Cardiac arrhythmias during sleep

The Obesity-Hypoventilation Syndrome Revisited

Over the last few years, various researches have reached the conclusion that cosmic ray variations and geomagnetic disturbances are related to the condition of the human physiological state. In this study, medical data concerning the number of incidents of different types of cardiac arrhythmias for the time period 1983–1992, which refer to 1902 patients in Tbilisi, Georgia, were used. The smoothing method and the Pearson r-coefficients were used to examine the possible effect of different solar and geomagnetic activity parameters and cosmic ray intensity variations on the different types of arrhythmias. The time interval under examination was separated into two different time periods, which coincided with the polarity reversal of the solar magnetic field occurred in the years 1989–1990, and as a result, a different behavior of all the above-mentioned parameters as well as of the different types of arrhythmias was noticed during the two time intervals. In addition, changing of polarity sign of the solar magnetic field was found to affect the sign of correlation between the incidence of arrhythmias and the aforementioned parameters. The primary and secondary maxima observed in the solar parameters during the solar cycle 22, also appeared in several types of arrhythmias with a time lag of about 5 months.

Night-to-night variability of obstructive sleep apnea severity is considerable and may depend on the diagnostic modality used. We investigated the night-to-night variability using peripheral arterial tonometry (PAT). Home sleep apnea testing was performed in 51 patients during 3 consecutive nights using PAT. Patients referred to our sleep clinic were screened and prospectively recruited for this study. All recordings were automatically and manually scored according to the PAT scoring guidelines. No systematic differences in PAT-derived apnea-hypopnea index (pAHI) were found between the nights. The night-to-night variability was comparable between manually and automatically scored data. pAHI varied in 35% of patients more than 10 events/h between the nights. The obstructive sleep apnea severity of 24% of patients was misclassified when using 1 night compared to the average of all nights. On average, pAHI varied by 57% from night to night. The variability of pAHI could partially be explained by the variability of time spent in the supine position with more time supine leading to a higher pAHI. On measuring a subsequent night, 12-14% of patients spontaneously fulfilled the commonly accepted criteria for treatment success without any intervention. With repeated recordings of PAT, we found no first night effect. However, there is considerable night-to-night variability similar to values found for polysomnography, which can partially be explained by the variability of time spent in the supine position. Obstructive sleep apnea severity was frequently misclassified due to the night-to-night variability. Our findings make a strong case for multiple testing in the diagnostic work-up of obstructive sleep apnea patients. Tschopp S, Wimmer W, Caversaccio M, Borner U, Tschopp K. Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. J Clin Sleep Med. 2021;17(9):1751-1758.

Many patients with severe obstructive sleep apnea (OSA) do not complain of excessive daytime sleepiness (EDS), possibly due to increased sympathetic nervous activity (SNA) and accompanying heightened alertness. We hypothesized that in patients with OSA, those without subjective EDS (Epworth Sleepiness Scale, ESS score < 11) would have higher very low frequency (VLF) heart rate variability (HRV) during sleep, reflecting greater sympathetic heart rate modulation than patients with an ESS score ≥ 11. Patients with severe OSA (AHI ≥ 30: 26 with and 65 without heart failure) were divided into those with and without EDS. Heart rate (HR) signals were acquired in stage 2 sleep during periods of recurrent apneas and hypopneas and submitted to coarse graining spectral analysis, which extracts harmonic, neurally mediated contributions to HRV from total spectral power. Because the apnea-hyperpnea cycle entrains muscle SNA at VLF (0 to 0.04 Hz), VLF power was our principal between-group comparison. Subjects without EDS had higher harmonic VLF power (944 ± 839 vs 447 ± 461 msec(2), p = 0.003) than those with EDS, irrespective of the presence or absence of heart failure (1218 ± 944 vs 426 ± 299 msec(2), p = 0.043, and 1029 ± 873 vs 503 ± 533 msec(2), p = 0.003, respectively). ESS scores correlated inversely with VLF power in all (r = -0.294, p = 0.005) and in heart failure subjects (r = -0.468, p = 0.016). Patients with severe OSA but without EDS have higher VLF-HRV than those with EDS. This finding suggests that patients with severe OSA but without EDS have greater sympathetic modulation of HRV than those with EDS that may reflect elevated adrenergically mediated alertness. Taranto Montemurro L; Floras JS; Picton P; Kasai T; Alshaer H; Gabriel JM; Bradley TD. Relationship of heart rate variability to sleepiness in patients with obstructive sleep apnea with and without heart failure.

