Ventricular Arrhythmias in Patients with Obstructive Sleep Apnea

Author(s): Rita Marinheiro*, Leonor Parreira, Pedro Amador, Dinis Mesquita, José Farinha, Marta Fonseca, Tatiana Duarte, Cláudia Lopes, Andreia Fernandes, Rui Caria.

Journal Name: Current Cardiology Reviews

Volume 15 , Issue 1 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Obstructive Sleep Apnea (OSA) is a prevalent condition thought to increase in the future. Being mostly undiagnosed, the most serious complications are cardiovascular diseases, among which are arrhythmias. Controversy remains as to whether OSA is a primary etiologic factor for ventricular arrhythmias, because of the high incidence of cardiovascular comorbidities in OSA patients. However, there is mostly a strong evidence of a relation between OSA and ventricular arrhythmias. A few mechanisms have been proposed to be responsible for this association and some electrocardiographic changes have also been demonstrated to be more frequent in OSA patients. Treatment of OSA with Continuous Positive Airway Pressure (CPAP) has the potential to reduce arrhythmias and confer a mortality benefit.

Keywords: Obstructive sleep apnea, ventricular arrhythmias, premature ventricular contractions, ventricular tachycardia, sudden cardiac death, continuous positive airway pressure.

Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37(38): 2893-962.
Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007; 49: 565-71.
Vizzardi E, Sciatti E, Bonadei I, D’Aloia A, Curnis A, Metra M. Obstructive sleep apnoea-hypopnoea and arrhythmias: New updates. J Cardiovasc Med (Hagerstown) 2017; 18(7): 490-500.
Digby GC, Baranchuk A. Sleep apnea and atrial fibrillation; 2012 update. Curr Cardiol Rev 2012; 8: 265-72.
Lin YK, Lai MS, Chen YC, et al. Hypoxia and reoxygenation modulate the arrhythmogenic activity of the pulmonary vein and atrium. Clin Sci 2012; 122: 121-32.
Linz D. Atrial fibrillation in obstructive sleep apnea: atrial arrhythmogenic substrate of a different sort. Am J Cardiol 2012; 110: 1071.
Raghuram A, Clay R, Kumbam A, Tereshchenko LG, Khan A. A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias. J Clin Sleep Med 2014; 10(10): 1155-60.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.
Levy P, Kohler M, McNicholas WT, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 2015; 1: 15015.
Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540-5.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485-91.
Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 2010; 57: 423-38.
Jelic S, LeJemtel TH. Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Cardiovasc Med 2008; 18: 253-60.
Sateia MJ. International classification of sleep disorders — third edition: highlights and modifications Chest 2014; 146: 1387-94.
Lamphere J, Roehrs T, Wittig R, Zorick F, Conway WA, Roth T. Recovery of alertness after CPAP in apnea. Chest 1989; 96: 1364-7.
Pépin JL, Krieger J, Rodenstein D, et al. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med 1999; 160: 1124-9.
Antic NA, Catcheside P, Buchan C, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep 2011; 34(1): 111-9.
Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007; 30(6): 711-9.
Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease. Circulation 2008; 118: 1080-111.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52: 490-4.
Hoffstein V, Mateika S. Cardiac arrhythmias, snoring, and sleep apnea. Chest 1994; 106: 466-71.
Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 1977; 63: 348-58.
Sicouri S, Antzelevitch C. A subpopulation of cells with unique electrophysiological properties in the deep subepicardium of the canine ventricle. Mol Cell Circ Res 1991; 68: 1729-41.
Hevia JC, Antzelevitch C, Bárzaga FT, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ ventricular fibrillation in patients with the brugada syndrome. J Am Coll Cardiol 2006; 47(9): 1828-34.
Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak to Tend interval on the resting electrocardiogram is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011; 4: 441-7.
Zhao X, Xie Z, Chu Y, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol 2012; 35: 559-64.
Cintra FD, Leite RP, Storti LJ, et al. Sleep apnea and nocturnal cardiac arrhythmia: A populational study. Arq Bras Cardiol 2014; 103(5): 368-74.
Selim BJ, Koo BB, Qin L, et al. The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM Study. J Clin Sleep Med 2016; 12(6): 829-37.
Shepard JW Jr, Garrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 1985; 88(3): 335-40.
Abe H, Takahashi M, Yaegashi H, et al. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessels 2010; 25: 63-9.
Tomaello L, Zanolla L, Vassanelli C, LoCascio V, Ferrari M. Sleep disordered breathing is associated with appropriate implantable cardioverter defibrillator therapy in congestive heart failure patients. Clin Cardiol 2010; 33(2): E27-30.
