Chest
Volume 127, Issue 1, January 2005, Pages 15-22
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Clinical Investigations: Cardiology
Cardiac Rhythm Disturbances and ST-Segment Depression Episodes in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome and Its Mechanisms*

https://doi.org/10.1378/chest.127.1.15Get rights and content

Study objectives

To compare the frequency of daytime and nocturnal cardiac arrhythmias and ST-segment depression episodes among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), snoring subjects, and healthy subjects, and to analyze the relationship between the cardiac disturbances, sleep characteristics, and sympathetic tone in patients with OSAHS.

Patients and interventions

Twenty-one consecutive patients with OSAHS, 12 snorers without hypersomnolence, and 15 healthy subjects were selected. Polysomnography, 24-h Holter ECG recording, and urinary catecholamine determination were simultaneously performed on all subjects.

Results

Patients with OSAHS had more daytime and nocturnal episodes of sinus and supraventricular arrhythmias and couplets than the snoring and control groups. Moreover, nocturnal ST-segment depression episodes were more frequent in the OSAHS group than in control subjects (0.565 ± 0.826/h vs 0 ± 0/h [mean ± SD]). In patients with OSAHS, arousal index and daytime epinephrine levels were related to daytime and nocturnal ST-segment depression episodes, whereas minimum arterial oxygen saturation was related to nocturnal sinus bradycardia and supraventricular tachycardia. Epinephrine and norepinephrine urinary concentrations correlated with sinus and supraventricular arrhythmias.

Conclusions

Patients with OSAHS have a higher frequency of cardiac rhythm disturbances and ST-segment depression episodes than snoring and control subjects. Moreover, ST-segment changes are related to sympathetic tone and sleep fragmentation, whereas most of the rhythm disturbances in patients with OSAHS are associated with sleep fragmentation, nocturnal hypoxemia, and sympathetic tone.

Section snippets

Study Subjects

Twenty-one consecutive patients with OSAHS, 12 consecutive snorers without hypersomnolence (Epworth sleepiness scale < 5), and 15 age- and body mass index (BMI)-matched healthy subjects were selected for study. Patients were excluded from the study for the following reasons: (1) unwillingness or inability to perform the testing procedure; (2) obstructive or restrictive lung disease demonstrated on pulmonary function testing; (3) known valvular heart disease or hypertension, based on the mean of

Results

Anthropometric characteristics sleep architecture, lung function, and BP in patients with OSAHS, snorers, and control subjects are given in Table 1. There were no significant differences in gender, age, weight, height, BMI, or smoking habit among the three groups. The mean values of forced expiratory lung volumes, arterial blood gases, pH, hemoglobin concentration, and office BP were similar in all groups.

Daytime and nocturnal catecholamine concentrations in urine are also shown in Table 1.

Discussion

The main results of this study are the following: (1) patients with OSAHS have a higher frequency of most of the cardiac arrhythmias analyzed and ST-segment dynamic changes, in comparison with snoring and control subjects; and (2) ST-segment depression episodes are related to sleep fragmentation and sympathetic tone, whereas most of the rhythm disturbances in patients with OSAHS are associated with sleep fragmentation, nocturnal hypoxemia, and urinary catecholamine excretion.

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    Supported by grants from Fondo de Investigaciones Sanitarias (96/1280, 99/0252, 01/0276, and 01/0278) and Neumomadrid (2000).

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    *

    From Servicios de Neumología (Drs. Alonso-Fern´ndez, García-Río, Pino, and Villamor), Cardiología (Dr. Ortuño), and Laboratorio de Bioquímica (Dr. Martínez), Hospital Universitario La Paz; and Sección de Neumología (Dr. Racionero), Hospital de Alcorcón, Alcorcón, Madrid, Spain.

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