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Kainulainen S, Suni A, Lipponen JA, Kulkas A, Duce B, Korkalainen H, Nikkonen S, Sillanmäki S. Morbid obesity influences the nocturnal electrocardiogram wave and interval durations among suspected sleep apnea patients. Ann Noninvasive Electrocardiol 2024; 29:e13101. [PMID: 38031823 PMCID: PMC10770811 DOI: 10.1111/anec.13101] [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: 05/02/2023] [Revised: 08/20/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Obesity is a global issue with a major impact on cardiovascular health. This study explores how obesity influences nocturnal cardiac electrophysiology in suspected obstructive sleep apnea (OSA) patients. METHODS We randomly selected 12 patients from each of the five World Health Organization body mass index (BMI) classifications groups (ntotal = 60) while keeping the group's age and sex matched. We evaluated 1965 nocturnal electrocardiography (ECG) samples (10 s) using modified lead II recorded during normal saturation conditions. R-wave peaks were detected and confirmed using dedicated software, with the exclusion of ventricular extrasystoles and artifacts. The duration of waves and intervals was manually marked. The average electric potential graphs were computed for each segment. Thresholds for abnormal ECG waveforms were P-wave > 120 ms, PQ interval > 200 ms, QRS complex > 120 ms for, and QTc > 440 ms. RESULTS Obesity was significantly (p < .05) associated with prolonged conduction times. Compared to the normal weight (18.5 ≤ BMI < 25) group, the morbidly obese patients (BMI ≥ 40) had a significantly longer P-wave duration (101.7 vs. 117.2 ms), PQ interval (175.8 vs. 198.0 ms), QRS interval (89.9 vs. 97.7 ms), and QTc interval (402.8 vs. 421.2 ms). We further examined ECG waveform prolongations related to BMI. Compared to other patient groups, the morbidly obese patients had the highest number of ECG segments with PQ interval (44% of the ECG samples), QRS duration (14%), and QTc duration (20%) above the normal limits. CONCLUSIONS Morbid obesity predisposes patients to prolongation of cardiac conduction times. This might increase the risk of arrhythmias, stroke, and even sudden cardiac death.
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Affiliation(s)
- Samu Kainulainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Aaron Suni
- The School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Jukka A. Lipponen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Emergency CareKuopio University HospitalKuopioFinland
| | - Antti Kulkas
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Clinical NeurophysiologySeinäjoki Central HospitalSeinäjokiFinland
| | - Brett Duce
- Sleep Disorders Centre, Department of Respiratory & Sleep MedicinePrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- Institute for Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Henri Korkalainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Sami Nikkonen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Saara Sillanmäki
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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Sun C, Hong S, Wang J, Dong X, Han F, Li H. A systematic review of deep learning methods for modeling electrocardiograms during sleep. Physiol Meas 2022; 43. [PMID: 35853448 DOI: 10.1088/1361-6579/ac826e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022]
Abstract
Sleep is one of the most important human physiological activities and plays an essential role in human health. Polysomnography (PSG) is the gold standard for measuring sleep quality and disorders, but it is time-consuming, labor-intensive, and prone to errors. Current research has confirmed the correlations between sleep and the respiratory/circulatory system. Electrocardiography (ECG) is convenient to perform, and ECG data are rich in breathing information. Therefore, sleep research based on ECG data has become popular. Currently, deep learning (DL) methods have achieved promising results on predictive health care tasks using ECG signals. Therefore, in this review, we systematically identify recent research studies and analyze them from the perspectives of data, model, and task. We discuss the shortcomings, summarize the findings, and highlight the potential opportunities. For sleep-related tasks, many ECG-based DL methods produce more accurate results than traditional approaches by combining multiple signal features and model structures. Methods that are more interpretable, scalable, and transferable will become ubiquitous in the daily practice of medicine and ambient-assisted-living applications. This paper is the first systematic review of ECG-based DL methods for sleep tasks.
