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The effects of simulated obstructive apnea and hypopnea on arrhythmic potential in healthy subjects

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Abstract

Preliminary evidence supports an association between OSA and cardiac dysrhythmias. Negative intrathoracic pressure, as occurring during OSA, may provoke cardiac dysrhythmias. Thus, we aimed to study the acute effects of simulated apnea and hypopnea on arrhythmic potential and measures of cardiac repolarization [QTC and T peak to T end intervals (\( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \))] in humans. In 41 healthy volunteers, ECG was continuously recorded prior, during and after simulated obstructive hypopnea (inspiration through a threshold load), simulated apnea (Mueller maneuver), end-expiratory central apnea and normal breathing in randomized order. The number of subjects with premature beats was significantly higher during inspiration through a threshold load (n = 7), and the Mueller maneuver (n = 7) compared to normal breathing (n = 0) (p = 0.008 for all comparisons), but not during end-expiratory central apnea (n = 3, p = 0.125). Inspiration through a threshold load was associated with a non-significant mean (SD) increase of the QTC interval [+5.4 (22.4) ms, 95 %CI −1.7 to +12.4 ms, p = 0.168] and a significant increase of the \( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \) interval [+3.7 (8.9) ms, 95 %CI +0.9 to +6.6 ms, p = 0.010]. The Mueller maneuver induced a significant increase of the QTC interval [+8.3 (23.4) ms, 95 %CI 0.9 to +15.6 ms, p = 0.035] and the \( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \) interval (+4.2 (8.2) ms, 95 %CI +1.6 to +6.8 ms, p = 0.002). There were no significant changes of the QTC and \( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \) intervals during central end-expiratory apnea. These data indicate that simulated obstructive apnea and hypopnea are associated with an increase of premature beats and prolongation of QTC and \( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \) intervals. Therefore, negative intrathoracic pressure changes may be a contributory mechanism for the association between OSA and cardiac dysrhythmias.

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Abbreviations

AF:

Atrial fibrillation

Ap:

End-expiratory central apnea

BMI:

Body mass index

CI:

Confidence interval

CPAP:

Continuous positive airway pressure

ECG:

Electrocardiogram

iTH:

Inspiration through inspiratory threshold

MM:

Mueller maneuver

OSA:

Obstructive sleep apnea

QT:

QT interval

QTC :

Heart rate-corrected QT interval by Bazett’s formula

SD:

Standard deviation

SPB:

Supraventricular premature beats

T p T e :

T peak to T end interval

\( T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} \) :

Heart rate-corrected T peak to T end interval by Bazett’s formula

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No conflict of interest, financial or otherwise, is declared by the authors.

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Authors and Affiliations

  1. Sleep Disorders Center and Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Giovanni Camen, Christian F. Clarenbach, Anne-Christin Stöwhas, Valentina A. Rossi, Noriane A. Sievi & Malcolm Kohler

  2. Oxford Center for Respiratory Medicine, Churchill Hospital, Oxford, UK

    John R. Stradling

  3. Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    Malcolm Kohler

Authors
  1. Giovanni Camen
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  2. Christian F. Clarenbach
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  3. Anne-Christin Stöwhas
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  4. Valentina A. Rossi
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  5. Noriane A. Sievi
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  6. John R. Stradling
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  7. Malcolm Kohler
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Correspondence to Malcolm Kohler.

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Communicated by Dag Linnarsson.

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Camen, G., Clarenbach, C.F., Stöwhas, AC. et al. The effects of simulated obstructive apnea and hypopnea on arrhythmic potential in healthy subjects. Eur J Appl Physiol 113, 489–496 (2013). https://doi.org/10.1007/s00421-012-2457-y

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