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Kapıcı OB, Abuş S, Ayhan S, Koparal M, Kaya H. Comparison of frontal QRS-T angle of patients with nasal septal deviation with healthy controls. BMC Cardiovasc Disord 2023; 23:415. [PMID: 37612611 PMCID: PMC10464060 DOI: 10.1186/s12872-023-03421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study compares frontal QRS-T angle (fQRS-T) in electrocardiogram (ECG) examinations of people with nasal septal deviation (NSD) with healthy controls (HC). METHODS Eighty-two patients whom a radiologist with paranasal computed tomography definitively diagnosed with NSD were included in the study. 101 individuals without NSD were selected as HC. RESULTS Compared to the HC group, the fQRS-T in was considerably wider in patients with NSD (p < .001). According to Spearman correlation analysis, fQRS-T and NSD angle, and platelet lymphocyte ratio (PLR) were significantly correlated (p = .021, p < .001, and p = .003, respectively). In linear regression analysis where the fQRS-T was taken as a dependent variable, NSD angle and PLR predicted the fQRS-T significantly and positively (F(5.76) = 8.451, R2 = 0.357, Adjusted R2 = 0.315 and p < .001). CONCLUSION In this study, fQRS-T was significantly higher in patients with NSD. In future studies, fQRS-T can be compared before and after septoplasty in NSD patients.
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Affiliation(s)
- Olga Bayar Kapıcı
- Department of Radiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
| | - Sabri Abuş
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Selçuk Ayhan
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Mehtap Koparal
- Department of Otorhinolaryngology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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Wang Z, Jiang F, Xiao J, Chen L, Zhang Y, Li J, Yi Y, Min W, Su L, Liu X, Zou Z. Heart rate variability changes in patients with obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res 2023; 32:e13708. [PMID: 36070876 DOI: 10.1111/jsr.13708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea is a common sleep breathing disorder related to autonomic nervous function disturbances. Heart rate variability is an important non-invasive indicator of autonomic nervous system function. The PubMed, Embase, Medline and Web of Science databases were systematically searched for English literature comparing patients with obstructive sleep apnea with controls up to May 2021. Heart rate variability outcomes, including integrated indices (parasympathetic function and total variability), time domain indices (the standard deviation of NN intervals and the root mean square of the successive differences between normal heartbeats) and frequency domain indices (high-frequency, low-frequency, very-low-frequency and the ratio of low-frequency to high-frequency) were derived from the studies. Twenty-two studies that included 2565 patients with obstructive sleep apnea and 1089 healthy controls were included. Compared with controls, patients with obstructive sleep apnea exhibited significantly reduced parasympathetic function. For the obstructive sleep apnea severity subgroup meta-analysis, patients with severe obstructive sleep apnea had significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and higher low-frequency and ratios of low-frequency to high-frequency. However, only the ratio of low-frequency to high-frequency was significantly higher in patients with moderate obstructive sleep apnea than in controls. Finally, for the collection time analysis, patients with obstructive sleep apnea had significantly higher low-frequency and ratio of low-frequency to high-frequency at night, significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and a higher ratio of low-frequency to high-frequency during the day than controls. Autonomic function impairment was more serious in patients with severe obstructive sleep apnea. During sleep, low-frequency can well reflect the impairment of autonomic function in obstructive sleep apnea, and the ratio of low-frequency to high-frequency may play an important role in obstructive sleep apnea diagnosis.
