Severe Obstructive Sleep Apnea Syndrome with Symptomatic Daytime Bradyarrhythmia

Ji, Ki‐Hwan; Kim, Dae Hyeok; Yun, Chang-Ho

doi:10.5664/jcsm.27494

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…Our study confirms the previous findings [ 42 ] in which CPAP application revealed an absence of a sinus and AV block in mild sleep apnoea, which was better explained by pressure effects. Different from an optimal pressure of 15 cm H 2 O to make the observed arrhythmia disappeared as recorded by Ki-Hwan Ji [ 15 ], our curve show a pressure of 12 H 2 O cm generates the greatest benefit except for the improvement in O 2 saturation.…”

Section: Discussioncontrasting

confidence: 83%

“…One randomised controlled trial by Sonya Craig et al [ 13 ] confirmed that there was no significant reduction in frequencies of dysrhythmias comparing therapeutic CPAP groups with the subtherapeutic control, in contrast to the results of another randomized controlled study [ 14 ] that confirmed the alleviation of ventricular ectopy by CPAP in patients with heart failure. Moreover, one case report [ 15 ] demonstrated that despite atrial pacing, occasional atrioventricular (AV) block still persisted during patient’s follow-up. According to the study of Fietze [ 16 ], the prevalence of sleep disorder breathing (SDB) in cardiac pacemaker patients was similar to those without pacemakers.…”

Section: Introductionmentioning

confidence: 99%

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Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study

Liu

Chang

et al. 2016

Respir Res

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BackgroundNocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP).MethodsPatients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP.ResultsThe symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of episodes of heart block, from 148.58 ± 379.44 to 16.07 ± 58.52 (p < 0.05), same to the change of the longest RR pausing time (from 4.38 ± 2.95 s to 0.57 ± 1.05 s, p = 0.169) in 51 patients. The optimal therapy pressure to make the observed arrhythmia disappeared is 12 cm H2O.ConclusionConcerning high prevalence of OSA in heart block patients, BQ provided an economical and efficient screening method for OSA. For better management, CPAP therapy is feasible to prevent heart blocks avoiding unnecessary concomitant pacemaker implantation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0333-8) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study

Liu

Chang

et al. 2016

Respir Res

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“…Some case reports showed an association between OSA and atrioventricular block (88-90) that were resolved after CPAP therapy (91). However, the impact of OSA treatment on bradycardic rhythms is still unclear and relies on studies with a limited sample size (88)(89)(90)(91). For instance, one study evaluated 23 moderate-to-severe OSA patients with insertable loop recorder during 16 months and reported that almost 50% had severe nocturnal bradycardic events (91).…”

Section: Other Arrhythmiasmentioning

confidence: 99%

Cardiac rhythm disorders in obstructive sleep apnea

Geovanini

Lorenzi‐Filho

2018

J. Thorac. Dis

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Obstructive sleep apnea (OSA) is common among patients with cardiac rhythm disorders. OSA may contribute to arrhythmias due to acute mechanisms, such as generation of negative intrathoracic pressure during futile efforts to breath, intermittent hypoxia, and surges in sympathetic activity. In addition, OSA may lead to heart remodeling and increases arrhythmia susceptibility. Atrial distension and remodeling, that has been shown to be associated with OSA, is a well-known anatomical substrate for atrial fibrillation (AF). AF is the arrhythmia most commonly described in patients with OSA. Several observational studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) reduces recurrence of AF after electrical cardioversion and catheter ablation. There is also evidence that nocturnal hypoxemia, a hallmark of OSA, predicts sudden cardiac death (SCD) independently of well-established cardiovascular risk factors. Among patients with an implantable cardiac defibrillator, those with OSA have a higher risk of receiving treatment for life-threatening arrhythmias. Nocturnal hypoxemia may also increase vagal tone, which increases susceptibility to bradycardic and conduction rhythm disorders that have also been described in patients with OSA. In conclusion, there are several biological pathways linking OSA and increased cardiac arrhythmogenesis propensity. However, the independent association is derived from observational studies and the direction of the association still needs clarification due to the lack of large clinical trials. This review focuses on the current scientific evidence linking OSA to cardiac rhythm disorders and point out future directions.

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“…299 A recently published study performed in a large population of Japanese OSAS patients demonstrated the efficacy of CPAP in preventing OSAS-associated arrhythmias. 300 These studies have reported an increased association between OSAS and bradyarrhythmias 301,302 due mainly to parasympathetic hyperactivity that occurs during the apneic phase. In contrast, the Sleep Heart Health Study failed to demonstrate a significant association between bradycardia and OSAS.…”

Section: Obstructive Sleep Apnea Syndrome and Endocrine-metabolic Dismentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Cardiovascular Diseases

Fava

Montagnana

Favaloro

et al. 2011

Semin Thromb Hemost

110

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Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or complete upper airway collapse and obstruction during sleep, associated with intermittent oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Increasing focus is being placed on the relationship between OSAS and all-cause and cardiovascular disease-related mortality, but it still largely unclear whether this association is causative or simply speculative and epidemiological. Basically, reliable clinical evidence supports the hypothesis that OSAS might be associated with essential and resistant hypertension, as well as with an incremental risk of developing stroke, cardiac rhythm perturbations (e.g., atrial fibrillation, bradyarrhythmias, supraventricular and ventricular arrhythmias), coronary artery disease, acute myocardial infarction, and heart failure. Although it is still unclear whether OSAS might represent an independent risk factor for several acute or chronic conditions, or rather might trigger cardiovascular disease in the presence of traditional cardiovascular risk factors (e.g., obesity, diabetes, and dyslipidemia), there is a plausible biological background underlying this association, in that most of the mechanisms implicated in the pathogenesis of OSAS (i.e., hypoxia, hypercapnia, negative intrathoracic pressure, micro-arousal, sympathetic hyperactivity, metabolic and hormonal changes, oxidative stress, phlogosis, endothelial dysfunction, hypercoagulability, and genetic predisposition) might also be involved in the pathogenesis of cardiovascular disorders. In this article we discuss the different aspects of the relationship between OSAS and pathogenically different conditions such as systemic hypertension, coronary artery disease, stroke, metabolic abnormalities, arrhythmias, and heart failure, and we also discuss the kaleidoscope of phenomena implicated in the pathogenesis of this challenging disease.

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Severe Obstructive Sleep Apnea Syndrome with Symptomatic Daytime Bradyarrhythmia

Cited by 9 publications

References 7 publications

Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study

Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study

Cardiac rhythm disorders in obstructive sleep apnea

Obstructive Sleep Apnea Syndrome and Cardiovascular Diseases

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