Hazem Omran1, Thomas Bitter2, Dieter Horstkotte2, Olaf Oldenburg2, Henrik Fox2. 1. Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany. homran@hdz-nrw.de. 2. Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
Abstract
BACKGROUND: Cardiac arrhythmias and sleep-disordered breathing (SDB) are common comorbidities in heart failure with reduced ejection fraction (HFrEF). However, understanding of the association between arrhythmias and SDB is poor. This study assessed the occurrence and circadian distribution of ventricular arrhythmias in HFrEF patients with and without SDB. METHODS: This retrospective analysis included HFrEF patients admitted for unattended overnight cardiorespiratory polygraphy and 24-h Holter-ECG recording. Holter-ECG data (events/h) were categorized by time of day: morning, 06:00-13:59; afternoon, 14:00-21:59; nighttime, 22:00-05:59. Respiratory events were expressed using the apnea-hypopnea index (AHI) and an AHI ≥ 15/h was categorized as moderate to severe SDB. RESULTS: 167 patients were included (82% male, age 65 ± 10.4 years, left ventricular ejection fraction 30.9 ± 7.9%); SDB was predominantly central sleep apnea (CSA) in 45.5%, obstructive sleep apnea (OSA) in 23.9% or none/mild (nmSDB) in 17.4%. Morning premature ventricular contractions (PVCs) were detected significantly more frequently in CSA versus nmSDB patients (44.4/h versus 1.8/h; p = 0.02). Non-sustained VT was more frequent in patients with CSA versus versus OSA or nmSDB (17.9 versus 3.2 or 3.2%/h; p = 0.003 and p = 0.005, respectively). There was no significant variation in VT occurrence by time of day in HFrEF patients with CSA (p = 0.3). CSA was an independent predictor of VT occurrence in HFrEF in multivariate logistic regression analysis (odds ratio 4.1, 95% confidence interval 1.5-11.4, p = 0.007). CONCLUSION: CSA was associated with VT occurrence irrespective of sleep/wake status in HFrEF patients, and independently predicted the occurrence of VT. This association may contribute to chances by which CSA increases sudden death risk in HFrEF patients.
BACKGROUND:Cardiac arrhythmias and sleep-disordered breathing (SDB) are common comorbidities in heart failure with reduced ejection fraction (HFrEF). However, understanding of the association between arrhythmias and SDB is poor. This study assessed the occurrence and circadian distribution of ventricular arrhythmias in HFrEF patients with and without SDB. METHODS: This retrospective analysis included HFrEF patients admitted for unattended overnight cardiorespiratory polygraphy and 24-h Holter-ECG recording. Holter-ECG data (events/h) were categorized by time of day: morning, 06:00-13:59; afternoon, 14:00-21:59; nighttime, 22:00-05:59. Respiratory events were expressed using the apnea-hypopnea index (AHI) and an AHI ≥ 15/h was categorized as moderate to severe SDB. RESULTS: 167 patients were included (82% male, age 65 ± 10.4 years, left ventricular ejection fraction 30.9 ± 7.9%); SDB was predominantly central sleep apnea (CSA) in 45.5%, obstructive sleep apnea (OSA) in 23.9% or none/mild (nmSDB) in 17.4%. Morning premature ventricular contractions (PVCs) were detected significantly more frequently in CSA versus nmSDB patients (44.4/h versus 1.8/h; p = 0.02). Non-sustained VT was more frequent in patients with CSA versus versus OSA or nmSDB (17.9 versus 3.2 or 3.2%/h; p = 0.003 and p = 0.005, respectively). There was no significant variation in VT occurrence by time of day in HFrEF patients with CSA (p = 0.3). CSA was an independent predictor of VT occurrence in HFrEF in multivariate logistic regression analysis (odds ratio 4.1, 95% confidence interval 1.5-11.4, p = 0.007). CONCLUSION: CSA was associated with VT occurrence irrespective of sleep/wake status in HFrEF patients, and independently predicted the occurrence of VT. This association may contribute to chances by which CSA increases sudden death risk in HFrEF patients.