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Affiliation(s)
- Zuxing Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fugui Jiang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Lili Chen
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jieying Li
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yang Yi
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Wenjiao Min
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Liuhui Su
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xuemei Liu
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
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Patel SI, Zareba W, LaFleur B, Couderc JP, Xia X, Woosley R, Patel IY, Combs D, Mashaqi S, Quan SF, Parthasarathy S. Markers of ventricular repolarization and overall mortality in sleep disordered breathing. Sleep Med 2022; 95:9-15. [PMID: 35533628 PMCID: PMC10563794 DOI: 10.1016/j.sleep.2022.04.016] [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: 01/13/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Variability and prolongation of ventricular repolarization - measured by changes in QT interval and QT variability are independently associated with ventricular arrhythmias, sudden death, and mortality but such studies did not examine the role of sleep-disordered breathing. We aimed to determine whether sleep-disordered breathing moderated the association between measures of ventricular repolarization and overall mortality. METHODS Eight hundred participants were randomly selected from each of the following four groups in the Sleep Heart Health Study: mild, moderate, severe or no sleep disordered breathing (n = 200 each). Overnight electrocardiograms were analyzed for QTc duration and QT variability (standard deviation of QT intervals, normalized QT interval variance and the short-term interval beat-to-beat QT variability). Cox proportional hazards penalized regression modeling was used to identify predictors of mortality. RESULTS Eight hundred of 5600 participants were randomly selected. The participants (68 ± 10 years; 56.8% male) were followed for an average of 8.2 years during which time 222 (28.4%) died. QTc, SDQT, and QTVN were associated with the presence of SDB (p = 0.002, p = 0.014, and p = 0.024, respectively). After adjusting for covariates, the presence of sleep-disordered breathing did not moderate the association between QTc length, QT variability and mortality (p > 0.05). CONCLUSION Sleep-disordered breathing was associated with some measures of ventricular repolarization. However, sleep-disordered breathing was not an effect modifier for the relationship between QTc and QT variability and mortality.
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Affiliation(s)
- Salma I Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA.
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, USA
| | - Bonnie LaFleur
- UAHS Center for Biomedical Informatics and Biostatistics, University of Arizona, USA; BIO5, University of Arizona, USA; R. Ken Coit College of Pharmacy University of Arizona, USA
| | - Jean-Phillipe Couderc
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, USA
| | - Xiaojuan Xia
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, USA
| | - Raymond Woosley
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine, Phoenix, USA
| | - Imran Y Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Daniel Combs
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Department of Pediatrics, University of Arizona College of Medicine, Tucson, USA
| | - Saif Mashaqi
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Stuart F Quan
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Sairam Parthasarathy
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA
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Wang T, Yang J, Song Y, Pang F, Guo X, Luo Y. Interactions of central and autonomic nervous systems in patients with sleep apnea-hypopnea syndrome during sleep. Sleep Breath 2021; 26:621-631. [PMID: 34231085 DOI: 10.1007/s11325-021-02429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep apnea-hypopnea syndrome (SAHS) is an independent risk factor for various cardiovascular and cerebrovascular diseases, but the underlying relationship of its physiological subsystems remains unclear. Thus, we aimed to investigate the effect of SAHS on central and autonomic nervous system (CNS-ANS) interactions during sleep. METHODS Thirty-five patients with SAHS and 19 healthy age-matched controls underwent overnight polysomnography. The absolute spectral powers of five frequency bands from six EEG channels and ECG morphological features (HR, PR interval, QT interval) were calculated. Multivariable transfer entropy was applied to analyze the differences of the CNS-ANS network interactions between patients with SAHS of different severities and healthy controls during deep, light, and rapid eye movement sleep. RESULTS The CNS-ANS network interacted bidirectionally in all researched groups, with the cardiac information modulating the brain activity. The information strength from QT to most EEG components and PR to some EEG components was significantly affected by SAHS severity during light sleep, which indicates the coupling features of QT-brain nodes are important indicators. The driver effects from the β-band significantly increased in patients with SAHS. CONCLUSIONS Respiratory events may be the main reason for the CNS-ANS interaction changes in SAHS. These findings help explain the physiological regulation process of SAHS and provide valuable information for analysis of the development of SAHS-related cardiovascular and chronic diseases.
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Affiliation(s)
- Tingting Wang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Juan Yang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Yingjie Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Feng Pang
- Sleep-Disordered Breathing Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinwen Guo
- Psychology Department, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Yuxi Luo
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China.
