Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Jun 22;169(12):1147-55.
doi: 10.1001/archinternmed.2009.138.

Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study

Reena Mehra  1 , Katie L Stone, Paul D Varosy, Andrew R Hoffman, Gregory M Marcus, Terri Blackwell, Osama A Ibrahim, Rawan Salem, Susan Redline
Affiliations
Comparative Study

Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study

Reena Mehra et al. Arch Intern Med. .

Abstract

Background: Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men.

Methods: A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed.

Results: An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19-3.89) and CVE (OR, 1.43; 95% CI, 1.12-1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95% CI, 1.61-4.47) than CVE (OR, 1.27; 95% CI, 0.97-1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23-2.14) compared with the lowest quartile.

Conclusions: In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Arrhythmia by increasing Respiratory Disturbance Index (RDI) quartile relative to atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE). The error bars indicate standard errors.
Figure 2
Figure 2
Arrhythmia by increasing Obstructive Apnea Index (OAI) quartile relative to atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE). The error bars indicate standard errors.
Figure 3
Figure 3
Arrhythmia by increasing Central Apnea Index (CAI) category relative to atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE). The error bars indicate standard errors.
Figure 4
Figure 4
Arrhythmia by increasing Cheyne-Stokes respirations–central sleep apnea (CSR-CSA) category relative to atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE). The error bars indicate standard errors.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–1904. - PMC - PubMed
    1. Somers VK, Dyken ME, Skinner JL. Autonomic and hemodynamic responses and interactions during the Mueller maneuver in humans. J Auton Nerv Syst. 1993;44(2–3):253–259. - PubMed
    1. Arias MA, Alonso-Fernandez A, Garcia-Rio F, Sanchez A, Lopez JM, Pagola C. Obstructive sleep apnea in atrial fibrillation patients. Int J Cardiol. 2006;110(3):426. - PubMed
    1. Arias MA, Sanchez AM. Obstructive sleep apnea and its relationship to cardiac arrhythmias. J Cardiovasc Electrophysiol. 2007;18(9):1006–1014. - PubMed
    1. Flemons WW, Remmers JE, Gillis AM. Sleep apnea and cardiac arrhythmias: is there a relationship? Am Rev Respir Dis. 1993;148(3):618–621. - PubMed

Publication types

Grants and funding