Nocturnal Arrhythmias and Heart‐Rate Swings in Patients With Obstructive Sleep Apnea Syndrome Treated With Beta Blockers

Background The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced by apneas. Thus, the aim of our study is to quantify peri‐apneic heart‐rate swings and prevalence of nocturnal bradyarrhythmias in BB‐treated and BB‐naïve patients with obstructive sleep apnea. Methods and Results Our real‐life, retrospective, cohort study analyzed data from patients with obstructive sleep apnea after a basal cardiorespiratory polysomnography. Among 228 eligible participants, we enrolled 78 BB‐treated and 88 BB‐naïve patients excluding those treated with antiarrhythmic drugs or pacemakers, or with uninterpretable ECG traces during polysomnography. In each patient, type and frequency of arrhythmias were identified and peri‐apneic changes of RR intervals were evaluated for each apnea. BB‐treated patients were older and with more comorbidities than BB‐naïve patients, but had similar obstructive sleep apnea severity, similar frequency of arrhythmic episodes, and similar prevalence of bradyarrhythmias. Apnea‐induced heart‐rate swings, unadjusted for age, showed lower RR interval changes in BB‐treated (133.5±63.8 ms) than BB‐naïve patients (171.3±87.7 ms, P =0.01), lower RR interval increases during apneas (58.5±28.5 versus 74.6±40.2 ms, P =0.01), and lower RR interval decreases after apneas (75.0±42.4 versus 96.7±55.5 ms, P <0.05). Conclusions BB appear to be safe in patients with obstructive sleep apnea because they are not associated with worse episodes of nocturnal bradyarrhythmias and even seem protective in terms of apnea‐induced changes of heart rate.

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Faculty Opinions recommendation of Association between heart rate recovery and severity of obstructive sleep apnea syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1097072.553046 ◽

2007 ◽

Author(s):

Ronald Oudiz

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Heart Rate Recovery ◽

Sleep Apnea Syndrome ◽

Obstructive Sleep ◽

Apnea Syndrome

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Identification of Obstructive Sleep Apnea Syndrome by Ambulatory Electrocardiography: Clinical Evaluation of Time-domain and Frequency-domain Analyses of Heart Rate Variability in Chinese Patients

Cell Biochemistry and Biophysics ◽

10.1007/s12013-010-9128-6 ◽

2010 ◽

Vol 59 (3) ◽

pp. 165-170 ◽

Cited By ~ 9

Author(s):

Sun Jianling ◽

Li Xiaoying ◽

Guo Jihong ◽

Han Fang ◽

Zhang Haicheng

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Time Domain ◽

Sleep Apnea Syndrome ◽

Chinese Patients ◽

Ambulatory Electrocardiography ◽

Obstructive Sleep ◽

Apnea Syndrome

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Use of Sample Entropy Approach to Study Heart Rate Variability in Obstructive Sleep Apnea Syndrome

IEEE Transactions on Biomedical Engineering ◽

10.1109/tbme.2006.889772 ◽

2007 ◽

Vol 54 (10) ◽

pp. 1900-1904 ◽

Cited By ~ 133

Author(s):

Haitham M. Al-Angari ◽

Alan V. Sahakian

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Sample Entropy ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Study Heart Rate

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Determinants of heart rate variability in obstructive sleep apnea syndrome during wakefulness and sleep

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01065.2003 ◽

2005 ◽

Vol 288 (3) ◽

pp. H1103-H1112 ◽

Cited By ~ 38

Author(s):

J. A. Jo ◽

A. Blasi ◽

E. Valladares ◽

R. Juarez ◽

A. Baydur ◽

...

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Heart Rate Variability ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Normal Subjects ◽

Sinus Arrhythmia ◽

Obstructive Sleep ◽

Apnea Syndrome

Heart rate variability (HRV) is mediated by at least three primary mechanisms: 1) vagal feedback from pulmonary stretch receptors (PSR), 2) central medullary coupling between respiratory and cardiovagal neurons (RCC), and 3) arterial baroreflex (ABR)-induced fluctuations. We employed a noninvasive experimental protocol in conjunction with a minimal model to determine how these sources of HRV are altered in obstructive sleep apnea syndrome (OSAS). Respiration, heart rate, and blood pressure were monitored in eight normal subjects and nine untreated OSAS patients in relaxed wakefulness and stage 2 and rapid eye movement sleep. A computer-controlled ventilator delivered inspiratory pressures that varied randomly from breath to breath. Application of the model to the corresponding subject responses allowed the delineation of the three components of HRV. In all states, RCC gain was lower in OSAS patients than in normal subjects ( P < 0.04). ABR gain was also reduced in OSAS patients ( P < 0.03). RCC and ABR gains increased from wakefulness to sleep ( P < 0.04). However, there was no difference in PSR gain between subject groups or across states. The findings of this study suggest that the adverse autonomic effects of OSAS include impairment of baroreflex gain and central respiratory-cardiovascular coupling, but the component of respiratory sinus arrhythmia that is mediated by lung vagal feedback remains intact.

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