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, Sun Yat-Sen University, Guangzhou, China.
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5
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Dissanayake HU, Bin YS, Ucak S, de Chazal P, Sutherland K, Cistulli PA. Association between autonomic function and obstructive sleep apnea: A systematic review. Sleep Med Rev 2021; 57:101470. [PMID: 33839505 DOI: 10.1016/j.smrv.2021.101470] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor for hypertension and cardiovascular disease. Effects of OSA on the autonomic nervous system may mediate this association. We performed a systematic literature review to determine the profile of autonomic function associated with OSA. Three electronic databases were searched for studies of OSA patients aged ≥18 years in which autonomic function was assessed. Studies comparing patients with and without OSA, or examining the association of OSA severity with changes in autonomic function were included. Seventy-one studies met the inclusion criteria and autonomic function has been assessed using a range of techniques. The profile of autonomic function found in OSA include increased sympathetic activity, reduced parasympathetic activity and less consistently found low heart rate variability. Altered autonomic function in OSA may explain the pathophysiology of increased cardiovascular risk. Evidence from intervention studies is required to determine if treatment improves autonomic function associated with OSA.
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Affiliation(s)
- Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Yu S Bin
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Seren Ucak
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
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6
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Effects of Septoplasty on Tp-e Interval and Tp-e/QT Ratio in Patients With Nasal Septal Deviation. J Craniofac Surg 2020; 31:91-94. [PMID: 31469741 DOI: 10.1097/scs.0000000000005890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES There are multiple nasal airway pathologies leading to upper airway obstruction, and one of the most common ones is nasal septum deviation (NSD). Our study aimed to evaluate the effect of nasal septal surgery in patients with NSD on ventricular arrhythmogenesis using the novel electrocardiographic parameters, Tp-e interval, and Tp-e/QT ratio. METHODS This retrospective cross-sectional study included 102 consecutive patients diagnosed with NSD. All participants completed a validated outcomes instrument (the NOSE scale), echocardiographic and electrocardiographic evaluation before and 3 months after septoplasty. The degree of nasal septal deviation was evaluated with the Dreher classification. RESULTS All of the electrocardiography parameters (except heart rate and QTmin) were significantly decreased with the septoplasty operation. Electrocardiographic parameters have significantly decreased especially in marked NSD patients. (Δ = difference between the preoperative and postoperative values) ΔNOSE was positively correlated both ΔcTp-e (r = 0.348, P < .001) and ΔcTp-e/QT values (r = 0.536, P < .001). CONCLUSION Consequently, marked NSD was associated with increased risk of arrhythmogenesis, which were too much improved after septoplasty. So, treatment of especially marked NSD not only reduces otolaryngological complaints, but also leads to improvement of ventricular repolarization parameters.
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7