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Affiliation(s)
- Chenxi Sun
- School of Artificial Intelligence, Peking University, No. 5, Yiheyuan Road, Haidian District, Beijing, 100871, CHINA
| | - Shenda Hong
- National Institute of Health Data Science, Peking University, No. 5, Yiheyuan Road, Haidian District, Beijing, Beijing, 100871, CHINA
| | - Jingyu Wang
- Sleep Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, CHINA
| | - Xiaosong Dong
- Sleep Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, CHINA
| | - Fang Han
- Sleep Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, CHINA
| | - Hongyan Li
- School of Artificial Intelligence, Peking University, No. 5, Yiheyuan Road, Haidian District, Beijing, Beijing, 100871, CHINA
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Pal A, Martinez F, Aguila AP, Akey MA, Chatterjee R, Conserman MGE, Aysola RS, Henderson LA, Macey PM. Beat-to-beat blood pressure variability in patients with obstructive sleep apnea. J Clin Sleep Med 2021; 17:381-392. [PMID: 33089774 DOI: 10.5664/jcsm.8866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVES Cardiovascular comorbidities in obstructive sleep apnea (OSA) are difficult to treat, perhaps due to autonomic dysfunction. We assessed beat-to-beat blood pressure (BP) variability (BPV) in OSA while considering other markers derived from electrocardiogram and continuous BP signals. METHODS We studied 66 participants (33 participants with OSA: respiratory event index [mean ± SEM]: 21.1 ± 2.7 events/h; 12 females, aged 51.5 ± 2.4 years; body mass index: 32.8 ± 1.4 kg/m²; 33 healthy controls: 20 females; aged 45.3 ± 2.4 years; body mass index: 26.3 ± 0.7 kg/m²). We collected 5-minute resting noninvasive beat-to-beat BP and electrocardiogram values. From BP, we derived systolic, diastolic, and mean BP values, and calculated variability as standard deviations (systolic BPV, diastolic BPV, BPV). We also calculated diastole-to-systole time (time to peak). From the electrocardiogram, we derived QRS markers and calculated heart rate and heart rate variability. We performed a multivariate analysis of variance based on sex and group (OSA vs control), with Bonferroni-corrected post hoc comparisons (P ≤ .05) between groups. We calculated correlations of BPV with biological variables. RESULTS Multivariate analysis of variance showed effects of diastolic BPV and BPV in OSA; post hoc comparisons revealed high diastolic BPV and BPV only in female participants with OSA vs controls. QRS duration was higher in OSA, with post hoc comparisons showing the effect only in males. BPV correlated positively with heart rate variability in controls but not in participants with OSA. BPV correlated positively with time to peak in females with OSA and OSA combined, whereas there was no BPV-time-to-peak correlation in healthy participants. CONCLUSIONS The findings show sex-specific autonomic dysfunction reflected in beat-to-beat BP in OSA. The higher BPV may reflect poor baroreflex control or vascular damage in OSA, which are potential precursors to cardiovascular complications.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, Los Angeles, California
| | | | | | | | | | | | - Ravi S Aysola
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
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Nasifoglu H, Erogul O. Obstructive sleep apnea prediction from electrocardiogram scalograms and spectrograms using convolutional neural networks. Physiol Meas 2021; 42. [PMID: 34116519 DOI: 10.1088/1361-6579/ac0a9c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
Objective.In this study, we conducted a comparative analysis of deep convolutional neural network (CNN) models in predicting obstructive sleep apnea (OSA) using electrocardiograms. Unlike other studies in the literature, this study automatically extracts time-frequency features by using CNNs instead of manual feature extraction from ECG recordings.Approach.The proposed model generates scalogram and spectrogram representations by transforming preprocessed 30 s ECG segments from time domain to the frequency domain using continuous wavelet transform and short time Fourier transform, respectively. We examined AlexNet, GoogleNet and ResNet18 models in predicting OSA events. The effect of transfer learning on success is also investigated. Based on the observed results, we proposed a new model that is found more effective in estimation. In total, 152 ECG recordings were included in the study for training and evaluation of the models.Main results.The prediction using scalograms immediately 30 s before potential OSA onsets gave the best performance with 82.30% accuracy, 83.22% sensitivity, 82.27% specificity and 82.95% positive predictive value. The prediction using spectrograms also achieved up to 80.13% accuracy and 81.99% sensitivity on prediction. Per-recording classification suggested considerable results with 91.93% accuracy for prediction of OSA events.Significance.Time-frequency deep features of scalograms and spectrograms of ECG segments prior to OSA events provided reliable information about the possible events in the future. The proposed CNN model can be used as a good indicator to accurately predict OSA events using ECG recordings.
