Triggering of Nocturnal Arrhythmias by Sleep-Disordered Breathing Events

Abstract

Objectives This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in those with sleep-disordered breathing (SDB). Background SDB is associated with increased risk of atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. Methods Overnight polysomnograms (PSGs) from the Sleep Heart Health Study (n = 2816) were screened for paroxysmal atrial fibrillation (PAF) and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of PAF or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. PSGs were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-second hazard period preceding each arrhythmia or control period. Results Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia following a respiratory disturbance were nearly 18-times (OR 17.5; 95% CI 5.3–58.4) the odds of an arrhythmia occurring following normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia/40000 respiratory disturbances). Neither hypoxia nor EEG-defined arousals alone increased arrhythmia risk. Conclusions Although the absolute arrhythmia rate is low, the relative risk of PAF and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.