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Kwon Y, Misialek JR, Duprez D, Jacobs DR, Alonso A, Heckbert SR, Zhao YY, Redline S, Soliman EZ. Sleep-disordered breathing and electrocardiographic QRS-T angle: The MESA study. Ann Noninvasive Electrocardiol 2018; 23:e12579. [PMID: 29963729 DOI: 10.1111/anec.12579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/06/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) has been linked to sudden cardiac death (SCD) but the mechanism is unclear. Abnormal QRS-T angle, a novel electrocardiographic (ECG) marker of ventricular repolarization, has been linked to adverse cardiovascular outcomes including SCD. We hypothesized that individuals with SDB have more pronounced abnormality in QRS-T angle. METHODS We performed a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam Sleep ancillary study. We calculated the odds ratio (OR) of abnormal frontal and spatial QRS-T angle (defined as >sex-specific 95th percentile thresholds) related to the apnea-hypopnea index (AHI) using logistic regression, adjusting for demographics, body habitus, cardiovascular risks, and prevalent cardiovascular disease. Linear associations between AHI and frontal and spatial QRS-T angle, separately, were also examined using multiple regression models. RESULTS A total of 1,804 participants (mean age 67.9 (±9.0) years, 55.3% women and 64.1% non-whites) were included in the study. Sleep-disordered breathing was common among participants (median AHI 8.6 events/hr IQR [3.2-19.5/hr]). Higher AHI was associated with the odds of abnormal frontal (≥81° in men and ≥79° in women) and spatial QRS-T angle (≥129.7° in men and ≥115.9° in women; OR [95%CI]: 1.25 [1.02-1.51], p = 0.03; 1.23 [1.01-1.50], p = 0.04 respectively per 1 SD [16.8 events/hr] increase in AHI). Similarly, linear associations were observed (frontal QRS-T angle: beta coefficient: 2.30° [0.92, 3.66], p = 0.001; spatial QRS-T angle: beta coefficient: 2.16° [0.67, 3.64], p = 0.005). CONCLUSION In a racially/ethnically diverse community cohort, severity of SDB is associated with abnormal ventricular repolarization as measured by QRS-T angle.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Duprez
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ying Y Zhao
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Sleep Disorders Clinic, Hamilton, Ontario, Canada
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Elsayed Z Soliman
- Department of Epidemiology, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Medicine-Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Morand J, Arnaud C, Pepin JL, Godin-Ribuot D. Chronic intermittent hypoxia promotes myocardial ischemia-related ventricular arrhythmias and sudden cardiac death. Sci Rep 2018; 8:2997. [PMID: 29445096 PMCID: PMC5813022 DOI: 10.1038/s41598-018-21064-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/29/2018] [Indexed: 12/15/2022] Open
Abstract
We investigated the effects of intermittent hypoxia (IH), such as that encountered in severe obstructive sleep apnea (OSA) patients, on the development and severity of myocardial ischemia-related ventricular arrhythmias. Rats were exposed to 14 days of IH (30 s at 5%O2 and 30 s at 21%O2, 8 h·day−1) or normoxia (N, similar air-air cycles) and submitted to a 30-min coronary ligature. Arterial blood pressure (BP) and ECG were recorded for power spectral analysis, ECG interval measurement and arrhythmia quantification. Left ventricular monophasic action potential duration (APD) and expression of L-type calcium (LTCC) and transient receptor potential (TRPC) channels were assessed in adjacent epicardial and endocardial sites. Chronic IH enhanced the incidence of ischemic arrhythmias, in particular ventricular fibrillation (66.7% vs. 33.3% in N rats, p < 0.05). IH also increased BP and plasma norepinephine levels along with increased low-frequency (LF), decreased high-frequency (HF) and increased LF/HF ratio of heart rate and BP variability. IH prolonged QTc and Tpeak-to-Tend intervals, increased the ventricular APD gradient and upregulated endocardial but not epicardial LTCC, TRPC1 and TRPC6 (p < 0.05). Chronic IH, is a major risk factor for sudden cardiac death upon myocardial ischemia through sympathoactivation and alterations in ventricular repolarization, transmural APD gradient and endocardial calcium channel expression.
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Affiliation(s)
- Jessica Morand
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Claire Arnaud
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Jean-Louis Pepin
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Diane Godin-Ribuot
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France.