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Affiliation(s)
- Huseyin Nasifoglu
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara 06560, Turkey
| | - Osman Erogul
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara 06560, Turkey
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Niroshana SMI, Zhu X, Nakamura K, Chen W. A fused-image-based approach to detect obstructive sleep apnea using a single-lead ECG and a 2D convolutional neural network. PLoS One 2021; 16:e0250618. [PMID: 33901251 PMCID: PMC8075238 DOI: 10.1371/journal.pone.0250618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common chronic sleep disorder that disrupts breathing during sleep and is associated with many other medical conditions, including hypertension, coronary heart disease, and depression. Clinically, the standard for diagnosing OSA involves nocturnal polysomnography (PSG). However, this requires expert human intervention and considerable time, which limits the availability of OSA diagnosis in public health sectors. Therefore, electrocardiogram (ECG)-based methods for OSA detection have been proposed to automate the polysomnography procedure and reduce its discomfort. So far, most of the proposed approaches rely on feature engineering, which calls for advanced expert knowledge and experience. This paper proposes a novel fused-image-based technique that detects OSA using only a single-lead ECG signal. In the proposed approach, a convolutional neural network extracts features automatically from images created with one-minute ECG segments. The proposed network comprises 37 layers, including four residual blocks, a dense layer, a dropout layer, and a soft-max layer. In this study, three time-frequency representations, namely the scalogram, the spectrogram, and the Wigner-Ville distribution, were used to investigate the effectiveness of the fused-image-based approach. We found that blending scalogram and spectrogram images further improved the system's discriminative characteristics. Seventy ECG recordings from the PhysioNet Apnea-ECG database were used to train and evaluate the proposed model using 10-fold cross validation. The results of this study demonstrated that the proposed classifier can perform OSA detection with an average accuracy, recall, and specificity of 92.4%, 92.3%, and 92.6%, respectively, for the fused spectral images.
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Affiliation(s)
- S. M. Isuru Niroshana
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Fukushima, Japan
| | - Xin Zhu
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Fukushima, Japan
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Meguro, Tokyo, Japan
| | - Wenxi Chen
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Fukushima, Japan
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Dalgaard F, North R, Pieper K, Fonarow GC, Kowey PR, Gersh BJ, Mahaffey KW, Pokorney S, Steinberg BA, Naccarrelli G, Allen LA, Reiffel JA, Ezekowitz M, Singer DE, Chan PS, Peterson ED, Piccini JP. Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation. Am Heart J 2020; 223:65-71. [PMID: 32179257 DOI: 10.1016/j.ahj.2020.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF). However, it remains unclear whether OSA is independently associated with worse cardiovascular and neurological outcomes in patients with AF. METHODS We used the ORBIT-AF I and ORBIT-AF II to conduct a retrospective cohort study of 22,760 patients with AF with and without OSA. Adjusted multivariable Cox proportional hazards models was used to determine whether OSA was associated with increased risk for major adverse cardiac and neurologic events (MACNEs) (cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-central nervous system embolism (stroke/SE), and new-onset heart failure], combined and individually. RESULTS A total of 4,045 (17.8%) patients had OSA at baseline. Median follow-up time was 1.5 (interquartile range: 1-2.2) years, and 1,895 patients experienced a MACNE. OSA patients were younger (median [interquartile range] 68 [61-75] years vs 74 [66-81] years), were more likely male (70.7% vs 55.3%), and had increased body mass index (median 34.6 kg/m2 [29.8-40.2] vs 28.7 kg/m2 [25.2-33.0]). Those with OSA had a higher prevalence of concomitant comorbidities such as diabetes, chronic obstructive pulmonary disease, and heart failure. OSA patients had higher use of antithrombotic therapy. After adjustment, the presence of OSA was significantly associated with MACNE (hazard ratio: 1.16 [95% CI: 1.03-1.31], P = .011). OSA was also an independent risk factor for stroke/SE beyond the CHA2DS2-VASc risk factors (HR: 1.38 [95% CI 1.12-1.70], P = .003) but not cardiovascular death, myocardial infarction, new-onset heart failure, or major bleeding. CONCLUSIONS Among patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.
