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Obstructive sleep apnea in heart failure patients: evidence for persistent conduction disturbances or sinus node

S Steiner¹, P O Schueller, M G Hennersdorf

¹Division of Cardiology, Pneumology and Angiology, Department of Medicine, Heinrich Heine University Hospital, Düsseldorf, Germany. steinest@uni-duesseldorf.de

Journal of Physiology and Pharmacology : an Official Journal of the Polish Physiological Society

|February 17, 2009

Summary

Mild sleep apnea in heart failure patients did not show abnormal sinus node or AV conduction. However, sleep apnea patients had shorter AH/HV intervals, possibly due to sympathetic activation.

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Area of Science:

Cardiology
Sleep Medicine
Electrophysiology

Background:

Bradycardia is common in obstructive sleep apnea (OSA) and heart failure (HF).
The relationship between nocturnal hypoxemia, apnea-hypopnea index (AHI), and cardiac electrophysiology in HF patients is not fully understood.

Purpose of the Study:

To investigate the association between OSA severity (AHI), nocturnal hypoxemia, and electrophysiological parameters of sinus node and atrioventricular (AV) conduction in patients with heart failure.

Main Methods:

Electrophysiological studies and polygraphic monitoring were performed in 12 heart failure patients.
Patients were classified based on AHI >10/h for sleep apnea diagnosis.
Comparison of sinus node recovery time, AV conduction intervals (AH, HV), heart rate, and conduction durations (PQ, QRS) between groups.

Main Results:

50% of HF patients had mild sleep apnea (AHI 17.8 +/- 4.4/h).
No significant differences were observed in resting heart rate, PQ, QRS duration, or sinus node recovery time between sleep apnea and non-sleep apnea groups.
Patients with sleep apnea exhibited significantly decreased infranodal (HV) conduction time (P=0.01) and a trend towards decreased atrioventricular (AH) conduction time (P=0.1).

Conclusions:

Mild sleep apnea in heart failure patients is not associated with abnormal sinus node function or AV conduction properties.
The observed decrease in AH/HV intervals in sleep apnea patients may indicate sympathetic nervous system activation secondary to apneic events.