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
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Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
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10
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May AM, Van Wagoner DR, Mehra R. OSA and Cardiac Arrhythmogenesis: Mechanistic Insights. Chest 2017; 151:225-241. [PMID: 27693594 PMCID: PMC5989643 DOI: 10.1016/j.chest.2016.09.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
A surge of data has reproducibly identified strong associations of OSA with cardiac arrhythmias. As an extension of epidemiologic and clinic-based findings, experimental investigations have made strides in advancing our understanding of the putative OSA and cardiac arrhythmogenesis mechanistic underpinnings. Although most studies have focused on the links between OSA and atrial fibrillation (AF), relationships with ventricular arrhythmias have also been characterized. Key findings implicate OSA-related autonomic nervous system fluctuations typified by enhanced parasympathetic activation during respiratory events and sympathetic surges subsequent to respiratory events, which contribute to augmented arrhythmic propensity. Other more immediate pathophysiologic influences of OSA-enhancing arrhythmogenesis include intermittent hypoxia, intrathoracic pressure swings leading to atrial stretch, and hypercapnia. Intermediate pathways by which OSA may trigger arrhythmia include increased systemic inflammation, oxidative stress, enhanced prothrombotic state, and vascular dysfunction. Long-term OSA-associated sequelae such as hypertension, atrial enlargement and fibrosis, ventricular hypertrophy, and coronary artery disease also predispose to cardiac arrhythmia. These factors can lead to a reduction in atrial effective refractory period, triggered and abnormal automaticity, and promote slowed and heterogeneous conduction; all of these mechanisms increase the persistence of reentrant arrhythmias and prolong the QT interval. Cardiac electrical and structural remodeling observed in OSA animal models can progress the arrhythmogenic substrate to further enhance arrhythmia generation. Future investigations clarifying the contribution of specific OSA-related mechanistic pathways to arrhythmia generation may allow targeted preventative therapies to mitigate OSA-induced arrhythmogenicity. Furthermore, interventional studies are needed to clarify the impact of OSA pathophysiology reversal on cardiac arrhythmogenesis and related adverse outcomes.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - David R Van Wagoner
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Reena Mehra
- Neurologic Institute, Respiratory Institute, Heart and Vascular Institute and Molecular Cardiology Department, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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11
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Pathak RK, Mahajan R, Lau DH, Sanders P. Sleep Apnea and Cardiac Arrhythmia: A Timely Wake-Up Call! Sleep 2015; 38:1005-6. [PMID: 26085295 DOI: 10.5665/sleep.4796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rajeev K Pathak
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol 2015; 31:928-34. [PMID: 26037822 DOI: 10.1016/j.cjca.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023] Open
Abstract
Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.
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Affiliation(s)
- Thomas Bitter
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - SaiPrassad Gaddam
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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Bitter T, Körber B, Horstkotte D, Oldenburg O. [Sleep-disordered breathing and cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2012; 23:22-6. [PMID: 22351149 DOI: 10.1007/s00399-011-0164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep-disordered breathing (SDB) is an important comorbidity in patients with cardiac arrhythmias. Previous studies confirmed associations between supraventricular and ventricular arrhythmias and SDB. In heart failure patients, SDB was also found independently associated with a shorter event-free survival to the occurrence of malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapy. In obstructive sleep apnea, repetitive hypoxemia, mechanical stress (wall tension), arousals from sleep, and activation of the sympathetic nervous system promote cardiac arrhythmias. Pathophysiological concepts for the link between Cheyne-Stokes respiration and malignant arrhythmias are not fully understood and require further research. In addition, large-scale, randomized, controlled trials are awaited to prove whether adequate treatment of SDB is associated with a risk reduction for the occurrence of arrhythmias, in general, and malignant ventricular arrhythmias, in particular, in these patients.