Entities:
Keywords:
Central sleep apnea; Circadian distribution; Heart failure with reduced ejection fraction; Sleep apnea; Ventricular arrhythmia
Authors: Dominik Linz; Holger Woehrle; Thomas Bitter; Henrik Fox; Martin R Cowie; Michael Böhm; Olaf Oldenburg Journal: Clin Res Cardiol Date: 2015-04-23 Impact factor: 5.460
Authors: Christine Eulenburg; Karl Wegscheider; Holger Woehrle; Christiane Angermann; Marie-Pia d'Ortho; Erland Erdmann; Patrick Levy; Anita K Simonds; Virend K Somers; Faiez Zannad; Helmut Teschler; Martin R Cowie Journal: Lancet Respir Med Date: 2016-08-31 Impact factor: 30.700
Authors: Ulrich Koehler; Sandra Apelt; Werner Cassel; Olaf Hildebrandt; Christoph Nell; Stephan Ranft; Wolfram Grimm Journal: Wien Klin Wochenschr Date: 2011-11-15 Impact factor: 1.704
Authors: Owen D Lyons; John S Floras; Alexander G Logan; Robert Beanlands; Joaquin Durán Cantolla; Michael Fitzpatrick; John Fleetham; R John Kimoff; Richard S T Leung; Geraldo Lorenzi Filho; Pierre Mayer; Lisa Mielniczuk; Debra L Morrison; Clodagh M Ryan; Frederic Series; George A Tomlinson; Anna Woo; Michael Arzt; Sairam Parthasarathy; Stefania Redolfi; Takatoshi Kasai; Gianfranco Parati; Diego H Delgado; T Douglas Bradley Journal: Eur J Heart Fail Date: 2017-04 Impact factor: 15.534
Authors: Maria Teresa La Rovere; Gian Domenico Pinna; Roberto Maestri; Elena Robbi; Andrea Mortara; Francesco Fanfulla; Oreste Febo; Peter Sleight Journal: Eur J Heart Fail Date: 2007-07-26 Impact factor: 15.534
Authors: Tobias Schupp; Ibrahim Akin; Linda Reiser; Armin Bollow; Gabriel Taton; Thomas Reichelt; Dominik Ellguth; Niko Engelke; Uzair Ansari; Kambis Mashayekhi; Christel Weiß; Christoph Nienaber; Muharrem Akin; Martin Borggrefe; Michael Behnes Journal: Clin Res Cardiol Date: 2019-02-12 Impact factor: 5.460
Authors: Muhammed Gerçek; Olaf Oldenburg; Mustafa Gerçek; Henrik Fox; Volker Rudolph; Thomas Puehler; Hazem Omran; Lisa Katharina Wolf; Kavous Hakim-Meibodi; Andreas M Zeiher; Jan Gummert; Zisis Dimitriadis Journal: J Clin Med Date: 2021-05-10 Impact factor: 4.241
Authors: Christoph Fisser; Jannis Bureck; Lara Gall; Victoria Vaas; Jörg Priefert; Sabine Fredersdorf; Florian Zeman; Dominik Linz; Holger Wöhrle; Renaud Tamisier; Helmut Teschler; Martin R Cowie; Michael Arzt Journal: ERJ Open Res Date: 2021-08-02
Authors: Olaf Oldenburg; Maria Rosa Costanzo; Robin Germany; Scott McKane; Timothy E Meyer; Henrik Fox Journal: J Cardiovasc Transl Res Date: 2020-08-12 Impact factor: 4.132
Authors: Christoph Fisser; Kristina Götz; Andrea Hetzenecker; Kurt Debl; Florian Zeman; Okka W Hamer; Florian Poschenrieder; Claudia Fellner; Stefan Stadler; Lars S Maier; Michael Pfeifer; Stefan Buchner; Michael Arzt Journal: Clin Res Cardiol Date: 2020-06-09 Impact factor: 5.460