The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM study

Bernardo J. Selim, Brian B. Koo, Li Qin, Sangchoon Jeon, Christine Won, Nancy S. Redeker, Rachel J. Lampert, John P. Concato, Dawn M. Bravata, Jared Ferguson, Kingman Strohl, Adam Bennett, Andrey Zinchuk, Henry K. Yaggi

Research output: Contribution to journalArticle

25 Scopus citations


Study Objectives: To determine whether sleep-disordered breathing (SDB) is associated with cardiac arrhythmia in a clinic-based population with multiple cardiovascular comorbidities and severe SDB. Methods: This was a cross-sectional analysis of 697 veterans who underwent polysomnography for suspected SDB. SDB was categorized according to the apnea-hypopnea index (AHI): none (AHI < 5), mild (5 ≥ AHI < 15), and moderate-severe (AHI ≥ 15). Nocturnal cardiac arrhythmias consisted of: (1) complex ventricular ectopy, (CVE: non-sustained ventricular tachycardia, bigeminy, trigeminy, or quadrigeminy), (2) combined supraventricular tachycardia, (CST: atrial fibrillation or supraventricular tachycardia), (3) intraventricular conduction delay (ICD), (4) tachyarrhythmias (ventricular and supraventricular), and (5) any cardiac arrhythmia. Unadjusted, adjusted logistic regression, and Cochran-Armitage testing examined the association between SDB and cardiac arrhythmias. Linear regression models explored the association between hypoxia, arousals, and cardiac arrhythmias. Results: Compared to those without SDB, patients with moderate-severe SDB had almost three-fold unadjusted odds of any cardiac arrhythmia (2.94; CI 95%, 2.01-4.30; p < 0.0001), two-fold odds of tachyarrhythmias (2.16; CI 95%,1.47-3.18; p = 0.0011), two-fold odds of CVE (2.01; 1.36-2.96; p = 0.003), and two-fold odds of ICD (2.50; 1.58-3.95; p = 0.001). A linear trend was identified between SDB severity and all cardiac arrhythmia subtypes (p value linear trend < 0.0001). After adjusting for age, BMI, gender, and cardiovascular diseases, moderate-severe SDB patients had twice the odds of having nocturnal cardiac arrhythmias (2.24; 1.48-3.39; p = 0.004). Frequency of obstructive respiratory events and hypoxia were strong predictors of arrhythmia risk. Conclusions: SDB is independently associated with nocturnal cardiac arrhythmias. Increasing severity of SDB was associated with an increasing risk for any cardiac arrhythmia.

Original languageEnglish (US)
Pages (from-to)829-837
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number6
StatePublished - Jan 1 2016


  • Atrial fibrillation
  • Autonomic nervous system
  • Cardiac arrhythmias
  • Hypoxemia
  • Obstructive sleep apnea
  • Sleep-disordered breathing
  • Sudden cardiac death

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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    Selim, B. J., Koo, B. B., Qin, L., Jeon, S., Won, C., Redeker, N. S., Lampert, R. J., Concato, J. P., Bravata, D. M., Ferguson, J., Strohl, K., Bennett, A., Zinchuk, A., & Yaggi, H. K. (2016). The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM study. Journal of Clinical Sleep Medicine, 12(6), 829-837.