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Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study
Archives of Internal Medicine, 06/29/09

Mehra R et al. – In a large cohort of older men, increasing severity of sleep-disordered breathing (SDB) was associated with a progressive increase in odds of atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE). When SDB was characterized by central or obstructive subtypes, CVE was associated most strongly with , obstructive sleep apnea (OSA) and hypoxia, whereas AF was most strongly associated with central sleep apnea (CSA), suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.

Methods

Study of the association between SDB with nocturnal AF and CVE in older men
Unattended polysomnography for 2911 pts in Outcomes of Sleep Disorders in Older Men Study
Electrocardiogram-specific analysis of polysomnographic data for nocturnal AF and CVE
SDB defined by respiratory disturbance index (RDI) quartile (major index for all apneas and hypopneas)
Ancillary definitions incorporating: 1) obstructive events (OSA; OSA Index quartile); 2) central events (CSA; Central Apnea Index category), and 3) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation)

Results

An increasing RDI quartile associated with increased odds of AF and CVE
Highest RDI quartile associated with increased odds of AF and CVE vs lowest quartile
Increasing OSA quartile significantly associated with increasing CVE but not AF
Central sleep apnea more strongly associated with AF
Hypoxia level associated with CVE; pts in highest hypoxia category had an increased odds of CVE vs lowest quartile