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Cited by 291Obstructive Sleep Apnea ResearchCardiac electrophysiology and arrhythmiasHeart Rate Variability and Autonomic Control

Triggering of Nocturnal Arrhythmias by Sleep-Disordered Breathing Events

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Monahan, Ken, Storfer-Isser, Amy, Mehra, Reena, Shahar, Eyal, Mittleman, Murray, Rottman, Jeff, Punjabi, Naresh, Sanders, Mark +3 more·2009·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2009.06.038PMC PMC2814244
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Abstract

Objectives This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in those with sleep-disordered breathing (SDB). Background SDB is associated with increased risk of atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. Methods Overnight polysomnograms (PSGs) from the Sleep Heart Health Study (n = 2816) were screened for paroxysmal atrial fibrillation (PAF) and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of PAF or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. PSGs were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-second hazard period preceding each arrhythmia or control period. Results Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia following a respiratory disturbance were nearly 18-times (OR 17.5; 95% CI 5.3–58.4) the odds of an arrhythmia occurring following normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia/40000 respiratory disturbances). Neither hypoxia nor EEG-defined arousals alone increased arrhythmia risk. Conclusions Although the absolute arrhythmia rate is low, the relative risk of PAF and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.

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Crossref · 10.1016/j.jacc.2009.06.038

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  • In the SHHS, paroxysmal atrial fibrillation events were markedly more likely to occur during the 90 seconds following an obstructive apnea or hypopnea than during periods without obstructive events (OR 17.9, 95% CI 2.2-144.2).

    “In the SHHS, paroxysmal AF events were markedly more likely to occur during the 90 s following an obstructive apnea or hypopnea than during periods without obstructive events (OR 17.9, 95% CI 2.2–144.2).733”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [733]

    Table 4 (Risk of Arrhythmia After Respiratory Disturbance Compared With Risk of Arrhythmia During Normal Nocturnal Breathing; page unavailable) reports the exact PAF estimate: OR 17.9, 95% CI 2.2–144.2. The study compares 90-second periods after any apnea or hypopnea with periods of normal breathing, rather than reporting an obstructive-only estimate. Respiratory disturbance characteristics (page unavailable) notes that one central apnea was included in a referent period. (LLM, conf=0.86)

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  • Polysomnography is the cornerstone for the diagnosis of sleep apnea and can detect various cardiac arrhythmias (AV block, sinus pauses, NSVT, and paroxysmal AF).

    “The cornerstone for the diagnosis of sleep apnea is polysomnography, during which a variety of cardiac arrhythmias (AV block, sinus pauses, NSVT, and paroxysmal AF) can be detected (Monahan et al., 2009).”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Monahan et al., 2009

    The Study population and Arrhythmia identification sections (page unavailable) describe using polysomnography to measure sleep-disordered breathing and its ECG channel to identify NSVT and paroxysmal AF. The paper does not establish polysomnography as the cornerstone of sleep-apnea diagnosis or report detecting AV block or sinus pauses. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Monahan, K., Storfer-Isser, A., Mehra, R., Shahar, E., Mittleman, M., Rottman, J., Punjabi, N., Sanders, M., Quan, S. F., Resnick, H., & Redline, S.
Affiliations
  • Vanderbilt University Medical Center (US)
  • Case Western Reserve University (US)
  • University of Arizona (US)
  • Harvard University (US)
  • Vanderbilt University (US)
  • Johns Hopkins University (US)
  • University of Pittsburgh (US)
  • Georgetown University (US)
Corresponding author
Redline, Susan
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2009-11
Volume
54
Issue
19
Pages
1797-1804
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2009.06.038
PMC
PMC2814244
OpenAlex
W2082609215
Semantic Scholar
c4a2a398ec4e6a7e4250183fb47f83cf5fbf3ddd
Cited by
291
References
40
Citations by year
2026: 7 · 2025: 18 · 2024: 12 · 2023: 13 · 2022: 18 · 2021: 20 · 2020: 9 · 2019: 11 · 2018: 18 · 2017: 16 · 2016: 22 · 2015: 22 · 2014: 29 · 2013: 20 · 2012: 16
FWCI
12.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
Funders
  • National Institutes of Health (5u01hl053940-05, 5u01hl053934-14)
  • National Heart, Lung, and Blood Institute (U01 HL 53940, U01HL53938, U01HL053941, R01HL075078, U01HL053938, U01 HL53934, U01HL053937, U01 HL 53941, U01 HL53916, U01HL053931, U01 HL 63429, U01HL064360, U01HL053916, U01 HL53931, R01HL086862, U01HL077813, U01HL063463, U01HL063429, U01-HL-053934, U01HL63463, U01-HL53937)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
sleep-disordered breathing, nocturnal arrhythmia, paroxysmal atrial fibrillation, non-sustained ventricular tachycardia, apnea, hypopnea, arrhythmia triggers, oxygen desaturation, arousal, sudden cardiac death, Sleep Heart Health Study
MeSH terms
Aged, Arrhythmias, Cardiac, Electrocardiography, Female, Humans, Male, Mathematical Computing, Middle Aged, Obesity, Surveys and Questionnaires, Risk Factors, Sleep Apnea Syndromes, Confounding Factors, Epidemiologic, Body Mass Index, Case-Control Studies, Polysomnography, Risk Assessment, Cross-Over Studies

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