be causally related with cardiac arrhythmias and sudden cardiac death.Searches of bibliographical databases revealed that several mechanisms seem to underpin the association between OSA and cardiac arrhythmias: intermittent hypoxia associated with autonomic nervous system activation and increased oxidative stress, which may lead to cardiac cellular damage and alteration in myocardial excitability; recurrent arousals, resulting in sympathetic activation and coronary vasoconstriction; and increased negative intrathoracic pressure which may mechanically stretch the myocardial walls and, thus, promote acute changes in myocardial excitability as well as structural remodelling of the myocardium.Findings from cross-sectional studies suggest a high prevalence of cardiac arrhythmias in patients with OSA and a high prevalence of OSA in those with cardiac arrhythmias. Preliminary evidence from uncontrolled interventional studies suggests that treatment of OSA may prevent cardiac arrhythmias.In conclusion, there is preliminary evidence that OSA is associated with the development of cardiac arrhythmias. Data from randomised controlled studies are needed to definitively clarify the role of OSA in arrhythmogenesis.

show abstract

“…Furthermore, in patients with OSA, QT dynamicity, a marker of augmented myocardial vulnerability to arrhythmias, has been found to be related to the severity of AHI [86].…”

Section: Observational Studiesmentioning

confidence: 99%

Effects of obstructive sleep apnoea on heart rhythm

2012

View full text Add to dashboard Cite

show abstract

“…Ari et al 19 reported that HRT worsened in OSA while HRV did not change and there was a relationship between HRT and AHI. Aytemir et al 20 observed increased myocardial vulnerability and autonomic nervous system imbalance in OSA cases. They found that HRT, HRV and QT dynamicity parameters were significantly worse among patients with OSA.…”

Section: Discussionmentioning

confidence: 98%

“…[19][20][21][24][25][26][27] The authors of these studies thought that this deterioration might be due to hypoxia during periods of apnea. Ari et al 19 reported that HRT worsened in OSA while HRV did not change and there was a relationship between HRT and AHI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients

et al. 2016

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING: Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS: 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and < 15), moderate OSA (AHI ≥ 15 and ≤ 30) and severe OSA (AHI > 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS: HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION: HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present. RMSSD, e entre dessaturação de oxigênio e declive da turbulência (respectivamente; r = -0,22, P = 0,037; e r = -0,28, P = 0,025). CONCLUSÃO: Os resultados da VFC e TFC deterioram em AOS. Parece haver relação entre a gravidade da apneia e tais parâmetros. RESUMO

show abstract

“…The mechanisms by which OSA affects the cardiovascular system may involve mechanical effects on intrathoracic pressure, sympathetic overstimulation, intermittent hypoxia, oxidative stress, inflammation, hyper coagulation, metabolic dysregulation and endothelial dysfunction (3,5). The repetitive respiratory events cause hypoxia, hypercapnea, arousals, or disrupted sleep singly or in combination (6)(7)(8)(9)(10). These abnormal physiologic events result in increased sympathetic outflow and alterations in blood pressure control mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Influence of the severity of obstructive sleep apnea on nocturnal heart rate indices and its association with hypertension

Özeke

Gungor²,

Hızel³

et al. 2011

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

ÖZETAmaç: Kalp hızı ve kan basıncı ölçümleri otonom sinir sistemi kontrolündeki kardiyovasküler düzenleyici mekanizmaların patofizyolojisi hakkın-da önemli veriler sağlarlar. Uyku apnesi gerek sempatik sinir sistemi aktivasyonu gerekse hipertansiyon ile ilişkili yeni bir kardiyovasküler risk faktörü olarak kabul edilmektedir. Bu çalışmada uyku apnesi ciddiyetinin gece kalp hızı değerleri üzerine etkisi ve gece kalp hızı değerlerinin hipertansiyon varlığı ile ilişkisi araştırıldı. Yöntemler: Hastanemizde gece kalp hızlarını da kaydeden polisomnografi cihazı ile uyku apnesi tanısı konulan tüm hastaların tıbbi kayıtları ve polisomnografik verileri retrospektif olarak değerlendirildi. Gece en düşük, ortalama ve en yüksek kalp hızları ile uyku apnesi alt gruplarındaki değişkenlik ve hipertansiyon varlığı arasındaki ilişki araştırıldı. Bulgular: Çalışmaya toplam 540 hasta alındı. Ciddi uyku apneli bireylerde, gece "ortalama" ve "en yüksek" kalp hızları, orta (sırasıyla, p=<0.049 ve p=0.044, erkeklerde; sırasıyla, p=0.002 ve P=NS, kadınlarda) ve hafif uyku apneli (sırasıyla, p=<0.001 ve p=0.004, erkeklerde; sırasıyla, p=<0.001 ve p=0.003, kadınlarda) olan gruplara göre istatistiki anlamlı olarak daha yüksekti. Yine gece ortalama kalp hızı ile apne hipopne indeksi (Pearson's p=0.504, p<0.001 kadınlarda; Pearson's p=0.254, p<0.001 erkeklerde) ve hipertansiyon varlığı (Spearman's p=0.090, p=0.394 kadınlar-da; Spearman's p=0.272, p<0.001 erkeklerde) arasında pozitif korelasyon mevcuttu. Sonuç: Bu çalışmada gece ortalama ve en yüksek kalp hızı değerlerinin uyku apnesi ciddiyeti ve hipertansiyon varlığı ile ilişkili olduğu saptandı. Uyku apneli hastalardaki artmış sempatik sinir sistemi aktivasyonuna bağlı artan ortalama ve en yüksek kalp hızlarının, uyku apnesi ve hipertansiyon varlığı arasındaki ilişkiyi açıklayan mekanizmalardan biri olabileceği ileri sürüldü. (Anadolu Kardiyol Derg 2011; 11: 509-14) Anahtar kelimeler: Gece kalp hızı, uyku apnesi, hipertansiyon, sempatik sinir sistemi aktivasyonu ABSTRACT Objective: Both heart rate (HR) and blood pressure parameters provide important information on the pathophysiology of the cardiovascular regulatory mechanisms, and are mainly affected by the autonomic nervous system. We sought to clarify whether the severity of obstructive sleep apnea (OSA) affects nocturnal HRs and whether there is a relationship between nocturnal HRs and the presence of hypertension. Methods: We retrospectively reviewed medical records of all patients who performed nocturnal polysomnography with monitoring of HRs, and examined whether there is a relationship among the nocturnal HRs, the severity of OSA and the presence of hypertension. Results: A total of 540 patients were included in the study. Nocturnal mean and maximal HRs were significantly higher in severe OSA group than in moderate (p=0.002 and p>0.05 in females; p<0.049 and p=0.044, in males, respectively) and mild OSA groups (p<0.001 and p=0.003, respectively in females, p<0.001 and p=0.004, respectively in males); and there was a positive corr...

show abstract

Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome

Abstract: OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS.

Cited by 41 publications

References 24 publications

Effects of obstructive sleep apnoea on heart rhythm

Effects of obstructive sleep apnoea on heart rhythm

The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients

Influence of the severity of obstructive sleep apnea on nocturnal heart rate indices and its association with hypertension

Contact Info

Product

Resources

About