Sleep-Related Breathing Disorders Are Associated With Ventricular Arrhythmias in Patients With an Implantable Cardioverter-Defibrillator

Study objectives The aim of this study was to examine the influence of sleep-related breathing disorders (SBDs) on the occurrence of ventricular arrhythmias in patients with reduced left ventricular ejection fraction (LVEF), and life-threatening ventricular tachyarrhythmias treated with an implantable cardioverter-defibrillator. Patients Thirty-eight patients with LVEF of 36 ± 13% (mean ± SD) underwent a sleep study. When an apnea-hypopnea index (AHI) > 10/h occurred, SBD was diagnosed. Measurements and results In patients with SBDs, ventricular arrhythmias (couplets, triplets, short runs) were recorded simultaneously by Holter ECG and differentiated in episodes with and without disordered breathing. An apnea-associated arrhythmia index (AI) was defined as the number of ventricular arrhythmias occurring simultaneous to disordered breathing. Accordingly, a nonapnea-associated arrhythmia index (NAI) was calculated as the number of ventricular arrhythmias during normal breathing. SBDs were diagnosed in 14 patients: Cheyne-Stokes respiration (CSR) [n = 8; AHI, 32.1 ± 25.0/h], and obstructive sleep apnea (OSA) [n = 6; AHI, 34.1 ± 14.6/h]. Four patients in the OSA group and four patients in the CSR group had ventricular arrhythmias during sleep, revealed by Holter ECG. In these eight patients, the AI was significantly higher than the NAI (20.9 ± 18.8/h vs 4.9 ± 3.3/h, respectively). Conclusions These data show that ventricular arrhythmias occurred significantly more often in association with disordered breathing in patients at high risk for arrhythmias and reduced LVEF.