Although atrial arrhythmias may have genetic causes, very few data are available on evaluation of the arrhythmic substrate in genetic atrial diseases in humans. In this study, we evaluate the nature and evolution of the atrial arrhythmic substrate in a genetic atrial cardiomyopathy. Repeated electroanatomic mapping and tomographic evaluations were used to investigate the evolving arrhythmic substrate in 5 patients with isolated arrhythmogenic atrial cardiomyopathy, caused by Natriuretic Peptide Precursor A (NPPA) gene mutation. Atrial fibrosis was assessed using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). The substrate of atrial tachycardia (AT) and atrial fibrillation (AF) was biatrial dilatation with patchy areas of low voltage and atrial wall scarring (in the right atrium: 68.5% ± 6.0% and 22.2% ± 10.2%, respectively). The evolution of the arrhythmic patterns to sinus node disease with atrial standstill (AS) was associated with giant atria with extensive low voltage and atrial scarring areas (in the right atrium: 99.5% ± 0.7% and 57.5% ± 33.2%, respectively). LGE-MRI-proven biatrial fibrosis (Utah stage IV) was associated with AS. Atrial conduction was slow and heterogeneous, with lines of conduction blocks. The progressive extension and spatial distribution of the scarring/fibrosis were strictly associated with the different types of arrhythmias. The evolution of the amount and distribution of atrial scarring/fibrosis constitutes the structural substrate for the different types of atrial arrhythmias in a pure genetic model of arrhythmogenic atrial cardiomyopathy.

The aim of this work is to detect and delineate the arrhythmogenic Pattern of congenital heart diseases regarding its types incidence, and out come. Background CHD represents the most important components of pediatric Cardiovascular disease. The incidence of CHD in live births ranged from (0.5–3%) WHO. The most life threatening complications of CHD were the different types of arrhythmias. Methodology The present study was conducted upon 100 children suffering from CHD. Also selected 50 healthy child as control group age matched were included. They were following the Outpatient Clinic Abou Riesh Hospital, Cairo University from (2008 to 2011). – They aged from (20 days till 6 years). – All patients were subjected to thorough clinical history and examination, X-ray Chest, ECG -12 leads, long strip lead II and Echocardiography. – Some cases were subjected to cardiac, 24-h ECG recording (Holter). Results All the results were statistically analyzed. – Sex distribution among study was 45% females 55% males. – The incidence if arrhythmogenic pattern in the studied group were (57%) suffering from arrhythmias. While (43%) were not affected. – The percentage of the different types of arrhythmias was as follows: among the affected group. – Atrial fibrillation (21.4%), supraventricular tachyarrhythmia (49.7%), Sick sinus syndrome (5.2%), ventricular tachycardia (5.2%), extrasystole (12%), heart block I(3.5%), heart block type II (3.5%). – Congenital cyanotic heart disease has highly significant statistical correlation with the incidence of arrhythmias pattern ( p – While acyanotic CHD has non significant relation ( p > 0.05). Conclusion – The congenital cyanotic heart diseases have the higher incidence of arrhythmias more than the acyanotic group and control. – The early affection of the different types of arrhythmias are most serious and life threatening.

Background Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients. Purpose Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality. Methods All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations. Results OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p&amp;lt;0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p&amp;lt;0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p&amp;lt;0.001) and sudden cardiac death (1.34% vs 0.4%; p&amp;lt;0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p&amp;lt;0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p&amp;lt;0.001]. Conclusion Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population. Funding Acknowledgement Type of funding sources: None.

Background:Refractory hypoxemia episodes are characteristic of obstructive sleep apnea (OSA). Patients with OSA suffer from oxidative stress in all systems. Atrial fibrillation (AF) is a type of arrhythmia that may be induced by OSA. In this study, we explored the dose-response relationship between OSA and AF. Our research provides the basis for a novel approach to AF prevention.Methods:We screened four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for observational studies on OSA and AF. Studies were collected from database establishment to November 2020. We performed a traditional subgroup meta-analysis. Linear and spline dose-response models were applied to assess the association between the apnea-hypopnea index, an indicator of OSA severity, and the risk of AF. Review Manager version 5.3 software and Stata 16.0 were used for the analysis.Results:Sixteen observational studies were included in the study. We excluded a study from the conventional meta-analysis. In the subgroup analysis, the odds ratios for new onset AF for no obvious reason, new onset AF after surgical operations, such as coronary artery bypass grafting, and AF after ablation treatment were 1.71 (95% CI 1.37–2.13, P < .05), 2.65 (95% CI 2.32–3.01, P < .05), and 2.93 (95% CI 2.47–3.49, P < .05), respectively. Linear dose-response meta-analysis results revealed that the risk of AF increased with increasing apnea-hypopnea index value.Conclusion:Through dose-response meta-analysis, we found a potential dose-response relationship between OSA severity and the risk of AF. This relationship should be considered in interventions aimed at AF prevention in the future.

Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS. Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ≤ 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting. Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.

The following is the abstract of the article discussed in the subsequent letter: Midlatency respiratory-related evoked potentials were measured during wakefulness by using a 60-electrode array placed over the cortical region of the scalp. We studied the responses evoked by 200-ms pressure pulses at

Severe Sinus Bradycardia Associated with Ibrutinib: One Rare Case from China

Abstract. Obstructive sleep apnea syndrome (OSAS) is increasingly being considered as a factor associated with the development of nocturnal arrhythmias, as well as an increased risk of sudden cardiac death. The prevalence of OSA reaches 5-7% in the adult population. The prognostic role of pathological breathing patterns has not been sufficiently investigated, and therefore further study of the pathogenesis of arrhythmias for the subsequent intensification of therapeutic measures is promising. Aim of the Research. To study the prognostic significance of individual breathing parameters in different sleep phases for the development of atrial fibrillation and ventricular arrhythmias in patients with obstructive sleep apnea syndrome (OSAS) and chronic heart failure (CHF) with preserved ejection fraction (EF). Materials and methods. 86 men with moderate and severe OSAS (with an apnea/hypopnea index (AHI) &gt;15 per hour) were examined. To diagnose OSAS, all patients underwent a polysomnographic study of night sleep. The severity of obstructive respiratory disorders during sleep was assessed by the apnea/hypopnea index for the total period of sleeping. Using polysomnography, we additionally investigated the following parameters of respiratory disturbances during the night sleep period: index of obstructive apnea/hypopnea selectively in REM sleep (AHIobsREM); index of respiratory distress syndrome for the entire period of sleep (IRDS); index of respiratory distress syndrome in the REM sleep phase (IRDS REM); average saturation per night; desaturation index for the total period of sleep; desaturation index in REM sleep. The observation period was 12 months, during which the presence of atrial fibrillation paroxysms lasting more than 30 s and the development of high-grade ventricular arrhythmias (III-V class according to Ryan) were assessed. Results. In the course of the study, a number of breathing parameters during the night time sleep (IAHobs, IAHobsREM, IRDS, IRDS REM) significantly correlated with the development of the studied cardiac arrhythmias. The most significant prognostic role has been stated for obstructive sleep apnea registered in the REM sleep phase. Conclusion. Breathing parameters during nighttime sleeping (IAHobs, IAHobs REM, IRDS, IRDS REM), which characterize the severity of OSAS are independent predictors of the development of paroxysmal atrial fibrillation and high-grade ventricular extrasystole in patients with OSAS and CHF with preserved EF. The results obtained make it possible to use these sleep parameters in the future in stratifying the risk of arrhythmias and determining treatment tactics in this cohort of patients.

Objective: Recently few studies have described presence of cervical spine anomalies in obstructive sleep apnoea syndrome (OSAS) patients. It is also reported that some cases of cervical spine pathologies and osteophytes producing obstructive sleep apnea. We aim to investigate the prevalence of facet joint arthrosis and degenerative disc disease (DDD) in cervical spine using computed tomography (CT) in OSAS patients. Materials and Methods: We studied on thirty patients with OSAS who had cervical spine CT. Facet joints were evaluated in four grades and scored in 1-4 points by using multiplanar CT images. Disc levels was evaluated by using two-point subjective scale for loss of height, posterior osteophytes, endplate sclerosis, and spinal canal stenosis to determinate DDD. Degeneration of anterior atlanto-odontoid joint (AAOJ) were classified into four grades. Tomographic findings were compared with those for thirty control subjects. Results: The mean degeneration scores of C2-T1 facet joints and C2-C5, C7-T1 disc spaces were significantly higher in the cases of OSAS group than the cases of the control group. There were no significant differences in the mean degeneration scores for C5-6 and C6-7 cervical intervertebral disc levels between the groups. Degeneration scores of the facet and disc for whole cervical spine in the cases of the OSAS group was significantly higher than in cases of the control group (P<0.001 and P=0.002). AAOJ degeneration degrees showed differences between the groups. Statistically significant correlations were found between the OSAS degrees and the intervertebral disc degeneration (R=0.338, P=0.007) and facet joint degeneration (R=0.543, P=0.000) for all cervical vertebrae. Conclusions: The cervical spine of the OSAS patients has more severe disc degeneration and facet joint and AAOJ arthrosis, compared to subjects without OSAS. This findings may contribute to clinic evaluation of OSAS patients with servical pain and limited movement.

Pulmonary Hemodynamics and Hypoxemia in Sleep Apnea

Comparison of Respiratory Polysomnographic Parameters in Matched Cohorts of Upper Airway Resistance and Obstructive Sleep Apnea Syndrome Patients