Zeidan-Shwiri T, Aronson D, Atalla K, et al. Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators. Heart Rhythm 2011; 8(5): 657-62.
Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: A longitudinal study of 10,701 adults. J Am Coll Cardiol 2013; 62(7): 610-6.
Harbison J, O’Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: Effects of nasal continuous positive airway pressure therapy. Chest 2000; 118(3): 591-5.
Javaheri S. Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure. Circulation 2000; 101: 392-7.
Ryan CM, Juvet S, Leung R, Bradley TD. Timing of nocturnal ventricular ectopy in heart failure patients with sleep apnea. Chest 2008; 133(4): 934-40.
May AM, VanWagoner DR, Mehra R. Obstructive sleep apnea and cardiac arrhythmogenesis: Mechanistic insights. Chest 2017; 151(1): 225-41.
Farré R, Montserrat JM, Navajas D. Morbidity due to obstructive sleep apnea: Insights from animal models. Curr Opin Pulm Med 2008; 14: 530-6.
Leung R. Sleep-disordered breathing: Autonomic mechanisms and arrhythmias. Prog Cardiovasc Dis 2009; 51(4): 324-38.
Daly MD, Scott MJ. The cardiovascular responses to stimulation of the carotid body chemoreceptors in the dog. J Physiol 1963; 165: 179-97.
De Daly MB, Scott MJ. The effects of stimulation of the carotid body chemoreceptors on heart rate in the dog. J Physiol 1958; 144(1): 148-66.
Souvannakitti D, Kumar GK, Fox A, Prabhakar NR. Contrasting effects of intermittent and continuous hypoxia on low O(2) evoked catecholamine secretion from neonatal rat chromaffin cells. Adv Exp Med Biol 2009; 648: 345-9.
Morand J, Arnaud C, Pepin JL, Godin-Ribuot D. Chronic intermittent hypoxia promotes myocardial ischemiarelated ventricular arrhythmias and sudden cardiac death. Sci Rep 2018; 8(1): 2997.
Brown DA, O’Rourke B. Cardiac mitochondria and arrhythmias. Cardiovasc Res 2010; 88(2): 241-9.
Jeong EM, Liu M, Sturdy M, et al. Metabolic stress, reactive oxygen species, and arrhythmia. J Mol Cell Cardiol 2012; 52(2): 454-63.
Somers VK, Dyken ME, Skinner JL. Autonomic and hemodynamic responses and interactions during the Mueller maneuver in humans. J Auton Nerv Syst 1993; 44: 253-9.
Virolainen J, Ventila M, Turto H, Kupari M. Effect of negative intrathoracic pressure on left ventricular pressure dynamics and relaxation. J Appl Physiol 1995; 79: 455-60.
Orban M, Bruce CJ, Pressman GS, et al. Dynamic changes of left ventricular performance and left atrial volume induced by the mueller maneuver in healthy young adults and implications for obstructive sleep apnea, atrial fibrillation, and heart failure. Am J Cardiol 2008; 102(11): 1557-61.
Linz D, Denner A, Illing S, et al. Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs. Clin Res Cardiol 2016; 105(8): 639-47.
Gami AS, Somers VK. Implications of obstructive sleep apnea for atrial fibrillation and sudden cardiac death. J Cardiovasc Electrophysiol 2008; 19(9): 997-1003.
Franz MR. Mechano-electrical feedback in ventricular myocardium. Cardiovasc Res 1996; 32: 15-24.
Zipes D. Autonomic modulation of cardiac arrhythmias.In: Jalife J, Zipes DP, editors.Cardiac electrophysiology: From cell to bedside. 2nd ed. Philadelphia: WB Saunders 1995; pp. 441-54.
Wit AL, Rosen AR. After depolarizations and triggered activity.In: Fossard HA, Haber E, Jenning RB, Katz M, Morgan E, editors.The heart and cardiovascular system. New York: Raven Press 1986; pp. 1449-90.
Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008; 41: 575-80.
Peters RW, Byington RP, Barker A, Yusuf S. Prognostic value of prolonged ventricular repolarization following myocardial infarction: The BHAT experience. J Clin Epidemiol 1990; 43: 167-72.
Munger RG, Prineas RJ, Crow RS, et al. Prolonged QT interval and risk of sudden death in South-East Asian men. Lancet 1991; 338(8762): 280-1.
Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. QTc prolongation measured by standard 12- lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation 1991; 83(6): 1888-94.
