Triggering of nocturnal arrhythmias by sleep-disordered breathing events.
Triggering of nocturnal arrhythmias by sleep-disordered breathing events.
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DOI：
10.1016/j.jacc.2009.06.038
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发表时间：
2009-11-03
影响因子：
24
通讯作者：
Redline, Susan
中科院分区：
文献类型：
--
作者：
Monahan, Ken;Storfer-Isser, Amy;Mehra, Reena;Shahar, Eyal;Mittleman, Murray;Rottman, Jeff;Punjabi, Naresh;Sanders, Mark;Quan, Stuart F.;Resnick, Helaine;Redline, Susan
本研究旨在评估呼吸紊乱是否是睡眠呼吸障碍 (SDB) 患者心律失常的潜在诱因。 SDB 与心房颤动 (AF) 和非持续性室性心动过速 (NSVT) 的风险增加以及夜间睡眠期间心源性猝死的倾向有关。然而，先前的研究尚未确定呼吸紊乱是否会引发夜间心律失常。对睡眠心脏健康研究 (n = 2816) 的隔夜多导睡眠图 (PSG) 进行阵发性心房颤动 (PAF) 和 NSVT 筛查。我们使用病例交叉设计来确定呼吸暂停和/或呼吸不足是否在时间上与 PAF 或 NSVT 发作相关。对于每种心律失常，将 3 个窦性心律周期确定为控制间隔。在每个心律失常或控制期之前的 90 秒危险期内，检查 PSG 是否存在呼吸紊乱、氧饱和度降低和皮质唤醒。 57 名具有广泛 SDB 的参与者导致了 62 例心律失常（76% NSVT）。呼吸障碍后发生心律失常的几率几乎是正常呼吸后发生心律失常的几率的 18 倍（OR 17.5；95% CI 5.3-58.4）。与呼吸障碍相关的心律失常的绝对发生率较低（1 次过度心律失常/40000 次呼吸障碍）。单独缺氧和脑电图定义的唤醒均不会增加心律失常的风险。尽管绝对心律失常发生率较低，但呼吸障碍后不久，睡眠期间发生 PAF 和 NSVT 的相对风险显着增加。这些结果支持 SDB 事件与这些心律失常的发展之间存在直接的时间联系。
This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in those with sleep-disordered breathing (SDB). SDB is associated with increased risk of atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. Overnight polysomnograms (PSGs) from the Sleep Heart Health Study (n = 2816) were screened for paroxysmal atrial fibrillation (PAF) and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of PAF or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. PSGs were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-second hazard period preceding each arrhythmia or control period. Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia following a respiratory disturbance were nearly 18-times (OR 17.5; 95% CI 5.3–58.4) the odds of an arrhythmia occurring following normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia/40000 respiratory disturbances). Neither hypoxia nor EEG-defined arousals alone increased arrhythmia risk. Although the absolute arrhythmia rate is low, the relative risk of PAF and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.
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