Sinus Arrest during Rem Sleep in Young Adults

Abstract

Four apparently healthy young adults with vague chest symptoms during the day, two of whom had infrequent syncope while ambulatory at night, had periods of asystole up to nine seconds in duration occurring repeatedly during rapid-eye-movement (REM) sleep. Extensive evaluations, including electrophysiologic studies in two patients, were normal. It is therefore suggested that the underlying pathophysiology involved autonomic dysfunction. REM sleep-related sinus arrests such as these, which may occur in apparently healthy subjects but are undetected, may explain some cases of sudden, unexpected death during sleep. Polygraphic monitoring during sleep may be helpful in delineating the pathophysiology of the sleep-related arrhythmia in persons with daytime cardiac arrhythmias thought to be secondary to abnormal vagal tone. The possibility of nocturnal asystole should be considered in patients such as those described here.

Sleep Apnea and Cardiovascular Disease

“…Note, however, that bradyarrhythmias have been reported in REM sleep even in healthy young subjects. 249 If the underlying cardiac conduction system is normal and there is no significant thyroid dysfunction, bradyarrhythmias or heart block, both of which occur during apneic periods, may be treated effectively with CPAP or, if necessary, with tracheostomy. 230,244,245,250 Observational data suggest that the presence of untreated OSA in patients after successful cardioversion for atrial fibrillation is associated with an 82% risk for recurrence of atrial fibrillation within 1 year, about double the risk seen in effectively treated OSA patients after cardioversion.…”

Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment

“…GUILLEMINAULT et al [12] reported asystolic periods up to 9 s in duration only during REM sleep in four apparently healthy young adults without sleep-related breathing disorder. NEVINS [13] describ-ed the case of a patient with heart failure who developed episodes of AV block also during REM sleep.…”

Prolonged Sinus Pause with Sleep Apnea Syndrome: A Case Report

“…Most arrhythmias that occur during sleep are detected incidentally on Holter monitoring and are benign, however, 15% of fatal ventricular arrhythmias still occur in sleep resulting in sudden nocturnal death. 1 Bradyarrhythmia, sinus pauses > 2 seconds and atrioventricular (AV) conduction delays commonly occur during sleep in young and healthy individuals specially more frequently in young athletes and less frequently in those over 80 years of age. In a series, long sinus pauses upto 9 seconds, were reported in 4 healthy athletes without cardiac disorders.…”

“…Human beings spend approximately one-third of their lives asleep 1 . Although generally considered to be a peaceful stable period for the body and mind to rest and heal, sleep in fact represents a complex dynamic process involving dynamic changes in physiological state.…”

“…In a series, long sinus pauses upto 9 seconds, were reported in 4 healthy athletes without cardiac disorders. 1 It is important to recognize predisposing factors to sleep-related arrhythmia in order to prevent and treat potentially dangerous cardiac rhythm. In patients with significant obstructive sleep apnea (OSA), even more dramatic conduction blockade can occur, and ventricular asystole of up to 15.6 seconds was described.…”