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Affiliation(s)
- T Bitter
- Klinik für Kardiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
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Rossi VA, Stoewhas AC, Camen G, Steffel J, Bloch KE, Stradling JR, Kohler M. The effects of continuous positive airway pressure therapy withdrawal on cardiac repolarization: data from a randomized controlled trial. Eur Heart J 2012; 33:2206-12. [DOI: 10.1093/eurheartj/ehs073] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith JH, Baumert M, Nalivaiko E, McEvoy RD, Catcheside PG. Arousal in obstructive sleep apnoea patients is associated with ECG RR and QT interval shortening and PR interval lengthening. J Sleep Res 2009; 18:188-95. [PMID: 19645965 DOI: 10.1111/j.1365-2869.2008.00720.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sudden cardiac death appears to be more prevalent during the normal sleeping hours in obstructive sleep apnoea (OSA) patients compared with the general population as well as to cardiovascular disease patients. The reasons for this remain unclear, but there are three likely main contributors to nocturnal death in OSA patients; cardiac arrhythmias, stroke/ruptured cerebral aneurism and myocardial infarction. Particularly marked cardiovascular system activation with arousal may play a role in initiating sudden adverse cardiovascular events in OSA. The purpose of this study was to investigate cardiac RR, QT and PR interval changes in the electrocardiogram (ECG) associated with spontaneous and respiratory-related arousals in OSA patients. A detailed observational study of ECG records obtained during conventional diagnostic sleep study with no further interventions was carried out in 20 patients (12 males, age 42.8 +/- 2.1 years, body mass index 35.1 +/- 1.9 kg m(-2), and respiratory disturbance index 51.8 +/- 6.4 events/hour). RR and QT intervals showed significant shortening during arousals. RR interval shortening was found to be greater during respiratory arousals when compared to spontaneous arousals. PR interval showed a trend toward a greater prolongation during respiratory arousal. QT interval shortening was weakly correlated with arterial oxygen saturation levels preceding arousal. In conclusion, these data suggest that despite greater cardiac acceleration following respiratory versus spontaneous arousals from sleep, QT shortening and PR prolongation responses are similar independent of arousal type. These data support that arousals produce quite marked and differential cardiac conduction system activation in OSA and that the degree and pattern of activation may be partly influenced by the presence and severity of preceding respiratory events.
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Affiliation(s)
- Janet H Smith
- Discipline of Physiology, School of Molecular and Biomedical Science, University of Adelaide, Adelaide, Australia
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Ito R, Hamada H, Yokoyama A, Oshima M, Katayama H, Ohnishi H, Kadowaki T, Ishimaru S, Irifune K, Higaki J. Successful Treatment of Obstructive Sleep Apnea Syndrome Improves Autonomic Nervous System Dysfunction. Clin Exp Hypertens 2009. [DOI: 10.1081/ceh-48874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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The impact of varying autonomic states on the dynamic beat-to-beat QT-RR and QT-TQ interval relationships. Br J Pharmacol 2008; 154:1508-15. [PMID: 18663381 DOI: 10.1038/bjp.2008.123] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The beat-to-beat dynamicity of the QT-RR interval relationship is difficult to assess with the use of traditional correction factors (QTc) and changes in QTc do not accurately reflect or quantify arrhythmogenic risk. Further, the interpretation of arrhythmogenic risk is influenced by autonomic state. To visualize the QT-RR interval dynamics under varying conditions of autonomic state from impaired repolarization, we have developed a system to sequentially plot the beat-to-beat confluence of ECG data or 'clouds' obtained from conscious dogs and humans. To represent the non-uniformity of the clouds, a bootstrap sampling method that computes the mathematical centre of the uncorrected beat-to-beat QT value (QTbtb) and defines the upper and lower 95% confidence bounds is used. The same method can also be used to examine heterogeneity, hysteresis (both acceleration and deceleration) and restitution (beat-to-beat QT-TQ interval relationship). Impaired repolarization with the combination of E-4031 and L-768,673 (inhibitor of IKs current) increased heterogeneity of restitution at rest 55-91%; increased hysteresis during heart rate acceleration after isoproterenol challenge by approximately 40-60%; and dramatically diminished the minimum TQ boundary by 72% to only 28 ms. Impaired repolarization alters restitution during normal sinus rhythm and increases hysteresis/heterogeneity during heart rate acceleration following sympathetic stimulation. These findings are supported by similar clinical observations in LQT1 and LQT2 syndromes. Therefore, the assessment of the dynamic QT-RR and QT-TQ interval relationships through quantification of heterogeneity, hysteresis and restitution may allow a more accurate non-invasive evaluation of the conditions leading to cardiac arrhythmia.
