Abstract
Obstructive sleep apnea (OSA) is the most common type of sleep apnea caused by a complete or partial obstruction of the upper airway.If the symptoms are also present in the daytime, it is referred to as obstructive sleep apnea syndrome. Multiple clinical reports have shown an association between OSA and heart failure. In patients with OSA, during the apneic events, substantial negative intrathoracic pressure develops due to continuous respiratory efforts against a partially or totally obstructed upper airway. This in turn causes a dramatic increase in after load resulting in decreased left ventricular stroke volume. In addition to these mechanical interactions, nocturnal myocardial ischemia may contribute to episodes of acute heart failure in patients with OSA. The aim of this study was to assess the changes in electrocardiographic parameters in proven obstructive sleep apnea patients to predict impending heart failure in a resource-scarce situation. A total of 30 proven OSA patients were included in the study and their electrocardiographic parameters were compared with the Apnea-Hyponea index derived from the polysomnography test results. In this study, the most common electrocardiographic markers seen were Prolonged PR interval(63.3%), Abnormal P wave (66.6%), Left ventricular hypertrophy(46.6%), Left axis deviation (30%), Prolonged QTc interval(46.6%). Studies have shown that prolonged QRS duration, left‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, and left bundle‐branch block, abnormal P‐wave axis, are associated with Heart failure. Hence this study shows that the at risk OSA population can be risk stratified for impending heart failure using low‐cost, noninvasive cardiac assessment tools like Electrocardiographs in rresource-scarce situations.
Keywords: Obstructive sleep apnea, Apnea hypopnea index, P-wave duration, QRS duration, QT prolongation.
References
- Namtvedt SK, Randby A, Einvik G, Hrubos‑Strom H, Somers VK, et al. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project). Am J Cardiol 2011;108:1141‑6.
- Koshino Y, Satoh M, Katayose Y, Yasuda K, Tanigawa T, Takeyasu N, et al. Association of sleep‑disordered breathing and ventricular arrhythmias in patients without heart failure. Am J Cardiol 2008;101:882‑6.
- O’Neal WT, Mazur M, Bertoni AG, Bluemke DA, Al‐Mallah MH, Lima JAC, et al. Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis. Journal of the American Heart Association. 2017;6(6):e006023.
- Silva RM, Kazzaz NM, Torres RM, Moreira Mda C. P‐wave dispersion and left atrial volume index as predictors in heart failure. Arq Bras Cardiol. 2013;100:67–74.
- Zhang ZM, Rautaharju PM, Prineas RJ, Loehr L, Rosamond W, Soliman EZ. Ventricular conduction defects and the risk of incident heart failure in the Atherosclerosis Risk in Communities (ARIC) Study. J Card Fail. 2015;21:307–312.
- Koshino Y, Satoh M, Katayose Y, Yasuda K, Tanigawa T, Takeyasu N, et al. Association of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure. Am J Cardiol 2008;101:882-6.
- Peng Y, Yuan G, Overholt JL, Kumar GK, Prabhakar NR. Systemic and cellular responses to intermittent hypoxia: Evidence for oxidative stress and mitochondrial dysfunction. Adv Exp Med Biol 2003;536:559-64.
- Prabhakar NR, Kumar GK. Oxidative stress in the systemic and cellular responses to intermittent hypoxia. J Biochem 2004;385:217-21.
- Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011;4:441-7.
- 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.
- Watanabe N, Kobayashi Y, Tanno K, Miyoshi F, Asano T, Kawamura M, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol 2004;37:191-200.
- Dhingra R, Ho Nam B, Benjamin EJ, Wang TJ, Larson MG, D'Agostino RB Sr., et al. Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions: The Framingham Heart Study. J Am Coll Cardiol 2005;45:685-9.
- Morin DP, Oikarinen L, Viitasalo M, Toivonen L, Nieminen MS, Kjeldsen SE, et al. QRS duration predicts sudden cardiac death in hypertensive patients undergoing intensive medical therapy: The LIFE study. Eur Heart J 2009;30:2908-14.
- Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110:364-7.
- Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007;49:565-71.
- Khan A, Latif F, Hawkins B, Tawk M, Sivaram CA, Kinasewitz G. Effects of obstructive sleep apnea treatment on left atrial volume and left atrial volume index. Sleep Breath 2008;12:141-7.
- Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003;107:2589-94.
Corresponding Author
Dr Aravind Kumar.V
Post Graduate, Department of Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
DOI: https://dx.doi.org/10.18535/jmscr/v11i1.24