Wheelan K, Mukharji J, Rude RE, et al. Sudden death and its relation to QT-interval prolongation after acute myocardial infarction: Two-year follow-up. Am J Cardiol 1986; 57(10): 745-50.
Gupta P, Patel C, Patel H, et al. Tp-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41: 567-74.
Kuo CS, Reddy CP, Munakata K, Surawicz B. Mechanism of ventricular arrhythmias caused by increased dispersion of repolarization. Eur Heart J 1985; 6: 63-71.
Perkiomaki J, Koistinen MJ, Yli-Mayry S, Huikuri HV. Dispersion of the QT interval in patients with andwithout susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995; 26: 174-9.
de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. QTc dispersion predicts cardiac mortality in the elderly: The Rotterdam-study. Circulation 1998; 97: 467-72.
Moss AJ. QTc prolongation and sudden cardiac death: The association is in the detail. J Am Coll Cardiol 2006; 47: 368-9.
Gillis AM, Stoohs R, Guilleminault C. Changes in the QT interval during obstructive sleep apnea. Sleep 1991; 14(4): 346-50.
Sökmen E, Özbek SC, Çelik M, Sivri S, Metin M, Avcu M. Changes in the parameters of ventricular repolarization during preapnea, apnea, and postapnea periods in patients with obstructive sleep apneaPacing Clin Electrophysiol 2018 (accepted article
Shamsuzzaman A, Somers V, Knilans T, Ackerman M, Wang Y, Amin R. Obstructive sleep apnea in patients with congenital long QT syndrome: Implications for increased risk of sudden cardiac death. Sleep 2015; 38(7): 1113-9.
Schlatzer C, Schwarz E, Sievi N, et al. Intrathoracic pressure swings induced by simulated obstructive sleep apnoea promote arrhythmias in paroxysmal atrial fibrillation. EP Europace 2016; 18(1): 64-70.
Shimoda L, Polak J. Hypoxia and ion channel function. Am J Physiol Cell Physiol 2011; 300(5): C951-67.
Jones D, Peters C, Tolhurst D, Claydon T, Ruben P. Extracellular proton modulation of the cardiac voltage-gated sodium channel, NaV1.5. Biophys J 2011; 101(9): 2147-56.
Kilicaslan F, Tokatli A, Ozdag F, et al. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol 2012; 35(8): 966-72.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36: 1749-66.
Dursunoglu D, Dursunoglu N, Evrengül H, et al. QT interval dispersion in obstructive sleep apnoea syndrome patients without hypertension. Eur Respir J 2005; 25(4): 677-81.
Nakamura T, Chin K, Hosokawa R, et al. Corrected QT dispersion and cardiac sympathetic function in patients with obstructive sleep apnea-hypopnea syndrome. Chest 2004; 125(6): 2107-14.
Barta K, Szabó Z, Kun C, et al. The effect of sleep apnea on QT interval, QT dispersion, and arrhythmias. Clin Cardiol 2010; 33(6): E35-9.
Sarubbi B, Esposito V, Ducceschi V, et al. Effect of blood gás derangement on QTc dispersion in severe chronic obstructive pulmonary disease: Evidence of an electropathy? Int J Cardiol 1997; 58: 287-92.
Kiely DG, Cargill RI, Grove A, Struthers AD, Lipworth BJ. Abnormal myocardial repolarisation in response to hypoxemia and fenoterol. Thorax 1995; 50: 1062-6.
Ishida S, Nakagawa M, Fujino T, Yonemochi H, Saikawa T, Ito M. Circadian variation of QT interval dispersion: correlation with heart rate variability. J Electrocardiol 1997; 30: 205-10.
Shimizu M, Ino H, Okeie K, et al. Increased QT dispersion does not reflect the increased regional variation of cardiac sympathetic nervous activity in hypertrophic cardiomyopathy. Am Heart J 2001; 142: 358-62.
Antzelevitch C. Cellular basis for the repolarization waves of the ECG. Ann N Y Acad Sci 2006; 1080: 268-81.
Xia Y, Liang Y, Kongstad O, Holm M, Olsson B, Yuan S. Tpeak–Tend interval as an index of global dispersion of ventricular repolarization: Evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol 2005; 14: 79-87.
Yamaguchi M, Shimizu M, Ino H, et al. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: A new index for arrhythmogenicity. Clin Sci (Lond) 2003; 105: 671-6.
Topilski I, Rogowski O, Rosso R, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007; 49: 320-8.
Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41(6): 567-74.
