Obstructive sleep apnea syndrome and heart rhythm disturbances

Review of terminology, predisposing factors, clinical signs and complications of the obstructive sleep apnea syndrome is presented. Main emphasis is made on heart rhythm disturbances in this disease. Possible causes of cardiac arrhythmias, special characteristics of their course in patients with severe concomitant pathology, methods of diagnosis and treatment, including the use of noninvasive positive pressure ventilation are discussed.     

Disturbances of heart rhythm in patients after myocardial infarction with obstructive sleep apnea during outpatient rehabilitation

We studied specific features of heart rhythm disturbances observed during outpatient rehabilitation of 432 patients after first myocardial infarction. In 94 of these patients (21.8%) we diagnosed obstructive sleep apnea syndrome (OSAS). We noted substantial preponderance of pathologic ectopy related to OSAS with most significant detection of frequent ventricular extrasystoles. Their paired variant and polymorphic forms in patients with OSAS were 3.4 and 7.4 times, respectively, more frequent than in patients without OSAS. Frequency of ventricular ectopy rose with increase of severity of OSAS and was maximal during nocturnal hours. Analysis of correlations revealed association between OSAS and frequencies of ventricular and supraventricular extrasystoles. CONCLUSION: After myocardial infarction patients should be thoroughly examined for timely detection of OSAS and corresponding correction of their rehabilitation program.     

Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury

Objectives

We hypothesized that obstructive sleep apnea (OSA) has a dose-dependent impact on mortality in those with ischemic heart disease or previous myocardial injury.

Methods

We performed a retrospective cohort study of 281 consecutive OSA patients with a history of myocardial injury as determined by elevated troponin levels or with known existing ischemic heart disease. We compared survival between those with severe OSA [apnea–hypopnea index (AHI) ≥30] and those with mild to moderate OSA (AHI >5 and <30).

Results

Of the 281 patients (mean age 65 years, mean BMI 34, 98% male, 58% with diabetes), 151 patients had mild-moderate OSA and 130 had severe OSA. During a mean follow-up of 4.1 years, there were significantly greater deaths in the severe OSA group compared to the mild-moderate OSA group [53 deaths (41%) vs. 44 deaths (29%), respectively, p?=?0.04]. The adjusted hazard ratio for mortality with severe OSA was 1.72 (95% confidence interval 1.01–2.91, p?=?0.04).

Conclusions

The severity of obstructive sleep apnea is associated with increased risk of death, and risk stratification based on OSA severity is relevant even in the diseased cardiac patient.     

Obstructive sleep apnea and heart failure

Obstructive sleep apnea (OSA) exerts several effects that may be particularly deleterious in patients with heart failure (HF). OSA should be considered especially in HF patients who are obese or have the metabolic syndrome, systemic hypertension, or pulmonary hypertension. HF patients in whom OSA is suspected should undergo a full evaluation by a sleep specialist, including a polysomnogram, to diagnose OSA and differentiate this disease from central sleep apnea. Those found to have OSA should then receive continuous positive airway pressure and/or other interventions, and standard disease management strategies should be used to maximize compliance. Those who cannot tolerate continuous positive airway pressure may be candidates for mandibular advancement devices or surgical therapies including tracheostomy. Standard HF medications should be used to treat HF, and optimization of fluid balance may help minimize OSA severity. However, it is still unknown whether treatment of OSA in HF patients will reduce hospitalizations or mortality.     

阻塞性睡眠呼吸暂停与心肌肥大

阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome,OSAS）是跳眠呼吸障碍疚病中发病率最高的一种疾病,已有多个研究证实OSAS是引起心血管疾病的独立危险因素之一。夜间慢性间歇性低氧是OSAS的显著病理生理特征。心肌肥大是心血管疾病的一一个非常重要的预后因子,且目前有许多证据表明OSAS与心肌肥大关系密切。     

Urinary catheterization prior to PCI worsens clinical outcomes in patients with acute myocardial infarction

