Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study

Abstract

Rationale: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development.

Objective: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing.

Methods: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index>or=30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5).

Results: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p=0.003) for atrial fibrillation; 5.3 versus 1.2% (p=0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5% (p=0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.03-15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95% CI, 1.03-11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95% CI, 1.11-2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p<0.0003) considered as a continuous outcome.

Conclusions: Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.

Figures

Figure 1.

Arrhythmia prevalence (%) according to sleep-disordered breathing (SDB) status. Shaded bars, SDB; open bars, non-SDB. AF, atrial fibrillation; CVE, complex ventricular ectopy; NSVT, nonsustained ventricular tachycardia. n = 228 with SDB and n = 338 without SDB.

Figure 2.

Odds ratios (OR; 95% confidence interval [CI]) of complex ventricular ectopy. Model 1: SDB only. Model 2: SDB and demographics (age, sex, body mass index, and race). Model 3: SDB, demographics, and cardiovascular disease (CVD) risk factors (hypertension, diabetes mellitus, cholesterol, triglycerides, high-density lipoprotein, smoking history). Model 4: SDB, demographics, CVD risk factors, and CVD manifestations (angina, coronary heart disease, congestive heart failure, stroke, pacemaker placement, other cardiac surgery). Model 5: Optimal* reduced model (SDB status, age, and coronary heart disease). Model 6: Optimal reduced model using all available observations (n = 566). Modeling performed with observations for which there was complete covariate data (n = 526). * Optimal model determination was based on statistical and clinical significance of covariates and unsure and missing data were considered as absence of the variable in question.

Figure 3.

ORs (95% CI) of complex ventricular ectopy in subjects with SDB according to age adjusted for coronary artery disease. This graph depicts the ORs (95% CI) of complex ventricular ectopy adjusted for coronary heart disease according to our final model given a 50-, 60-, and 70-yr-old person, respectively.