Relations among hypoxemia, sleep stage, and bradyarrhythmia during obstructive sleep apnea☆,☆☆
Section snippets
Patients
During a 17-month period 239 patients were found to have sleep apnea in an ambulatory study. In addition to the clinical interview and physical examination, a visually analyzed ambulatory monitoring of breathing sounds, heart rate, oxygen saturation, and body position (MESAM IV, Madaus Schwarzer, Munich, Germany) from 6 PM until 8 AM and a 2-channel Holter electrocardiogram (ECG) (Oxford Medilog 4000, Abingdon, UK) from approximately 2 PM until 8 AM were recorded.
Patients with nocturnal
Clinical characteristics of all study patients
Twenty-one of 239 patients were women. Mean age was 52 ± 10 years (range 16 to 78 years), body mass index was 32 ± 5 kg/m2 (range 20 to 58 kg/m2). Arterial hypertension was found in 47.3%, diabetes mellitus in 6%, hyperlipidemia in 49%, and hyperuricemia in 19%. Three of the patients (1%) had a history of myocardial infarction and 9 patients (3%) had evidence of coronary artery disease determined by bicycle stress test. Mean RDI was 29 ± 25 per hour (range 10 to 158 per hour). Episodes of sinus
Discussion
The major findings of the study are: (1) Patients with apnea-associated bradyarrhythmias are more overweight than patients without bradyarrhythmia. The higher RDI found in these patients may be caused by this circumstance. (2) Bradyarrhythmia occurred predominantly during REM sleep. (3) Bradyarrhythmia were found independently from decrease in SaO2; a threshold value as an upper limit could not be defined.
Obesity has been shown to be a predisposing factor for the occurrence of bradyarrhythmia
References (19)
Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance
Am J Med
(1982)- et al.
Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy
Am J Med
(1977) - et al.
Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome
Am J Cardiol
(1983) - et al.
Electrophysiological evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea
Am J Cardiol
(1996) - et al.
Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment
Eur Resp J
(1998) - et al.
Bradycardia during sleep apnea. Characteristics and mechanism
J Clin Invest
(1982) - et al.
Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure
Am J Respir Crit Care Med
(1995) - et al.
Einfluß der nCPAP-therapie auf bradycarde herzrhythmusstörungen bei schlafapnoe (SA)
Pneumologie
(1993) - et al.
A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects
(1968)
Cited by (68)
Prevalence, types and treatment of bradycardia in obstructive sleep apnea - A systematic review and meta-analysis
2022, Sleep MedicineCitation Excerpt :OSA is a condition that involves repeated upper airway collapse and oxygen desaturation during sleep [68]. It has been proposed that OSA causes bradycardia due to negative intrathoracic pressure from the stretch of thoracic cavity [69,70]; moreover, hypoxemia may also induce a vagally-mediated cardioprotective mechanism [71,72]. Furthermore, the cessation of breathing, together with hypoxemia seen in OSA, is necessary to cause bradycardia [73].
Sleep in infants with congenital myasthenic syndromes
2017, European Journal of Paediatric NeurologyCitation Excerpt :The role of oxygen desaturation as trigger of severe bradycardia during OSA is controversial, as the prolonged negative intrathoracic pressures during OSA may be more important as a trigger of increased vagal tone than oxygen desaturation.25,28 Bradycardia occurring during an apnoea represents a vagal response to hypoxaemia aiming at limiting the oxygen consumption of the heart.29,30 However some studies also reported the occurrence of tachycardia associated with respiratory events during sleep in infants or preschool children with OSA.31–34
Obstructive Sleep Apnea and the Metabolic Syndrome: Clinical Profiles and Relationships
2015, Modulation of Sleep by Obesity, Diabetes, Age, and DietArrhythmia and sleep-disordered breathing in patients undergoing cardiac surgery
2012, Journal of CardiologySleep-Related Cardiac Disorders
2012, Therapy in Sleep Medicine
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Reprint requests: Ulrich Koehler, MD, Department of Internal Medicine, Medizinische Poliklinik, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
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0002-8703/2000/$12.00 + 0 4/1/101492