BackgroundIndwelling urethral catheters (IUCs) are used to measure urine volume, keep patients on bed rest, or keep the groin area clean in patients with acute myocardial infarction (AMI). However, the association between IUC use and in-hospital urinary-related complications is unknown.MethodsThis was a single-center retrospective analysis of 303 patients admitted to our hospital in 2018–2020 who had AMI without cardiogenic shock. An IUC was inserted in the emergency room upon initiation of invasive catheter treatment and removed as soon as possible. The primary outcome was in-hospital adverse urinary event (IHAUE), which consisted of in-hospital urinary tract infection and in-hospital gross hematuria.ResultsOf 303 patients, 243 patients (80.2 %) underwent IUC insertion. A lower proportion of patients with IUCs were male (72 % vs. 85 %, p = 0.044). A higher proportion had Killip classification 2 or 3 (13 % vs. 0 %, p = 0.003) or ST-elevation myocardial infarction (65 % vs. 32 %, p < 0.001). IHAUEs occurred significantly more commonly in patients with IUCs than without IUCs (11 % vs. 2 %, p = 0.023). Kaplan-Meier analysis showed that IHAUEs occurred more frequently in patients with IUCs than patients without IUCs (log-rank test p = 0.033). Furthermore, IUC use longer than the median of 2 days was associated with a higher odds ratio (OR) for IHAUE when compared with those without IUC use (OR, 3.65; 95 % confidence interval, 1.28–10.4; p = 0.015). There were no significant differences in in-hospital mortality by IUC status.ConclusionsIUC use is associated with a higher risk of IHAUEs in patients with uncomplicated AMI. Routine IUC use might not be recommended.     

Predictors of heart rhythm disturbances in hypertensive obese patients with obstructive sleep apnea

Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with and without obstructive sleep apnea (OSA). Methods This is an open, cohort, prospective study. Out of 493 screened patients, we selected 279 hypertensive, obese individuals without severe concomitant diseases: 75 patients without sleep-disordered breathing (non-SDB group), and 204 patients with OSA (OSA group). At baseline, all patients underwent examination, including ECG, Holter ECG monitoring, and sleep study. During follow-up (on 3, 5, 7 and 10^th years; phone calls once per 6 months), information about new events, changes in therapy and life style was collected, diagnostic procedures were performed. As the endpoints, we registered significant heart rhythm and conduction disorders as following: atrial fibrillation (AF), ventricular tachycardia, atrioventricular block (AV) 2–3 degree, sinoatrial block, significant sinus pauses (> 2000 ms), and the required pacemaker implantation. Results The median follow-up was 108 (67.5–120) months. The frequency of heart rhythm disorders was higher in OSA patients (29 cases, χ² = 5.5; P = 0.019) compared to the non-SDB patients (three cases; OR: 3.92, 95% CI: 1.16–13.29). AF was registered in 15 patients (n = 12 in OSA group; P = 0.77). Heart conduction disturbance developed in 16 patients, without an association with the rate of coronary artery disease onset. Regression analysis showed that only hypertension duration was an independent predictor of AF (OR: 1.10, 95% CI: 1.04–1.16; P = 0.001). In case of heart conduction disturbances, apnea duration was the strongest predictor (Р = 0.002). Conclusions Hypertensive obese patients with OSA demonstrate 4-fold higher incidence of heart rhythm and conduction disturbances than subjects without SDB. Hypertension duration is an independent predictor for AF development, while sleep apnea/hypopnea duration is the main factor for heart conduction disorders onset in hypertensive obese patients with OSA.     

Obstructive sleep apnea in atrial fibrillation patients

A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients.     

Severe sleep apnea syndrome diagnosed with acute myocardial infarction

A 55-year-old man with acute myocardial infarction and no heart failure, had episodes of severe oxygen desaturation and apnea, while his hemodynamic parameters were stable. Sleep recordings revealed severe sleep apnea, and pulmonary function tests showed bronchial obstruction. Apnea and desaturation resolved on bi-level positive airway pressure. Patients with acute myocardial infarction who have apnea and hypoxemia without evident heart failure should be evaluated for sleep disorders.     

阻塞性睡眠呼吸暂停低通气综合征与糖代谢紊乱

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一常见病，其心脑血管疾病的发病率及病死率也明显增高，但其机制并不十分清楚。阻塞性睡眠呼吸事件可导致许多急性的病理生理改变如间断低氧、严重睡眠片段、急性血压升高、交感神经系统激活、胸内压改变及心输出量降低等，反复而长期的上述改变最终可导致高血压及心脑血管疾病，而睡眠呼吸暂停与糖代谢异常之间的独立关系也可能代表了另一条导致心血管疾病的途径。本文对OSAHS与糖代谢异常之间的关系、糖代谢异常的可能中间机制及治疗OSAHS本身对糖代谢异常的影响等进行了深入阐述。     

Obstructive sleep apnea patients without hypertension or diabetes and subsequent incidence of chronic kidney disease