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Saad AMJ, Hiyasat D, Jaddou H, Obeidat N. The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan. Diabetes Res Clin Pract 2019; 152:16-22. [PMID: 31078669 DOI: 10.1016/j.diabres.2019.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/03/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.
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Affiliation(s)
- Ahmad M J Saad
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan.
| | - Dana Hiyasat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Hashem Jaddou
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Nathir Obeidat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
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Shankar S, Gupta SS, Rojas-Marte G, Demir S, Saxena A, Obiagwu C, Aggarwal N, Rai AK, Kamholz S, Shetty V, Kupfer Y. Electrocardiographic Associations Seen with Obstructive Sleep Apnea. SLEEP DISORDERS 2019; 2019:9704785. [PMID: 30937193 PMCID: PMC6415287 DOI: 10.1155/2019/9704785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic respiratory disorder associated with repeated nocturnal partial or complete collapse that is often underdiagnosed and associated with multiple comorbidities. The association between specific features on an electrocardiogram and OSA has not been well studied. This retrospective study attempts to bridge this gap in knowledge. METHODS A total of 265 patients' medical records were reviewed retrospectively. Specific features of their electrocardiograms and their association with the severity of OSA were studied from April 2014 to May 2016. 215 patients were included in the final analysis. Tests of group difference between OSA patients and controls were done using student's t-tests for continuous variables and using chi-square tests for categorical outcomes. Multivariate tests of differences between OSA and control patients were done using logistic regression to control for possible confounding factors. RESULTS A total of 215 patients with diagnosed OSA and 41 controls in whom OSA was ruled out using polysomnography were compared. Males were more likely to present with OSA than females (93 % versus 76 %; p < 0.001). OSA patients were also significantly older: 52.18 ± 14.04 versus 44.55 ± 14.64; p = 0.002. Deep S waves in V5-6 (p=0.014) and RS pattern with Deep S waves in leads I and AVF (p=0.017) were both significantly associated with OSA based on univariate comparisons. These findings lost significance in the multivariate analysis. CONCLUSION The idea of using an electrocardiogram in aiding in the assessment of OSA is attractive and feasible, as it is a safe, noninvasive, and cost-effective method. Our results can be used for early risk stratification in patients with OSA.
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Affiliation(s)
- Shyam Shankar
- Fellow, Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sushilkumar Satish Gupta
- Fellow, Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Geurys Rojas-Marte
- Fellow, Department of Cardiology, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Selma Demir
- Attending, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Abhinav Saxena
- Fellow, Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Chukwudi Obiagwu
- Fellow, Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Nidhi Aggarwal
- Attending, Department of Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, New York, USA
| | - Anand Kumar Rai
- Fellow, Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Stephan Kamholz
- Chairman, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Vijay Shetty
- Attending, Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Yizhak Kupfer
- Director, Department of Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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Kerns ES, Kim ED, Meoni LA, Sozio SM, Jaar BG, Estrella MM, Parekh RS, Bourjeily G. Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients. Am J Nephrol 2018; 48:147-156. [PMID: 30110675 DOI: 10.1159/000489963] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. METHODS In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. RESULTS Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04-3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36-9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12-9.57]) and multiple cardiovascular risk factors. CONCLUSIONS Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.