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Aytemir K, Deniz A, Yavuz B, Ugur Demir A, Sahiner L, Ciftci O, Tokgozoglu L, Can I, Sahin A, Oto A. Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome. Respir Med 2006; 101:1277-82. [PMID: 17137777 DOI: 10.1016/j.rmed.2006.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is characterized by the repeated episodes of upper airway obstruction during sleep, leading to significant hypoxia. Noninvasive evaluation of autonomic nervous system (ANS) and myocardial vulnerability may help determination of OSAS patients who are under high risk of malignant cardiac arrhythmias. The aim of this study was to show the effects of OSAS on predictors of arrhythmias by the evaluation of heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity reflecting the ANS balance and myocardial vulnerability. METHODS After polysomnographic study, 80 patients with OSAS and 55 age matched OSAS (-) subjects were included in the study. Twenty-four-hour Holter monitoring was performed in all subjects. HRT, HRV and QT dynamicity parameters were calculated. RESULTS Turbulence slope was significantly decreased in OSAS patients whereas turbulence onset was increased (P<0.001). QT/RR slopes were significantly increased for QT end and QT apex (P<0.001). In HRV analysis, autonomic balance changed in favor of sympathetic system at night in OSAS patients. Furthermore, HRT and QT dynamicity parameters are found to be correlated with Apnea-Hypopnea Index (AHI). CONCLUSION OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS.
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Affiliation(s)
- Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Roche F, Barthélémy JC, Garet M, Duverney D, Pichot V, Sforza E. Continuous Positive Airway Pressure Treatment Improves the QT Rate Dependence Adaptation of Obstructive Sleep Apnea Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:819-25. [PMID: 16105010 DOI: 10.1111/j.1540-8159.2005.00188.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND QT rate dependence is one of the major properties of ventricular repolarization, with its circadian and autonomic modulations. The alteration of cardiac autonomic tone occurring in obstructive sleep apnea syndrome (OSAS) patients could explain the altered rate-dependent adaptation of the myocardial repolarization. Thus, we postulated that dynamic alterations in QT interval adaptation could be ameliorated in OSAS patients under continuous positive airway pressure (CPAP) treatment. To assess ventricular repolarization features in patients with OSAS, we compared QT parameters and their dynamicities along RR intervals from 24-hour ECG. METHODS The study groups consisted of 38 consecutive OSAS patients and 38 healthy age-matched subjects. The syndrome was confirmed for OSAS patients according to standard polysomnographic criteria (apnea plus hypopnea index: 56.9 +/- 28.4/h). A second polysomnography synchronized with 24-hour ECG Holter and realized under efficient CPAP therapy confirmed the control of sleep-related breathing disorder. RESULTS QT length related to heart rate was found significantly altered in patients with OSAS compared with controls (QTend/RR slope: -0.126 +/- 0.031 vs -0.173 +/- 0.038; P < 0.01). This flattened relationship was significantly improved with the treatment of the OSAS (-0.151 +/- 0.051; P < 0.01 vs pretreatment status). There was no significant impact of CPAP therapy on ventricular ectopic activity as well as on static repolarization parameters (QT, RT, QTc, RTc) measured separately over daytime and nighttime. CONCLUSIONS The prognostic implications of such findings and the protective role of CPAP treatment to prevent sudden cardiac death in OSAS need to be evaluated.
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Affiliation(s)
- Frédéric Roche
- Service de Physiologie Clinique et de l'Exercice-Groupe PPEH, Association de Recherche SYNAPSE, Faculte de Medecine Jacques Lisfranc, Saint-Etienne, France.
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Abstract
Sleep apnea has been increasingly recognized for its prevalence and its impact on cardiovascular health. The disorder has considerable impact on cardiovascular disease states, particularly congestive heart failure. Implantable cardiac pacing devices may have a role in both the diagnosis and therapy of sleep apnea, which may be of particular importance given the seemingly wide coprevalence of cardiac disorders and sleep apnea.
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Affiliation(s)
- Alaa A Shalaby
- University of Pittsburgh, Division of Cardiology, Pittsburgh VA Healthcare System, Pittsburgh, PA 15240, USA.
