Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators
Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators
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DOI：
10.1016/j.hrthm.2010.12.030
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发表时间：
2011-05-01
期刊：
影响因子：
5.5
通讯作者：
Boulos, Monther
中科院分区：
文献类型：
--
作者：
Zeidan-Shwiri, Tawfiq;Aronson, Doron;Boulos, Monther
背景：睡眠呼吸障碍（SDB）与睡眠中发生的各种良性心律失常有关。目的：本研究的目的是证明SDB有助于有心律失常底物的患者发生危及生命的室性心律失常。方法前瞻性研究45例植入式心律转复除颤器（ICD）患者SDB与危及生命的室性心律失常事件发生时间的关系。SDB定义为基于夜间睡眠研究的呼吸暂停-低通气指数（AHI） bbb10事件/小时。主要结局指标是适当的ICD治疗，在1年随访期间定义为抗心动过速起搏或室性心动过速或室性颤动的休克。结果26例（57.8%）患者存在SDB。适当的ICD治疗在SDB患者中更高（73% vs 47%, P = 0.02）。Logistic回归发现SDB是任何适当的ICD治疗的预测因子（优势比4.4,95%置信区间1.4-15.3,P = 0.01）。SDB患者发生室性心律失常的风险更高，仅仅是因为在午夜至早上6点之间发生的事件增加（优势比5.6,95%置信区间2.0-15.6,P = 0.001），而在非睡眠时间进行适当的ICD治疗没有明显的影响（优势比0.7,95%置信区间0.2-2.3,P = 0.61）。结论ICD和SDB患者在睡眠时间发生危及生命的室性心律失常事件的几率显著增加。这些发现为在适当的ICD治疗的患者中进行SDB筛查提供了理论依据，如果设备询问显示夜间起搏心律失常的优势。
BACKGROUND Sleep-disordered breathing (SDB) has been associated with various benign cardiac arrhythmias occurring during sleep.OBJECTIVE The purpose of this study was to demonstrate that SDB contributes to the development of life-threatening ventricular arrhythmias in patients with an established arrhythmic substrate.METHODS We prospectively studied the association between SDB and timing of life-threatening ventricular arrhythmic events in 45 patients with an implantable cardioverter-defibrillator (ICD). SDB was defined as an apnea-hypopnea index (AHI) >10 events/hour based on an overnight sleep study. The primary outcome measure was appropriate ICD therapy, defined as antitachycardia pacing or shock for ventricular tachycardia or ventricular fibrillation during 1-year follow-up.RESULTS SDB was present in 26 (57.8%) patients. Appropriate ICD therapies were higher among patients with SDB (73% vs 47%, P = .02). Logistic regression identified SDB as a predictor of any appropriate ICD therapy (odds ratio 4.4, 95% confidence interval 1.4-15.3, P = .01). The risk for ventricular arrhythmias was higher in patients with SDB solely due to an increase in events occurring between midnight and 6 AM (odds ratio 5.6, 95% confidence interval 2.0-15.6, P = .001) with no discernible effect on appropriate ICD therapy during nonsleeping hours (odds ratio 0.7, 95% confidence interval 0.2-2.3, P = .61).CONCLUSION Patients with an ICD and SDB have a striking increase in the onset of life-threatening ventricular arrhythmic events during sleeping hours. These findings provide a rationale for SDB screening in patients with appropriate ICD therapy if device interrogation reveals a predominance of nocturnal onset of arrhythmias.