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Solhjoo S, Haigney MC, Punjabi NM. Sleep-disordered breathing destabilizes ventricular repolarization: Cross-sectional, longitudinal, and experimental evidence. Heart Rhythm 2024:S1547-5271(24)03272-7. [PMID: 39214391 DOI: 10.1016/j.hrthm.2024.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) increases the risk of cardiac arrhythmias and sudden cardiac death. OBJECTIVE This study sought to characterize the associations between SDB, intermittent hypoxemia, and the beat-to-beat QT variability index (QTVI), a measure of ventricular repolarization lability associated with cardiac arrhythmias and sudden cardiac death. METHODS Three distinct cohorts were used: a matched sample of 122 participants with and without severe SDB for cross-sectional analysis; a matched sample of 52 participants with and without incident SDB for longitudinal analysis; and a sample of 19 healthy adults exposed to acute intermittent hypoxia and ambient air on 2 separate days. The cross-sectional and longitudinal cohorts were the Sleep Heart Health Study participants with no known comorbidities who were not taking any drugs known to affect cardiac repolarization and satisfied the inclusion criteria. Electrocardiographic measures were calculated from 1-lead electrocardiograms. RESULTS Participants with severe SDB had greater QTVI than those without SDB (P = .027). Total sleep time with <90% oxygen saturation, but not the arousal frequency, was a predictor of QTVI. QTVI during sleep was predictive of all-cause mortality. With incident SDB, mean QTVI increased from -1.23 to -0.86 during 5 years (P = .017). Finally, experimental exposure of healthy adults to acute intermittent hypoxia for 4 hours progressively increased QTVI (P = .016). CONCLUSION The results show that both prevalent SDB and incident SDB are associated with ventricular repolarization instability and suggest intermittent hypoxemia as the underlying mechanism that may contribute to increased mortality in SDB.
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Affiliation(s)
- Soroosh Solhjoo
- Johns Hopkins University School of Medicine, Baltimore, Maryland; F. Edward Hébert School of Medicine, Bethesda, Maryland.
| | - Mark C Haigney
- F. Edward Hébert School of Medicine, Bethesda, Maryland; Military Cardiovascular Outcomes Research (MiCOR), Bethesda, Maryland
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Ebrahimian S, Sillanmäki S, Hietakoste S, Kulkas A, Töyräs J, Bailón R, Hernando D, Lombardi C, Grote L, Bonsignore MR, Saaresranta T, Pépin JL, Leppänen T, Kainulainen S. Beat-to-beat cardiac repolarization lability increases during hypoxemia and arousals in obstructive sleep apnea patients. Am J Physiol Heart Circ Physiol 2024; 326:H1094-H1104. [PMID: 38426864 PMCID: PMC11380986 DOI: 10.1152/ajpheart.00760.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
Obstructive sleep apnea (OSA) is associated with the progression of cardiovascular diseases, arrhythmias, and sudden cardiac death (SCD). However, the acute impacts of OSA and its consequences on heart function are not yet fully elucidated. We hypothesized that desaturation events acutely destabilize ventricular repolarization, and the presence of accompanying arousals magnifies this destabilization. Ventricular repolarization lability measures, comprising heart rate corrected QT (QTc), short-time-variability of QT (STVQT), and QT variability index (QTVI), were calculated before, during, and after 20,955 desaturations from lead II electrocardiography signals of 492 patients with suspected OSA (52% men). Variations in repolarization parameters were assessed during and after desaturations, both with and without accompanying arousals, and groupwise comparisons were performed based on desaturation duration and depth. Regression analyses were used to investigate the influence of confounding factors, comorbidities, and medications. The standard deviation (SD) of QT, mean QTc, SDQTc, and STVQT increased significantly (P < 0.01), whereas QTVI decreased (P < 0.01) during and after desaturations. The changes in SDQT, mean QTc, SDQTc, and QTVI were significantly amplified (P < 0.01) in the presence of accompanying arousals. Desaturation depth was an independent predictor of increased SDQTc (β = 0.405, P < 0.01), STVQT (β = 0.151, P < 0.01), and QTVI (β = 0.009, P < 0.01) during desaturation. Desaturations cause acute changes in ventricular repolarization, with deeper desaturations and accompanying arousals independently contributing to increased ventricular repolarization lability. This may partially explain the increased risk of arrhythmias and SCD in patients with OSA, especially when the OSA phenotype includes high hypoxic load and fragmented sleep.NEW & NOTEWORTHY Nocturnal desaturations are associated with increased ventricular repolarization lability. Deeper desaturations with accompanying arousals increase the magnitude of alterations, independent of confounding factors, comorbidities, and medications. Changes associated with desaturations can partially explain the increased risk of arrhythmias and sudden cardiac death in patients with OSA, especially in patients with high hypoxic load and fragmented sleep. This highlights the importance of detailed electrocardiogram analytics for patients with OSA.