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Zakrzewska-Pniewska B, Nojszewska M, Przybylowski T, Byśkiniewicz K. Clinical Versus Electrophysiological Assessment of Dysautonomia in Obstructive Sleep Apnea Syndrome. J Clin Neurophysiol 2004; 21:435-9. [PMID: 15622130 DOI: 10.1212/01.wnl.0000135216.51489.1b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To assess the autonomic system in obstructive sleep apnea syndrome (OSAS), the sympathetic skin response (SSR) and the R-R interval variation (RRIV) tests were studied in 34 OSAS patients and in 32 healthy controls. The aim of the study was to evaluate the sympathetic and parasympathetic system function in OSAS, to define the pattern of autonomic abnormalities found in SSR and RRIV in patients, and to analyze the usefulness of both tests in paraclinical assessment of the dysautonomia, compared with clinical symptoms and signs of autonomic nervous system involvement. The correlations between both autonomic tests results were also studied. In OSAS patients, SSR test results were abnormal in about 44% and RRIV results were abnormal in about 21% of patients. The mean values of parameters studied in SSR were significantly different in OSAS patients and controls (P < 0.05), whereas the differences between RRIV results were less important. The SSR and RRIV results in patients with mild apnea (Apnea/ Hypopnea Index (AHI) < 15) were more frequently within normal limits if compared with those of patients with severe apnea, but without reaching statistical significance. The clinical studies results (according to the Autonomic Symptoms Questionnaire) were related to the SSR results (p < 0.05 on chi and Fisher exact test). According to these results, SSR and RRIV are simple paraclinical electrophysiologic tests that confirm clinical dysautonomia. They may be useful as screening tests for assessment of dysautonomia in OSAS.
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Fossa AA, Wisialowski T, Magnano A, Wolfgang E, Winslow R, Gorczyca W, Crimin K, Raunig DL. Dynamic Beat-to-Beat Modeling of the QT-RR Interval Relationship: Analysis of QT Prolongation during Alterations of Autonomic State versus Human Ether a-go-go-Related Gene Inhibition. J Pharmacol Exp Ther 2004; 312:1-11. [PMID: 15306635 DOI: 10.1124/jpet.104.073288] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Methods to correct the QT interval for heart rate are often in disagreement and may be further confounded by changes in autonomic state. This can be problematic when trying to distinguish the changes in QT interval by either drug-induced delayed repolarization or from autonomic-mediated physiological responses. Assessment of the canine dynamic QT-RR interval relationship was visualized by novel programming of the dynamic beat-to-beat confluence of data or "clouds". To represent the nonuniformity of the clouds, a bootstrap sampling method that computes the mathematical center of the uncorrected beat-to-beat QT value (QTbtb) with upper 95% confidence bounds was adopted and compared with corrected QT (QTc) using standard correction factors. Nitroprusside-induced reflex tachycardia reduced QTbtb by 43 ms, whereas an increase of 55 and 16 ms was obtained using the Bazett (QTcB) and Fridericia (QTcF) formulae, respectively. Phenylephrine-induced reflex bradycardia increased QTbtb by 3 ms but decreased QTcB by 20 ms and QTcF by 12 ms. Delayed repolarization with E-4031 (1-[2-(6-methyl-2-pyridyl)ethyl]-4-methylsulfonylaminobenzoyl)-piperidine), an inhibitor of rectifier potassium current, increased QTbtb by 26 ms but QT prolongation calculations using QTcF and QTcB were between 12 and 52% less, respectively, when small decreases in heart rate (5-8 beats per minute) were apparent. Dynamic assessment of beat-to-beat data, using the bootstrap method, allows quantification of QT interval changes under varying conditions of heart rate, autonomic tone, and direct repolarization that may not be distinguishable with use of standard correction factors.
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Affiliation(s)
- Anthony A Fossa
- Pfizer Global Research and Development, Eastern Point Rd., Bldg. 118, MS 4036, Groton, CT 06340, USA.
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