Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators

• Published in: Heart rhythm Vol. 8; no. 5; pp. 657 - 662
• Main Authors: Zeidan-Shwiri, Tawfiq, Aronson, Doron, Atalla, Khalid, Blich, Miry, Suleiman, Mahmoud, Marai, Ibrahim, Gepstein, Lior, Lavie, Lena, Lavie, Peretz, Boulos, Monther
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2011
• Subjects: Aged; Cardiovascular; Circadian Rhythm; Defibrillators, Implantable; Female; Humans; Implantable cardioverter-defibrillators; Male; Middle Aged; Sleep apnea; Sleep Apnea Syndromes - complications; Sleep-disordered breathing; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - therapy; Ventricular arrhythmia; AHI; OR; CI; ROC; Ventricular arrhythmia; Sleep apnea; ICD; Implantable cardioverter-defibrillators; Sleep-disordered breathing; SDB; VF; SCD; VT; ventricular fibrillation; odds ratio; sudden cardiac death; apnea-hypopnea index; ventricular tachycardia; confidence interval; receiver operating characteristic; implantable cardioverter-defibrillator
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2010.12.030

Sleep-disordered breathing (SDB) has been associated with various benign cardiac arrhythmias occurring during sleep. The purpose of this study was to demonstrate that SDB contributes to the development of life-threatening ventricular arrhythmias in patients with an established arrhythmic substrate. We prospectively studied the association between SDB and timing of life-threatening ventricular arrhythmic events in 45 patients with an implantable cardioverter-defibrillator (ICD). SDB was defined as an apnea-hypopnea index (AHI) >10 events/hour based on an overnight sleep study. The primary outcome measure was appropriate ICD therapy, defined as antitachycardia pacing or shock for ventricular tachycardia or ventricular fibrillation during 1-year follow-up. SDB was present in 26 (57.8%) patients. Appropriate ICD therapies were higher among patients with SDB (73% vs 47%, P = .02). Logistic regression identified SDB as a predictor of any appropriate ICD therapy (odds ratio 4.4, 95% confidence interval 1.4–15.3, P = .01). The risk for ventricular arrhythmias was higher in patients with SDB solely due to an increase in events occurring between midnight and 6 AM (odds ratio 5.6, 95% confidence interval 2.0–15.6, P = .001) with no discernible effect on appropriate ICD therapy during nonsleeping hours (odds ratio 0.7, 95% confidence interval 0.2–2.3, P = .61). Patients with an ICD and SDB have a striking increase in the onset of life-threatening ventricular arrhythmic events during sleeping hours. These findings provide a rationale for SDB screening in patients with appropriate ICD therapy if device interrogation reveals a predominance of nocturnal onset of arrhythmias.