Voigt L, Haq S, Mitre C, Lombardo G, Kassotis J. Effect of obstructive sleep apnea on QT dispersion: A potential mechanism of sudden cardiac death. Cardiology 2011; 118: 68-73.
Roche F, Xuong AN, Court-Fortune I, et al. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol 2003; 26(3): 669-77.
Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation 1998; 98: 1928-36.
Rossi VA, Stoewhas AC, Camen G, et al. The effects of continuous positive airway pressure therapy withdrawal on cardiac repolarization: Data from a randomized controlled trial. Eur Heart J 2012; 33(17): 2206-12.
Hayashi T, Fukamizu S, Hojo R, et al. Fragmented QRS predicts cardiovascular death of patients with structural heart disease and inducible ventricular tachyarrhythmia. Circ J 2013; 77: 2889-97.
Jain R, Singh R, Yamini S, Das MK. Fragmented ECG as a risk marker in cardiovascular diseases. Curr Cardiol Rev 2014; 10: 277-86.
Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol 2010; 25(1): 59-64.
Bacharova L, Triantafyllou E, Vazaios C, Tomeckova I, Paranicova I, Tkacova R. The effect of obstructive sleep apnea on QRS complex morphology. J Electrocardiol 2015; 48(2): 164-70.
Adar A, Kırış A, Bülbül Y, Bektaş H, Acat M, Casim H, et al. Association of Fragmented QRS with Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea. Med Princ Pract 2015; Jun 24(4): 376-81.
Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 1993; 328: 303-7.
Muller JE, Tofler GH, Verrier RL. Sympathetic activity as the cause of the morning increase in cardiac events. A likely culprit, but the evidence remains circumstantial. Circulation 1995; 91(10): 2508-9.
Fichter J, Bauer D, Arampatzis S, Fries R, Heisel A, Sybrecht GW. Sleep-related breathing disorders are associated with ventricular arrhythmias in patients with an implantable cardioverter-defibrillator. Chest 2002; 122(2): 558-61.
Camen G, Clarenbach CF, Stöwhas AC, et al. The effects of simulated obstructive apnea and hypopnea on arrhythmic potential in healthy subjects. Eur J Appl Physiol 2013; 113(2): 489-96.
Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The sleep heart health study. Am J Respir Crit Care Med 2006; 173: 910-6.
Namtvedt SK, Randby A, Einvik G, et al. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project). Am J Cardiol 2011; 108(8): 1141-6.
Almeneessier AS, Alasousi N, Sharif MM. Seithikurippu Rp, Hersi AS, Bahammam A. Prevalence and predictors of arrhythmia in patients with obstructive sleep apnea. Sleep Sci 2017; 10(4): 142-6.
Aydin M, Altin R, Ozeren A, Kart L, Bilge M, Unalacak M. Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms. Tex Heart Inst J 2004; 31(2): 132-6.
Miller WP. Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance. Am J Med 1982; 73(3): 317-21.
Flemons WW, Remmers JE, Gillis AM. Sleep apnea and cardiac arrhythmias. Is there a relationship? Am Rev Respir Dis 1993; 148(3): 618-21.
Mehra R, Stone KL, Varosy PD, et al. 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. Arch Intern Med 2009; 169: 1147-55.
Monahan K, Storfer-Isser A, Mehra R, et al. Triggering of nocturnal arrhythmias by sleep disoirdered breathing events. J Am Coll Cardiol 2009; 54(19): 1797.
Anselme F, Maounis T, Mantovani G, et al. Severity of sleep apnea syndrome correlates with burden of ventricular tachyarrhythmias in unselected ICD patients. [abstract]. Heart Rhythm 2013.
Bitter T, Fox H, Dimitriadis Z, et al. Circadian variation of defibrillator shocks in patients with chronic heart failure: the impact of Cheyne-Stokes respiration and obstructive sleep apnea. Int J Cardiol 2014; 176(3): 1033-5.
Serizawa N, Yumino D, Kajimoto K, et al. Impact of sleep-disordered breathing on life-threatening ventricular arrhythmia in heart failure patients with implantable cardioverter-defibrillator. Am J Cardiol 2008; 102(8): 1064-8.
Furlan R, Guzzetti S, Crivellaro W, et al. Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation 1990; 81: 537-47.
Muller JE, Ludmer PL, Willich SN, et al. Circadian variation in the frequency of sudden cardiac death. Circulation 1987; 75: 131-8.
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005; 352(12): 1206-14.
