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Increased ventricular premature contraction frequency during rem sleep in patients with coronary artery disease and obstructive sleep apnea.

Watanabe MA, Bhalodia R, Lundequam EJ, Domitrovich PP, Steinmeyer BC, Stein PK, Freedland KE, Duntley SP, Carney RM - Indian Pacing Electrophysiol J (2008)

Bottom Line: VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005) and by AHI (F=8.7, p<.005).Oxygen desaturation duration per apnea episode correlated positively with AHI (r(2)=.71, p<.0001), and was longer in REM than in non-REM (p<.0001).The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r(2)=.06, p=.014).

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, St. Louis University, USA. watanabe@slu.edu

ABSTRACT

Background: Patients with obstructive sleep apnea are reported to have a peak of sudden cardiac death at night, in contrast to patients without apnea whose peak is in the morning. We hypothesized that ventricular premature contraction (VPC) frequency would correlate with measures of apnea and sympathetic activity.

Methods: Electrocardiograms from a sleep study of 125 patients with coronary artery disease were evaluated. Patients were categorized by apnea-hypopnea index (AHI) into Moderate (AHI <15) or Severe (AHI>15) apnea groups. Sleep stages studied were Wake, S1, S2, S34, and rapid eye movement (REM). Parameters of a potent autonomically-based risk predictor for sudden cardiac death called heart rate turbulence were calculated.

Results: There were 74 Moderate and 51 Severe obstructive sleep apnea patients. VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005) and by AHI (F=8.7, p<.005). In Severe apnea patients, VPC frequency was higher in REM than in Wake (p=.011). In contrast, patients with Moderate apnea had fewer VPCs and exhibited no sleep stage dependence (p=.19). Oxygen desaturation duration per apnea episode correlated positively with AHI (r(2)=.71, p<.0001), and was longer in REM than in non-REM (p<.0001). The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r(2)=.06, p=.014).

Conclusions: Higher VPC frequency coupled with higher sympathetic activity caused by longer apnea episodes in REM sleep may be one reason for increased nocturnal death in apneic patients.

No MeSH data available.


Related in: MedlinePlus

Sleep time as percent of total sleep time (top panel), VPC count per sleep stage (center panel) and VPC frequency (bottom panel) for the different sleep stages for patients with No, Moderate, or Severe obstructive sleep apnea as defined by apnea-hypopnea index (AHI) value. Error bars indicate SEM. Severe sleep apnea patients spent more time in S1 sleep than patients with No or Moderate apnea. Both VPC count and frequency increased with increasing severity of apnea.
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Figure 1: Sleep time as percent of total sleep time (top panel), VPC count per sleep stage (center panel) and VPC frequency (bottom panel) for the different sleep stages for patients with No, Moderate, or Severe obstructive sleep apnea as defined by apnea-hypopnea index (AHI) value. Error bars indicate SEM. Severe sleep apnea patients spent more time in S1 sleep than patients with No or Moderate apnea. Both VPC count and frequency increased with increasing severity of apnea.

Mentions: Mean total sleep time was 302 ±12, 272 ±10, 255 ±10 minutes for patients with No, Moderate, and Severe sleep apnea, respectively. Total sleep time diminished as AHI increased (r2=.109, p<.001). When expressed as percent of total sleep time, approximately 60%, 25%, and 10% of time was spent in S2, REM, and S34 stages, respectively, regardless of apnea severity (Figure 1, top panel).


Increased ventricular premature contraction frequency during rem sleep in patients with coronary artery disease and obstructive sleep apnea.

Watanabe MA, Bhalodia R, Lundequam EJ, Domitrovich PP, Steinmeyer BC, Stein PK, Freedland KE, Duntley SP, Carney RM - Indian Pacing Electrophysiol J (2008)

Sleep time as percent of total sleep time (top panel), VPC count per sleep stage (center panel) and VPC frequency (bottom panel) for the different sleep stages for patients with No, Moderate, or Severe obstructive sleep apnea as defined by apnea-hypopnea index (AHI) value. Error bars indicate SEM. Severe sleep apnea patients spent more time in S1 sleep than patients with No or Moderate apnea. Both VPC count and frequency increased with increasing severity of apnea.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572026&req=5

Figure 1: Sleep time as percent of total sleep time (top panel), VPC count per sleep stage (center panel) and VPC frequency (bottom panel) for the different sleep stages for patients with No, Moderate, or Severe obstructive sleep apnea as defined by apnea-hypopnea index (AHI) value. Error bars indicate SEM. Severe sleep apnea patients spent more time in S1 sleep than patients with No or Moderate apnea. Both VPC count and frequency increased with increasing severity of apnea.
Mentions: Mean total sleep time was 302 ±12, 272 ±10, 255 ±10 minutes for patients with No, Moderate, and Severe sleep apnea, respectively. Total sleep time diminished as AHI increased (r2=.109, p<.001). When expressed as percent of total sleep time, approximately 60%, 25%, and 10% of time was spent in S2, REM, and S34 stages, respectively, regardless of apnea severity (Figure 1, top panel).

Bottom Line: VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005) and by AHI (F=8.7, p<.005).Oxygen desaturation duration per apnea episode correlated positively with AHI (r(2)=.71, p<.0001), and was longer in REM than in non-REM (p<.0001).The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r(2)=.06, p=.014).

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, St. Louis University, USA. watanabe@slu.edu

ABSTRACT

Background: Patients with obstructive sleep apnea are reported to have a peak of sudden cardiac death at night, in contrast to patients without apnea whose peak is in the morning. We hypothesized that ventricular premature contraction (VPC) frequency would correlate with measures of apnea and sympathetic activity.

Methods: Electrocardiograms from a sleep study of 125 patients with coronary artery disease were evaluated. Patients were categorized by apnea-hypopnea index (AHI) into Moderate (AHI <15) or Severe (AHI>15) apnea groups. Sleep stages studied were Wake, S1, S2, S34, and rapid eye movement (REM). Parameters of a potent autonomically-based risk predictor for sudden cardiac death called heart rate turbulence were calculated.

Results: There were 74 Moderate and 51 Severe obstructive sleep apnea patients. VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005) and by AHI (F=8.7, p<.005). In Severe apnea patients, VPC frequency was higher in REM than in Wake (p=.011). In contrast, patients with Moderate apnea had fewer VPCs and exhibited no sleep stage dependence (p=.19). Oxygen desaturation duration per apnea episode correlated positively with AHI (r(2)=.71, p<.0001), and was longer in REM than in non-REM (p<.0001). The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r(2)=.06, p=.014).

Conclusions: Higher VPC frequency coupled with higher sympathetic activity caused by longer apnea episodes in REM sleep may be one reason for increased nocturnal death in apneic patients.

No MeSH data available.


Related in: MedlinePlus