Methadone Destabilizes Cardiac Repolarization During Sleep.
Methadone Destabilizes Cardiac Repolarization During Sleep.
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DOI：
10.1002/cpt.2368
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发表时间：
2021-10
影响因子：
6.7
通讯作者：
Haigney MC
中科院分区：
文献类型：
--
作者：
Solhjoo S;Punjabi NM;Ivanescu AE;Crainiceanu C;Gaynanova I;Wicken C;Buckenmaier C 3rd;Haigney MC
美沙酮是一种广泛用于治疗慢性疼痛和阿片类药物成瘾的处方药，它与呼吸抑制和尖头扭转（一种潜在致命的心律失常）的易感性增加有关。大多数美沙酮相关死亡发生在睡眠期间。本研究的目的是确定美沙酮的致心律失常效应是否在睡眠期间增加，重点是使用QT变异性指数（QTVI）研究心脏复极不稳定性，这是一种预测心律失常和死亡率的测量方法。将24名接受慢性美沙酮治疗的患者转到三级诊所进行夜间多导睡眠检查的睡眠研究数据与两组不接受美沙酮治疗的患者进行比较：24名患者转到同一诊所进行夜间多导睡眠检查（临床组），24名志愿者在家中进行夜间多导睡眠检查（社区组）。尽管清醒时心率、心率变异性、校正QT间期、QTVI和氧饱和度（SpO2）的值相似，但美沙酮组患者睡眠时QTVI较大（p=0.015，与临床相比p<0.001）， SpO2较低（p=0.008，与临床相比p=0.013），睡眠时QTVI的增加与SpO2的降低相关（r=-0.54, p=0.013）。QTVI与睡眠时（r=0.51, p=0.012）和清醒时（r=0.73, p<0.001）美沙酮剂量呈正相关。高密度异位（每中位睡眠期早产1000次）是点扭转的前兆，不常见，但在美沙酮患者中更为常见（p=0.039）。这项研究表明，长期使用美沙酮与心脏复极不稳定性增加有关。美沙酮的促心律失常影响可能是由睡眠相关的低氧血症介导的，这可以解释与这种阿片类药物相关的夜间死亡率增加。
Methadone, a widely-prescribed medication for chronic pain and opioid addiction, is associated with respiratory depression and increased predisposition for torsades de pointes, a potentially fatal arrhythmia. Most methadone-related deaths occur during sleep. The objective of this study was to determine whether methadone’s arrhythmogenic effects increase during sleep, with a focus on cardiac repolarization instability using QT variability index (QTVI), a measure shown to predict arrhythmias and mortality. Sleep study data of 24 patients on chronic methadone therapy referred to a tertiary clinic for overnight polysomnography were compared with two matched groups not on methadone: 24 patients referred for overnight polysomnography to the same clinic (Clinic group), and 24 volunteers who had overnight polysomnography at home (Community group). Despite similar values for heart rate, heart rate variability, corrected QT interval, QTVI and oxygen saturation (SpO2) when awake, patients on methadone had larger QTVI (p=0.015 vs Clinic, p<0.001 vs Community) and lower SpO2 (p=0.008 vs Clinic, p=0.013 vs Community) during sleep, and the increase in their QTVI during sleep versus wakefulness correlated with the decrease in SpO2 (r=-0.54, p=0.013). QTVI positively correlated with methadone dose during sleep (r=0.51, p=0.012) and wakefulness (r=0.73, p<0.001). High-density ectopy (>1000 premature beats per median sleep period), a precursor for torsades de pointes, was uncommon but more frequent in patients on methadone (p=0.039). This study demonstrates that chronic methadone use is associated with increased cardiac repolarization instability. Methadone’s pro-arrhythmic impact may be mediated by sleep-related hypoxemia which could explain the increased nocturnal mortality associated with this opioid.
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影响因子：
39.3
作者：
Noda, T;Shimizu, W;Kamakura, S
通讯作者：
Kamakura, S
影响因子：
24
作者：
Haigney, MC;Zareba, W;Moss, AJ
通讯作者：
Moss, AJ
影响因子：
5.9
作者：
Chugh, Sumeet S.;Socoteanu, Carmen;Gunson, Karen
通讯作者：
Gunson, Karen
DOI：
10.1111/j.1540-8167.2006.00421.x
发表时间：
2006-06-01
影响因子：
2.7
作者：
Haigney, MCP;Alam, S;Cantilena, L
通讯作者：
Cantilena, L
影响因子：
39.2
作者：
Kao, David;Bartelson, Becki Bucher;Krantz, Mori J.
通讯作者：
Krantz, Mori J.