Koshino Y, Satoh M, Katayose Y, et al. Sleep apnea and ventricular arrhythmias: Clinical outcome, electrophysiologic characteristics, and follow-up after catheter ablation. J Cardiol 2010; 55(2): 211-6.
Koshino Y, Satoh M, Katayose Y, et al. Association of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure. Am J Cardiol 2008; 101(6): 882-6.
Weaver T, Grunstein R. Adherence to continuous positive airway pressure therapy. The challenge to effective treatment. Proc Am Thorac Soc 2008; 5(2): 173-8.
Kaneko Y, Floras JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003; 348: 1233-41.
N.Dursunoglu , D.Dursunoglu , S.Ozkurt , Gür S, Ozalp G, Evyapan F. Efects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension. Respir Res 2006; 7: 22.
Ryan CM, Usui K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax 2005; 60(9): 781-5.
Kaye DM, Mansfield D, Aggarwal A, Naughton MT, Esler MD. Acute effects of continuous positive airway pressure on cardiac sympathetic tone in congestive heart failure. Circulation 2001; 103: 2336-8.
Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 2004; 169(3): 361-6.
Sukegawa M, Noda A, Sugiura T, et al. Assessment of continuous positive airway pressure treatment in obstructive sleep apnea syndrome using 24-hour urinary catecholamines. Clin Cardiol 2005; 28(11): 519-22.
Franz MR, Cima R, Wang D, Profitt D, Kurz R. Electrophysiological effects of myocardial stretch and mechanical determinants of stretch-activated arrhythmias. Circulation 1992; 86: 968-78.
Vitulano N, Giubilato G, Santangeli P, et al. Continuous positive airway pressure treatment in addition to optimal medical therapy for ventricular ectopy in a patient with heart failure and sleep-related breathing disorder. J Cardiovasc Med (Hagerstown) 2013; 14(9): 673-6.
Jyothula SS, Ramachandran S. Reversible ventricular arrhythmia in REM sleep associated with hypoxic sleep-disordered breathing. Sleep Med 2006; 7(1): 81-2.
Monahan K, Brewster J, Wang L, et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2012; 110(3): 369-72.
Suzuki J, Ishihara T, Sakurai K, et al. Oxygen therapy prevents ventricular arrhythmias in patients with congestive heart failure and sleep apnea. Circ J 2006; 70(9): 1142-7.
Kupari M, Koskinen P. Alcohol, cardiac arrhythmias and sudden death. Novartis Found Symp 1998; 216: 68-79. discussion 79-85
Brunner S, Herbel R, Drobesch C, et al. Alcohol consumption, sinus tachycardia, and cardiac arrhythmias at the Munich Octoberfest: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW). Eur Heart J 2017; 38(27): 2100-6.
Spicuzza L, Bernardi L, Calciati A, Di Maria GU. Autonomic modulation of heart rate during obstructive versus central apneas in patients with sleepdisordered breathing. Am J Respir Crit Care Med 2003; 167: 902-10.
Passino C, Sleight P, Valle F, Spadacini G, Leuzzi S, Bernardi L. Lack of peripheral modulation by analysis of heart rate variability activity during apneas in humans. Am J Physiol 1997; 272: H123-9.
Craig S, Pepperell JC, Kohler M, Crosthwaite N, Davies RJ, Stradling JR. Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: A randomised controlled trial. J Sleep Res 2009; 18(3): 329-36.
Dediu GN, Dumitrache-Rujinski S, Lungu R, et al. Positive pressure therapy in patients with cardiac arrhythmias and obstructive sleep apnea. Pneumologia 2015; 64(1): 18-22.
Dursunoglu D, Dursunoglu N. Effect of CPAP on QT interval dispersion in obstructive sleep apnea patients without hypertension. Sleep Med 2007; 8(5): 478-83.
Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. J Am Coll Cardiol 1999; 34(6): 1744-9.
Roche F, Barthélémy JC, Garet M, Duverney D, Pichot V, Sforza E. Continuous positive airway pressure treatment improves the QT rate dependence adaptation of obstructive sleep apnea patients. Pacing Clin Electrophysiol 2005; 28(8): 819-25.
Seyis S, Usalan AK, Rencuzogullari I, Kurmus O, Can Gungen A. the effects of continuous positive airway pressure on premature ventricular contractions and ventricular wall stress in patients with heart failure and sleep apnea. Can Respir J 2018; 3: 1-8.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [64 - 74]
Pages: 11
DOI: 10.2174/1573403X14666181012153252
Price: $58

Article Metrics

PDF: 32