Prevalence of Sleep-related breathing disorders in Patients with Tachyarrhythmia without Heart Failure
Keywords:
Obstructive Sleep Apnea, Tachyarrhythmia, Hypertension, Cardiac IssuesAbstract
Background: Obstructive sleep apnea (OSA) and other sleep-related breathing disorders (SRBD) are becoming more widely co-occurring conditions in patients with cardiac arrhythmias. There is little information on their prevalence in patients with tachyarrhythmias who do not have heart failure, particularly in the South Asian population, despite their well-established link to heart failure. Objective: To determine the prevalence of sleep-related breathing disorders in patients with tachyarrhythmia without heart failure. Methodology: The study included 43 adult patients with tachyarrhythmias and no clinical or echocardiographic signs of heart failure (mean age: 54.2 ± 11.6 years; 62.8% male). BMI, neck circumference, comorbidities, and Epworth Sleepiness Score (ESS) were among the baseline clinical and demographic data gathered. To determine whether SRBD was present and how severe it was, each patient had overnight polysomnography based on the apnea-hypopnea index (AHI). Results: Among study cases, SRBD (AHI ≥5) was identified in 29 (67.4%) patients. The predominant type was obstructive sleep apnea (58.1%), followed by central (7.0%) and mixed (2.3%) apnea. Patients with SRBD had significantly higher Body Mass Index (30.4 ± 3.9 vs. 26.5 ± 4.1 kg/m²), greater ESS (10.1 ± 4.6 vs. 7.1 ± 3.4), and a higher prevalence of hypertension (62.1% vs. 28.6%; p=0.03) compared to those without SRBD. Conclusion: Even when heart failure was not present, a high prevalence of SRBD was noted in patients who had tachyarrhythmias. These results point out the necessity of routine SRBD screening in this population, especially for those who suffer from obesity, hypertension, and excessive daytime sleepiness.References
Adegunsoye A, Ramachandran S. Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleepâ€Related Breathing Disorders. Pulm Med. 2012;2012(1):273591. DOI: 10.1155/2012/273591.
Correale M, Paolillo S, Mercurio V, Limongelli G, Barilla F, Ruocco G, et al. Comorbidities in chronic heart failure: an update from Italian Society of Cardiology (SIC) Working Group on Heart Failure. Eur J Intern Med. 2020;71:23-31. DOI: 10.1016/j.ejim.2019.10.008
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the J Am Coll Cardiol. 2016;67(13):e27-115.
Mourad S, Wahab NA, Fayed A, Kassem A, Alsayed H. Occurrence of sleep related breathing disorders in Egyptian patients with tachyarrhythmia without heart failure. Egypt J Chest Dis Tuberc. 2017;66(1):127-36. DOI: 10.1016/j.ejcdt.2016.09.005.
Kendzerska T, Gershon AS, Atzema C, Dorian P, Mangat I, Hawker G, et al. Sleep apnea increases the risk of new hospitalized atrial fibrillation: a historical cohort study. Chest. 2018;154(6):1330–9. DOI: 10.1016/j.chest.2018.08.1075.
Latina JM, Estes NM III, Garlitski AC. The relationship between obstructive sleep apnea and atrial fibrillation: a complex interplay. Pulm Med. 2013;2013(1):621736. DOI: 10.1155/2013/621736.
Cadby G, McArdle N, Briffa T, Hillman DR, Simpson L, Knuiman M, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest. 2015;148(4):945–52. DOI: 10.1378/chest.15-0229.
Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Shahar E, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001;154(1):50–9. DOI: 10.1093/aje/154.1.50.
Abumuamar AM, Dorian P, Newman D, Shapiro CM. The prevalence of obstructive sleep apnea in patients with atrial fibrillation. Clin Cardiol. 2018;41(5):601–7. DOI: 10.1002/clc.22933.
Barolia R, Sayani AH. Risk factors of cardiovascular disease and its recommendations in Pakistani context. J Pak Med Assoc. 2017;67(11):1723. Available from URL: https://ecommons.aku.edu/pakistan_fhs_son/300.
Zubair F, Nawaz SK, Nawaz A, Nangyal H, Amjad N, Khan MS. Prevalence of cardiovascular diseases in Punjab, Pakistan: a cross-sectional study. J Public Health. 2018;26:523–9. DOI: 10.1007/s10389-018-0898-4.
Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;144(3):e56–67. DOI: 10.1161/CIR.0000000000000988.
Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71.
Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6. DOI: 10.1164/rccm.200509-1442OC.
Padeletti M, Zacà V, Mondillo S, Jelic S. Sleep-disordered breathing increases the risk of arrhythmias. J Cardiovasc Med. 2014;15(5):411–6. DOI: 10.2459/JCM.0000000000000019.
Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Böhm M, et al. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol. 2015;104:705–18. DOI: 10.1007/s00392-015-0859-7.
Cizza G, de Jonge L, Piaggi P, Mattingly M, Zhao X, Lucassen E, et al. Neck circumference is a predictor of metabolic syndrome and obstructive sleep apnea in short-sleeping obese men and women. Metab Syndr Relat Disord. 2014;12(4):231–41. DOI: 10.1089/met.2013.0093.
Craig S, Pépin JL, Randerath W, Caussé C, Verbraecken J, Asin J, et al. Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view. Eur Respir Rev. 2022;31(164):210230. DOI: 10.1183/16000617.0230-2021.
Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007;49(20):2028–34.
Naruse Y, Tada H, Satoh M, Yanagihara M, Tsuneoka H, Hirata Y, et al. Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy. Heart Rhythm. 2013;10(3):331–7. DOI: 10.1016/j.hrthm.2012.11.015.
Mills EW, Antman EM, Javaheri S. Breathless nights and heart flutters: understanding the relationship between obstructive sleep apnea and atrial fibrillation. Heart Rhythm. 2023;20(9):1267–73. DOI: 10.1016/j.hrthm.2023.04.022.
Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jais P, Josephson ME, et al. European heart rhythm association (EHRA) consensus document on the management of supraventricular arrhythmias. Europace. 2017;19(3):465–511. DOI: 10.1093/europace/euw301.
Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J, et al. Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol. 2009;54(19):1797–804.
Hersi AS. Sleep-related breathing disorders and cardiac arrhythmia. Cardiac Arrhythmias–New Considerations. 2012;267–88.
Gellert KS, Alonso A, Chen LY, Meyer ML, Soliman EZ, Suzuki T, et al. Association of sleep apnea, diagnosed by self-reported physician diagnosis or hospital discharge codes, with atrial fibrillation and ectopy using ambulatory electrocardiogram in the ARIC study. Circ Arrhythm Electrophysiol. 2020;13(4):e007574. DOI: 10.1161/CIRCEP.119.007574.
Georgoulis M, Yiannakouris N, Kechribari I, Lamprou K, Perraki E, Vagiakis E, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle intervention: secondary analyses of the “MIMOSA†randomized clinical trial. J Clin Sleep Med. 2022;18(5):1251–61. DOI: 10.5664/jcsm.9834.
Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest. 1993;103(1):30–6.
Friedman M, Wilson MN, Pulver T, Pandya H, Joseph NJ, Lin HC, et al. Screening for obstructive sleep apnea/hypopnea syndrome: subjective and objective factors. Otolaryngol Head Neck Surg. 2010;142(4):531–5.
Bradicich M, Sievi NA, Grewe FA, Gasperetti A, Kohler M, Schwarz EI. Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the Sleep Heart Health Study. J Thorac Dis. 2020;12(Suppl 2):S129. DOI: 10.21037/jtd-cus-2020-005.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
