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 Bravata, Jared Ferguson, Kingman Strohl, Adam Bennett, Andrey Zinchuk, Henry K. Yaggi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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
Volume12
Issue number6
DOIs
StatePublished - 2016

Fingerprint

Sleep Apnea Syndromes
Cardiac Arrhythmias
Apnea
Supraventricular Tachycardia
Tachycardia
Linear Models
Polysomnography
Veterans
Ventricular Tachycardia
Arousal
Atrial Fibrillation
Comorbidity
Cardiovascular Diseases
Cross-Sectional Studies
Logistic Models

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Selim, B. J., Koo, B. B., Qin, L., Jeon, S., Won, C., Redeker, N. S., ... 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. https://doi.org/10.5664/jcsm.5880

The association between nocturnal cardiac arrhythmias and sleep-disordered breathing : The DREAM study. / Selim, Bernardo J.; Koo, Brian B.; Qin, Li; Jeon, Sangchoon; Won, Christine; Redeker, Nancy S.; Lampert, Rachel J.; Concato, John P.; Bravata, Dawn; Ferguson, Jared; Strohl, Kingman; Bennett, Adam; Zinchuk, Andrey; Yaggi, Henry K.

In: Journal of Clinical Sleep Medicine, Vol. 12, No. 6, 2016, p. 829-837.

Research output: Contribution to journalArticle

Selim, BJ, Koo, BB, Qin, L, Jeon, S, Won, C, Redeker, NS, Lampert, RJ, Concato, JP, Bravata, D, Ferguson, J, Strohl, K, Bennett, A, Zinchuk, A & Yaggi, HK 2016, 'The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM study', Journal of Clinical Sleep Medicine, vol. 12, no. 6, pp. 829-837. https://doi.org/10.5664/jcsm.5880
Selim, Bernardo J. ; Koo, Brian B. ; Qin, Li ; Jeon, Sangchoon ; Won, Christine ; Redeker, Nancy S. ; Lampert, Rachel J. ; Concato, John P. ; Bravata, Dawn ; Ferguson, Jared ; Strohl, Kingman ; Bennett, Adam ; Zinchuk, Andrey ; Yaggi, Henry K. / The association between nocturnal cardiac arrhythmias and sleep-disordered breathing : The DREAM study. In: Journal of Clinical Sleep Medicine. 2016 ; Vol. 12, No. 6. pp. 829-837.
@article{cc7179e3d84f4d56a174b965a6402160,
title = "The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM study",
abstract = "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.",
keywords = "Atrial fibrillation, Autonomic nervous system, Cardiac arrhythmias, Hypoxemia, Obstructive sleep apnea, Sleep-disordered breathing, Sudden cardiac death",
author = "Selim, {Bernardo J.} and Koo, {Brian B.} and Li Qin and Sangchoon Jeon and Christine Won and Redeker, {Nancy S.} and Lampert, {Rachel J.} and Concato, {John P.} and Dawn Bravata and Jared Ferguson and Kingman Strohl and Adam Bennett and Andrey Zinchuk and Yaggi, {Henry K.}",
year = "2016",
doi = "10.5664/jcsm.5880",
language = "English (US)",
volume = "12",
pages = "829--837",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "6",

}

TY - JOUR

T1 - The association between nocturnal cardiac arrhythmias and sleep-disordered breathing

T2 - The DREAM study

AU - Selim, Bernardo J.

AU - Koo, Brian B.

AU - Qin, Li

AU - Jeon, Sangchoon

AU - Won, Christine

AU - Redeker, Nancy S.

AU - Lampert, Rachel J.

AU - Concato, John P.

AU - Bravata, Dawn

AU - Ferguson, Jared

AU - Strohl, Kingman

AU - Bennett, Adam

AU - Zinchuk, Andrey

AU - Yaggi, Henry K.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Autonomic nervous system

KW - Cardiac arrhythmias

KW - Hypoxemia

KW - Obstructive sleep apnea

KW - Sleep-disordered breathing

KW - Sudden cardiac death

UR - http://www.scopus.com/inward/record.url?scp=84975288452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975288452&partnerID=8YFLogxK

U2 - 10.5664/jcsm.5880

DO - 10.5664/jcsm.5880

M3 - Article

C2 - 26951420

AN - SCOPUS:84975288452

VL - 12

SP - 829

EP - 837

JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

SN - 1550-9389

IS - 6

ER -