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Affiliation(s)
- Serajeddin Ebrahimian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Salla Hietakoste
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David Hernando
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sleep and Vigilance Laboratory, Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Jean-Louis Pépin
- Inserm U1300, HP2 Laboratory, University of Grenoble Alpes, Grenoble, France
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Solhjoo S, Haigney MC, Siddharthan T, Koch A, Punjabi NM. Sleep-Disordered Breathing Destabilizes Ventricular Repolarization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.02.10.23285789. [PMID: 36824787 PMCID: PMC9949208 DOI: 10.1101/2023.02.10.23285789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Rationale Sleep-disordered breathing (SDB) increases the risk of cardiac arrhythmias and sudden cardiac death. Objectives To characterize the associations between SDB, intermittent hypoxemia, and the beat-to-beat QT variability index (QTVI), a measure of ventricular repolarization lability associated with a higher risk for cardiac arrhythmias, sudden cardiac death, and mortality. Methods Three distinct cohorts were used for the current study. The first cohort, used for cross-sectional analysis, was a matched sample of 122 participants with and without severe SDB. The second cohort, used for longitudinal analysis, consisted of a matched sample of 52 participants with and without incident SDB. The cross-sectional and longitudinal cohorts were selected from the Sleep Heart Health Study participants. The third cohort comprised 19 healthy adults exposed to acute intermittent hypoxia and ambient air on two separate days. Electrocardiographic measures were calculated from one-lead electrocardiograms. Results Compared to those without SDB, participants with severe SDB had greater QTVI (-1.19 in participants with severe SDB vs. -1.43 in participants without SDB, P = 0.027), heart rate (68.34 vs. 64.92 beats/minute; P = 0.028), and hypoxemia burden during sleep as assessed by the total sleep time with oxygen saturation less than 90% (TST90; 11.39% vs. 1.32%, P < 0.001). TST90, but not the frequency of arousals, was a predictor of QTVI. QTVI during sleep was predictive of all-cause mortality. With incident SDB, mean QTVI increased from -1.23 to -0.86 over 5 years (P = 0.017). Finally, exposing healthy adults to acute intermittent hypoxia for four hours progressively increased QTVI (from -1.85 at baseline to -1.64 after four hours of intermittent hypoxia; P = 0.016). Conclusions Prevalent and incident SDB are associated with ventricular repolarization instability, which predisposes to ventricular arrhythmias and sudden cardiac death. Intermittent hypoxemia destabilizes ventricular repolarization and may contribute to increased mortality in SDB.
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Affiliation(s)
- Soroosh Solhjoo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
| | - Mark C. Haigney
- F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR), Bethesda, Maryland, USA
| | | | - Abigail Koch
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Araujo M, Mehra R. The Influence of Physiologic Burdens Related to Obstructive Sleep Apnea on Cardiovascular Outcomes. Am J Respir Crit Care Med 2023; 208:752-754. [PMID: 37610456 PMCID: PMC10563193 DOI: 10.1164/rccm.202307-1243ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/23/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Matheus Araujo
- Neurological Institute Cleveland Clinic Foundation Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland, Ohio
| | - Reena Mehra
- Neurological Institute Respiratory Institute
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland, Ohio
- Department of Cardiovascular and Metabolic Sciences Cleveland Clinic Lerner Research Institute Cleveland, Ohio
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Immanuel SA, Shahrbabaki SS, Baumert M. Symbolic dynamics of sleep heart rate variability is associated with cognitive decline in older men. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083241 DOI: 10.1109/embc40787.2023.10340848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
We aimed to investigate the association between autonomic and cognitive functions in older men. We investigated heart rate variability (HRV) during sleep using time domain metrics and symbolic dynamics analysis of inter-beat intervals. These metrics were statistically analysed for associations with cognitive function which was elicited by administering the modified mini-mental state examination (3MS) and the Trail making test part-B in older men participating in the MrOS sleep study.Multivariable linear regression adjusted for age, body-mass-index (BMI), apnea-hypopnea index (AHI) and arousal index (A.I.) showed that symbolic dynamics of HRV especially the 0V% which is a measure of sympathetic outflow to the heart during rapid eye movement (REM) sleep is significantly associated with 3MS and Trail B scores. In conclusion, nonlinear HRV during sleep provides a unique window to probe the association between cognitive and autonomic function.Clinical Relevance- This study shows that cognitive decline is associated with altered cardiac autonomic function.
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