Occurrence of sleep related breathing disorders in Egyptian patients with tachyarrhythmia without heart failure

Abstract

Obstructive sleep apnea hypopnea syndrome (OSAHS) has been implicated in the pathogenesis of many cardiovascular diseases. Over the last decade, the association between OSAHS and cardiac rhythm disorders has garnered the attention of cardiologists and researchers from different clinical subspecialties. Aim of the work: The aim of the study was to assess the occurrence of OSAHS in Egyptian patients with tachyarrhythmia, and to describe characteristics of patients with concomitant OSAHS and tachyarrhythmia. Methods: We enrolled 32 patients with tachyarrhythmia. In addition to standard examination, investigations and echocardiography to exclude possible causes for arrhythmia all patients underwent an over-night sleep study (level III) to diagnose OSAHS. Manual scoring was performed by two specialists according to criteria established by the American Academy of Sleep Medicine 2012. We considered AHI of 15/h as a cutoff point for diagnosing OSAHS. Results: Of the 32 patients: seventeen had rapid atrial fibrillation (AF), eight had premature ventricular contractions, five had persistent sinus tachycardia and three had paroxysmal supraventricular tachycardia. OSAHS was present in 27 patients (84.4%), three patients of them had obesity hypoventilation also. Dividing OSAHS patients according to the disease severity showed that moderate OSAHS in 29.6% patients, and severe OSAHS in 70.4% patients. Studying characteristics of patients with OSAHS revealed that the mean ± SD of neck circumference (NC) was 39.9 ± 2.47 cm, BMI was 36.3 ± 9.17 kg/m2, Waist/hip ratio was 0.91 ± 0.08, Epworth Sleepiness Scale (ESS) was 10.85 ± 4.5, Mallampati score (MS) was 2.11 ± 0.84, clinical apnea score was 2.8 ± 1.5, and STOP BANG score was 4.03 ± 1.99. Apnea hypopnea index (AHI) was 49.3 ± 33.2, oxygen desaturation index [3%] (ODI) was 39.9 ± 31, mean O2 saturation was 93.6 ± 8.84 and minimal O2 saturation was 7.9 ± 14.49. Nocturnal bradytachyarrhythmia was found in most of patients, the minimal pulse rate during sleep ranges from 22 to 82/min while the maximal pulse rate ranges from 77 to 254/min. Both AHI and ODI were found to be significantly directly correlated with each of BMI, NC, waist/hip ratio, clinical apnea score, STOP BANG score, ESS, MS and mean pulse rate. Linear regression analysis of potential predictors of increased apnea hypopnea index revealed that triglyceride level is the highest predictor followed by NC then BMI. Conclusions: OSAHS is highly prevalent in patients with tachyarrhythmia. High triglyceride, NC and BMI are the most predictors of presence of OSAHS. AF is the most common form of the arrhythmia in patients with OSAHS. Clinical implications: OSAHS should be considered as part of the workup of patients with tachyarrhythmia. Both clinical apnea score and STOP BANG are good screening questionnaire to choose patients who need sleep study.