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Affiliation(s)
- Eric S Kerns
- Department of Medicine, Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Esther D Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucy A Meoni
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Bernard G Jaar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Michelle M Estrella
- University of California San Francisco, Kidney Health Research Collaborative, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Rulan S Parekh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics and Medicine, School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ghada Bourjeily
- Department of Medicine, Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, The Miriam Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Vizzardi E, Sciatti E, Bonadei I, D'Aloia A, Curnis A, Metra M. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates. J Cardiovasc Med (Hagerstown) 2018; 18:490-500. [PMID: 25000252 DOI: 10.2459/jcm.0000000000000043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. METHODS We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. RESULTS Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. CONCLUSION Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.
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Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
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Kwon Y, Picel K, Adabag S, Vo T, Taylor BC, Redline S, Stone K, Mehra R, Ancoli-Israel S, Ensrud KE. Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men. Sleep Breath 2016; 20:1161-1168. [PMID: 26971326 PMCID: PMC5018906 DOI: 10.1007/s11325-016-1326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities. METHODS We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, β-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications. RESULTS Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00-3.40), and median AHI was 7.06 (IQR 2.55-15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32-0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08-0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29-15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters. CONCLUSIONS Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Katherine Picel
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Selcuk Adabag
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tien Vo
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Reena Mehra
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.
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Szulik M, Sredniawa B, Streb W, Lenarczyk R, Jarski P, Kalarus Z, Kukulski T. Sleep-disordered breathing and echocardiographic measures of function and dyssynchrony: a complex approach to cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2016; 17:886-895. [PMID: 25022934 DOI: 10.2459/jcm.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION We investigated the relationship between sleep-disordered breathing (SDB), cardiac function, and cardiac resynchronization therapy (CRT). METHODS Fifty-five CRT patients with SDB diagnosed by Holter ECG (apnea/hypopnea index - AHI) were included in the study. We sought to determine right ventricle (RV) predictors of short-term SDB improvement and long-term outcome in patients with (AHI dippers) and without (AHI nondippers) 25% AHI improvement, markers of CRT response, and SDB influence on survival. RESULTS Baseline tricuspid E-wave (AUC - 0.925, cut-off value > 0.336 m/s; sensitivity - 90%, specificity - 100%) and RV E/E' - 0.864, ≤16.25; 73%, 100%, respectively) were found as predictors of 25% AHI reduction. Spiroergometric tests, mitral regurgitation, and LVEF results improved significantly in AHI dippers. Regression analysis identified the absence of 25% AHI reduction (OR-7.67, 95% CI 1.52-38.6 and OR-9.92, 95%CI 6.02-15.3) and septal-lateral atrial velocities delay (OR-1.09, 95% CI 0.99-1.2 and 1.07, 95% CI 0.99-1.16) as independent predictors of both clinical and echocardiographic nonresponse. During median follow-up of 6.8 years, mortality was significantly reduced in patients with both AHI 25% reduction and 10% absolute LVEF increase in the first 3 months of CRT, compared with the subjects with only one or none of those criteria. CONCLUSION The baseline RV diastolic indices were found as independent predictors of SDB improvement during CRT. Both clinical and echocardiographic long-term response can be independently predicted by SDB and intraatrial dyssynchrony. The best survival rate was observed in patients with SDB and LVEF improvement noted in the first 3 months of CRT.
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Affiliation(s)
- Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland
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Sharma H, Sharma KK. An algorithm for sleep apnea detection from single-lead ECG using Hermite basis functions. Comput Biol Med 2016; 77:116-24. [PMID: 27543782 DOI: 10.1016/j.compbiomed.2016.08.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Hemant Sharma
- Department of Electronics & Communication Engineering, Malaviya National Institute of Technology, Jaipur 302017, India.
| | - K K Sharma
- Department of Electronics & Communication Engineering, Malaviya National Institute of Technology, Jaipur 302017, India
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Gaisl T, Wons AM, Rossi V, Bratton DJ, Schlatzer C, Schwarz EI, Camen G, Kohler M. Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion. PLoS One 2016; 11:e0152994. [PMID: 27071039 PMCID: PMC4829247 DOI: 10.1371/journal.pone.0152994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background A high P-wave duration and dispersion (Pd) have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF), a condition linked to obstructive sleep apnea (OSA). We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF. Methods 12-lead-electrocardiography (ECG) was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM), obstructive hypopnea (inspiration through a threshold load, ITH), central apnea (AP), and during normal breathing (BL) in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis. Results P-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1ms and +13.8ms during MM; +11.7ms and +12.9ms during ITH; p<0.001 for all comparisons). In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05). Conclusion Intrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF.
