QT interval variability index and QT interval duration during different sleep stages in patients with obstructive sleep apnea

Viigimäe, Moonika; Karai, Deniss; Pilt, Kristjan; Pirn, Peeter; Huhtala, Heini; Polo, Olli; Meigas, Kalju; Kaik, J.

doi:10.1016/j.sleep.2017.06.026

Cited by 18 publications

(26 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sympathetic tonus modulates ventricular repolarization in the healthy myocardium, but its effect on diseased cardiac substrate is less clear (16,27,35). Sympathetic tone is higher in REM sleep than in NREM sleep (40), but, surprisingly, previous studies have reported no sleep stage-specific changes in QTV (4,22,44,45). This fact seems all the more puzzling because heart rate variability (HRV) that influences over QTV reflects such changes (4,8,42).…”

Section: Introductionmentioning

confidence: 99%

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Schmidt

Baumert

Penzel

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

The objective of the present study was to quantify repolarization lability and its association with sex, sleep stage, and cardiovascular mortality. We analyzed polysomnographic recordings of 2,263 participants enrolled in the Sleep Heart Health Study (SHHS-2). Beat-to-beat QT interval variability (QTV) was quantified for consecutive epochs of 5 min according to the dominant sleep stage [wakefulness, nonrapid eye movement stage 2 (NREM2), nonrapid eye movement stage 3 (NREM3), and rapid eye movement (REM)]. To explore the effect of sleep stage and apnea-hypopnea index (AHI) on QT interval parameters, we used a general linear mixed model and mixed ANOVA. The Cox proportional hazards model was used for cardiovascular disease (CVD) death prediction. Sex-related differences in T wave amplitude ( P < 0.001) resulted in artificial QTV differences. Hence, we corrected QTV parameters by T wave amplitude for further analysis. Sleep stages showed a significant effect ( P < 0.001) on QTV. QTV was decreased in deep sleep compared with wakefulness, was higher in REM than in NREM, and showed a distinct relation to AHI in all sleep stages. The T wave amplitude-corrected QTV index (cQTVi) in REM sleep was predictive of CVD death (hazard ratio: 2.067, 95% confidence interval: 1.105–3.867, P < 0.05) in a proportional hazards model. We demonstrated a significant impact of sleep stages on ventricular repolarization variability. Sex differences in QTV are due to differences in T wave amplitude, which should be corrected for. Independent characteristics of QTV measures to sleep stages and AHI showed different behaviors of heart rate variability and QTV expressed as cQTVi. cQTVi during REM sleep predicts CVD death. NEW & NOTEWORTHY We demonstrate here, for the first time, a significant impact of sleep stages on ventricular repolarization variability, quantified as QT interval variability (QTV). We showed that QTV is increased in rapid eye movement sleep, reflective of high sympathetic drive, and predicts death from cardiovascular disease. Sex-related differences in QTV are shown to be owing to differences in T wave amplitude, which should be corrected for.

show abstract

Section: Introductionmentioning

confidence: 99%

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Schmidt

Baumert

Penzel

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…In GISSI‐HF, QTVI was lower during the hours of sleep (QTVI = −1.18) and higher during the hours of waking ( P < 0.0001) 28 . Viigimae et al studied QTVI in subjects with and without obstructive sleep apnea and found that in men with sleep‐disordered breathing, QTVI values were lower during sleep than during wake 29 . In study samples with varying degrees of obstructive sleep apnea, Schmidt et al .…”

Section: Discussionmentioning

confidence: 99%

Methadone Destabilizes Cardiac Repolarization During Sleep

Solhjoo

Punjabi

Ivanescu

et al. 2021

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

Methadone, a widely-prescribed medication for chronic pain and opioid addiction, is associated with respiratory depression and increased predisposition for torsades de pointes, a potentially fatal arrhythmia. Most methadone-related deaths occur during sleep. The objective of this study was to determine whether methadone's arrhythmogenic effects increase during sleep, with a focus on cardiac repolarization instability using QT variability index (QTVI), a measure shown to predict arrhythmias and mortality. Sleep study data of 24 patients on chronic methadone therapy referred to a tertiary clinic for overnight polysomnography were compared with two matched groups not on methadone: 24 patients referred for overnight polysomnography to the same clinic (Clinic group), and 24 volunteers who had overnight polysomnography at home (Community group). Despite similar values for heart rate, heart rate variability, corrected QT interval, QTVI and oxygen saturation (SpO 2 ) when awake, patients on methadone had larger QTVI (p=0.015 vs Clinic, p<0.001 vs Community) and lower SpO 2 (p=0.008 vs Clinic, p=0.013 vs Community) during sleep, and the increase in their QTVI during sleep versus wakefulness correlated with the decrease in SpO 2 (r=-0.54, p=0.013). QTVI positively correlated with methadone dose during sleep (r=0.51, p=0.012) and wakefulness (r=0.73, p<0.001).High-density ectopy (>1000 premature beats per median sleep period), a precursor for torsades de pointes, was uncommon but more frequent in patients on methadone (p=0.039). This study demonstrates that chronic methadone use is associated with increased cardiac repolarization instability. Methadone's pro-arrhythmic impact may be mediated by sleep-related hypoxemia which could explain the increased nocturnal mortality associated with this opioid.

show abstract

“…However, the study group was smaller and even more heterogeneous in terms of age and body weight than in the presented study. Also, Viigimae et al, while examining OSA patients, observed a correlation between breathing disorders and QTV by analyzing different sleep stages (27). So far, there was no study concerning this problem conducted on a bigger than 50 patients group, with no less control group.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea destabilizes myocardial repolarization homogeneity

Jarecka-Dobron¹,

Chrom²,

Braksator

2020

Preprint

View full text Add to dashboard Cite

Background: Literature shows that patients with obesity and Obstructive Sleep Apnea (OSA), both occurring independently, are more likely to develop cardiovascular diseases and sudden cardiac death (SCD). Assuming that ventricular depolarization is more stable than repolarization then QT interval parameters may be used for heart muscle repolarization assessment for those groups of patients. Methods: There were 121 patients included in the study, both - women and men, aging from 35-65 with visceral obesity. Only healthy patients were included - the ones who were not treated for any chronic disease, taking QT elongating drugs, or were not treated with Continuous Positive Airway Pressure (CPAP) therapy at that time. Results: OSA was diagnosed in 70 patients (including 41 males). A statistically significant difference for QT interval parameters between OSA positive and negative patients was found (p<0.001 for all variables). No difference for QTc max or for QT interval parameters between groups of patients with different OSA severity degrees was found. A correlation between QTVi2 and QTVi3 (p=0.008) and between polygraphy specific parameters and QTc max, QTVi2 and QTVi3 was found. Conclusions: OSA has a negative influence on heart muscle repolarization processes by increasing QTV and QTVi values, without such an impact on QTc max interval among patients with visceral obesity. A temporary intensification of OSA causes an additional increase in QTVi value. OSA severity degree expressed by specific parameters taken from polygraphic examination prolongs QTc max and increases QTV and QTVi values.

show abstract

QT interval variability index and QT interval duration during different sleep stages in patients with obstructive sleep apnea

Cited by 18 publications

References 35 publications

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Methadone Destabilizes Cardiac Repolarization During Sleep

Obstructive Sleep Apnea destabilizes myocardial repolarization homogeneity

Contact Info

Product

Resources

About