Chest
Clinical Investigations: SleepCardiac Arrhythmias, Snoring, and Sleep Apnea
Section snippets
Patients
We studied 458 consecutive and unselected patients referred to the sleep clinic at St. Michael's Hospital for evaluation of possible sleep apnea. Snoring was the chief complaint in the vast majority of patients, although daytime sleepiness and tiredness were also common.
Polysomnographic Measurements
In all 458 patients, we carried out nocturnal polysomnography, which included measurements of EEG, submental, and anterior tibial EMG, oronasal flow using thermistors, chest wall and abdominal excursions using inductance
Results
Table 1 summarizes the characteristics of the patient population examined in this study. There were 336 men and 122 women. Most patients (244/458) did not have obstructive sleep apnea (OSA) (AHI ≤10), 121/458 (26 percent) had AHI between 10 and 30, 41/458 (9 percent) had AHI between 30 and 50, and 52/458 patients (11 percent) had AHI >50.
There were 82 patients with history of cardiac disease (hypertension, 51; previous myocardial infarction, 6; angina pectoris, 5; congestive heart failure, 4;
Discussion
This study shows that (1) patients with obstructive sleep apnea have higher prevalence of arrhythmia than nonapneic patients, (2) patients without arrhythmias, as a group, have less severe apnea and nocturnal hypoxemia than patients with arrhythmias, and (3) prevalence of arrhythmias is independent of snoring, but it is linked to sleep apnea and nocturnal hypoxemia. The study design has certain limitations which could conceivably influence some of our conclusions.
One of the drawbacks is the use
References (23)
Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea
Clin Chest Med
(1992)- et al.
Cardiovascular effects of sleep disorders
Chest
(1990) - et al.
Cyclical variation of the heart rate in sleep apnea syndrome
Lancet
(1984) - et al.
Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome
Am J Cardiol
(1983) Cardiac arrhythmia and conduction disturbances in the sleep apnea syndrome
Am J Med
(1982)- et al.
Arrhythmias documented by 24-hour continuous ambulatory monitoring in young women without apparent heart disease
Am Heart J
(1981) - et al.
Arrhythmias documented by 24-hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart-disease
Am J Cardiol
(1977) Nocturnal hypoxemia in patients with chronic obstructive pulmonary disease
Clin Chest Med
(1992)- et al.
Nocturnal vs diurnal cardiac arrhythmias in patients with chronic obstructive pulmonary disease
Chest
(1979) Cardiovascular stress and sleep
Ann Clin Res
(1987)
Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary artery disease
Klin Wochenschr
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Obstructive sleep apnea
2022, Handbook of Clinical NeurologyCitation Excerpt :Classically, apneas and hypopneas are accompanied by dynamic changes in heart rate, with relative bradycardia (during apnea) followed by tachycardia (postapneic arousal) (Somers et al., 1995). OSA can increase risks of atrial as well as ventricular arrhythmias (Hoffstein and Mateika, 1994) by up to 4-fold (Mehra et al., 2006) and these may occur during the daytime or nighttime (Alonso-Fernandez et al., 2005). OSA has been closely associated with new-onset atrial fibrillation (AF) (Gami et al., 2007) as well as drivers such as elevated sympathetic activity (Somers et al., 1995), prolonged coronary sinus conduction times, longer P-wave duration, and atrial enlargement (Dimitri et al., 2012).
Transfer learning artificial intelligence for automated detection of atrial fibrillation in patients undergoing evaluation for suspected obstructive sleep apnoea: a feasibility study
2021, Sleep MedicineCitation Excerpt :This is an important limitation because the AI model used in our study had only been trained to perform a binary classification (AF vs no AF – primarily sinus rhythm). As such, a high prevalence of ECGs with artefacts, other non-AF atrial arrhythmias, sinus pauses, and supraventricular and ventricular ectopics, which are frequently observed in patients with OSA [30–32], potentially contributed to the reduced specificity resulting from a misclassification of these non-AF arrhythmias and artefacts as AF by the AI model. Indeed, artefacts and traces of short-duration sinus rhythm accounted for most AF misclassifications.
Obstructive Sleep Apnea and Cardiovascular Disease
2021, Clinics in Geriatric Medicine2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society
2019, Journal of the American College of Cardiology
Revision accepted December 9