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Affiliation(s)
- Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Spital Zollikerberg, Zollikerberg, Switzerland
| | - Annette M. Wons
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Valentina Rossi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel J. Bratton
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
- * E-mail:
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15
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Sayin MR, Altuntas M, Aktop Z, Oz II, Yavuz N, Akpinar I, Sagatli E, Karabag T, Aydin M. Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome. Chin Med J (Engl) 2015; 128:2141-6. [PMID: 26265605 PMCID: PMC4717978 DOI: 10.4103/0366-6999.162503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients. METHODS Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated. RESULTS Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203). CONCLUSIONS In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.
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Affiliation(s)
- Muhammet Rasit Sayin
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Murat Altuntas
- Department of Pulmonology, Uzun Mehmet State Hospital, Zonguldak, Turkey
| | - Ziyaeddin Aktop
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ibrahim I Oz
- Department of Radiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Nesimi Yavuz
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ibrahim Akpinar
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Erol Sagatli
- Department of Cardiology, Ataturk State Hospital, Zonguldak, Turkey
| | - Turgut Karabag
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Mustafa Aydin
- Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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Mansukhani MP, Wang S, Somers VK. Sleep, death, and the heart. Am J Physiol Heart Circ Physiol 2015; 309:H739-49. [PMID: 26188022 DOI: 10.1152/ajpheart.00285.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022]
Abstract
Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death.
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Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Community Medical Centers, Willmar, Minnesota; and
| | - Shihan Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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17
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The effect of obstructive sleep apnea on QRS complex morphology. J Electrocardiol 2015; 48:164-70. [DOI: 10.1016/j.jelectrocard.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Indexed: 12/15/2022]
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Obstructive sleep apnea syndrome: An important piece in the puzzle of cardiovascular risk factors. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 27:256-63. [PMID: 25496654 DOI: 10.1016/j.arteri.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/20/2022]
Abstract
The obstructive sleep apnea syndrome (OSA) is a clinical entity characterized by recurring episodes of apnea and/or hypopnea during sleep, due to a total or partial collapse, respectively, of the upper airway. This collapse originates a set of pathophysiological changes that determine the appearance of several cardiovascular complications. OSA contributes for the development of hypertension, heart failure, arrhythmias and coronary heart disease. Nowadays it is recognized to be an important public health problem, taking into account not just its repercussions but also its prevalence, since the main risk factor for the disease is obesity, a growing problem worldwide, both in developed and developing countries. The present review summarizes the current knowledge about OSA, as regards its definition, pathophysiology, clinical manifestations, diagnosis, cardiovascular effects and treatment.
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Abstract
Heart failure (HF) is one of the most prevalent and costly diseases in the United States. Sleep apnea is now recognized as a common, yet underdiagnosed, comorbidity of HF. This article discusses the unique qualities that sleep apnea has when it occurs in HF and explains the underlying pathophysiology that illuminates why sleep apnea and HF frequently occur together. The authors provide an overview of the treatment options for sleep apnea in HF and discuss the relative efficacies of these treatments.
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Affiliation(s)
- David Rosen
- Pulmonary Medicine, Montefiore Medical Center, 111 E 210 Street, Bronx, NY 10467, USA.
| | - Francoise Joelle Roux
- Connecticut Multispecialty Group, Division of Pulmonary, Critical Care and Sleep Medicine, 85 Seymour Street, Suite 923, Hartford, CT 06106, USA
| | - Neomi Shah
- Pulmonary Medicine, Montefiore Medical Center, 111 E 210 Street, Bronx, NY 10467, USA
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