Sleep and Breathing -     

老年急性心肌梗死介入治疗的临床结果和成本趋势分析

目的　分析老年人急性心肌梗死 (AMI)介入治疗的临床结果和成本趋势。　 方法 　收集从 1996～2 0 0 1年 45 7例老年人AMI患者的临床资料。医疗成本资料从医院的信息管理系统获得。　 结果 　 2 0 0 1年进行冠状动脉介入 (PCI)治疗的老年患者比 1996年增加约 2 7 4% ,1996年与 2 0 0 1年因任何原因再住院患者的比例分别为5 3 3 %和 17 0 % (P <0 0 5 ) ,与PCI治疗有关的再住院患者的比例分别为 40 0 %和 3 7% (P <0 0 5 ) ,再次血管重建术患者的比例分别为 13 3 %和 1 5 % (P <0 0 5 )。 2 0 0 1年PCI的治疗成本比 1996年减少约 8744元 ,其中 99%是手术费的减少。　 结论　近几年老年人AMI介入治疗的临床结果是有改进的。PCI治疗成本的减少主要是手术费的减少 ,可能与再次血管重建术的比例减少有一定的关系     

Prevalence of concomitant sleep disorders in patients with obstructive sleep apnea

We determined the prevalence of concomitant sleep disorders in patients with a primary diagnosis of obstructive sleep apnea (OSA). We retrospectively analyzed 643 patients, aged 18, with a primary diagnosis of OSA, evaluated by sleep specialists, in whom clinical and polysomnographic data were derived using standardized techniques by reviewing data from a standardized database and clinical charts. Concomitant sleep disorders were listed according to the International Classification of Sleep Disorders (American Academy of Sleep Medicine, 2000). The mean age was 48.5±13.5 years and 55% were male. Racial distributions were African–Americans 51.8% and Caucasian 47%. Indices of disordered breathing were respiratory disturbance index 32.4±30.4/h sleep and time <90% O₂ saturation 44.5±81.6 min. Thirty-one percent of patients had a concomitant sleep disorder. The most common were inadequate sleep hygiene (14.5%) and periodic limb movement disorder (PLMD, 8.1%). Of patients with other sleep disorders, 66.8% had treatment initiated for these disorders. Predictors of inadequate sleep hygiene (logistic regression) were: age (each decade OR=0.678, P=0.000000), gender (for M, OR=0.536), and the presence of at least one other major system disorder (OR=2.123, P=0.0015). Predictors of PLMD were: age (each decade OR=0.794, P=0.0005), gender (for M, OR=0.433, P=0.004), and total sleep time (for each 10 min, OR=0.972, P=0.0013). We conclude that approximately one third of patients with sleep apnea have another identifiable sleep disorder, usually requiring treatment. This suggests that practitioners evaluating and treating sleep apnea ought to be prepared to deal with other sleep disorders as well.     

Obstructive sleep apnea is common in patients with interstitial lung disease

Purpose

The incidence of obstructive sleep apnea (OSA) in interstitial lung disease (ILD) has been reported at different frequencies in several studies. The aims of our study were to evaluate the frequency of OSA in ILD and to analyze the relationship between polysomnography (PSG) findings and pulmonary function, disease severity, parenchymal involvement, and Epworth Sleepiness Scale (ESS) scores.

Methods

ILD patients with parenchymal involvement were evaluated. The disease severity was assessed using an index consisting of body mass index (BMI), carbon monoxide diffusion capacity, the Modified Medical Research Council dyspnea scale, and the 6-min walking distance. All of the patients had lung function, chest X-ray, PSG, ESS scoring, and an upper airway examination. Patients with a BMI?≥?30 or significant upper airway pathologies were excluded.

Results

Of 62 patients, 50 patients comprised the study group (14 male, 36 female; mean age 54?±?12.35 years, mean BMI 25.9?±?3.44 kg/m²) with diagnoses of idiopathic pulmonary fibrosis (IPF; n?=?17), stage II–III sarcoidosis (n?=?15), or scleroderma (n?=?18). The frequency of OSA was 68 %. The mean apnea–hypopnea index (AHI) was 11.4?±?12.5. OSA was more common in IPF patients (p?=?0.009). The frequency of rapid eye movement-related sleep apnea was 52.9 %. The frequency of OSA was higher in patients with a disease severity index ≥3 (p?=?0.04). The oxygen desaturation index and the AHI were higher in patients with diffuse radiological involvement (p?=?0.007 and p?=?0.043, respectively).

Conclusions

OSA is common in ILD. PSG or at minimum nocturnal oximetry should be performed, particularly in patients with functionally and radiologically severe disease.