Association of sleep-disordered breathing and disturbed cardiac repolarization in patients with ST-segment elevation myocardial infarction

Christoph Fisser; Alina Marcinek; Andrea Hetzenecker; Kurt Debl; Andreas Luchner; Ulrich Sterz; Jörg Priefert; Florian Zeman; Malcolm Kohler; Lars S Maier; Stefan Buchner; Michael Arzt

doi:10.1016/j.sleep.2017.01.007

Association of sleep-disordered breathing and disturbed cardiac repolarization in patients with ST-segment elevation myocardial infarction

Sleep Med. 2017 May:33:61-67. doi: 10.1016/j.sleep.2017.01.007. Epub 2017 Jan 23.

Authors

Affiliations

¹ Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany. Electronic address: christoph.fisser@ukr.de.
² Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
³ Clinic of Internal Medicine, Klinikum St. Marien Amberg, Amberg, Germany.
⁴ Center of Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
⁵ Clinic of Pneumology, University Hospital of Zurich, Zurich, Switzerland; Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.

PMID: 28449908
DOI: 10.1016/j.sleep.2017.01.007

Abstract

Objective: In patients with ST-segment elevation myocardial infarction (STEMI), disturbed cardiac repolarization before percutaneous coronary intervention (PCI) is a risk factor for malignant ventricular arrhythmia. We tested the hypothesis that sleep-disordered breathing (SDB) in patients with STEMI is associated with disturbed cardiac repolarization.

Methods: Thirty-three patients with STEMI who underwent PCI were prospectively enrolled. To assess cardiac repolarization, the heart-rate corrected interval from the peak of the T wave to the end of the T wave (TpTec) and QTc intervals were assessed with 12-lead electrocardiography before PCI, within 24 h after PCI, and 12 weeks after PCI. SDB defined as an apnea-hypopnea index (AHI) ≥15 per hour was diagnosed by polysomnography.

Results: Before PCI, patients with SDB had a significantly prolonged TpTec interval compared to patients without SDB (133 vs 104 ms, p = 0.035). Within 24 h after PCI, the TpTec interval was 107 vs 92 ms (p = 0.178). QTc intervals showed a similar pattern (pre-PCI: 443 vs 423 ms, p = 0.199; post-PCI: 458 vs 432 ms, p = 0.115). In multiple linear regression analyses, AHI was significantly associated with prolonged TpTec intervals (pre-PCI: B-coefficient = 1.11, 95% confidence interval (CI) 0.48-1.74, p = 0.001; post-PCI: B = 0.97, 95% CI 0.29-1.65, p = 0.007), prolonged QTc intervals (pre-PCI: B = 1.05, 95% CI 0.20-1.91, p = 0.018; post-PCI: B = 1.37, 95% CI 0.51-2.24, p = 0.003), and higher TpTe/QT-ratios (pre-PCI: B = 0.16, 95% CI 0.05-0.27, p = 0.007; post-PCI: B = 0.13, 95% CI < 0.01-0.25, p = 0.036), independent of known risk factors for cardiac arrhythmia.

Conclusion: In patients with STEMI, SDB was significantly associated with disturbed cardiac repolarization before and after PCI, independent of known risk factors. These findings suggest that SDB may contribute to the risk of developing malignant ventricular arrhythmia.

Keywords: Acute myocardial infarction; Cardiac arrhythmias; Cardiac repolarization; Risk; Sleep apnea; TpTe–QT.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Arrhythmias, Cardiac / complications*
Arrhythmias, Cardiac / physiopathology
Electrocardiography / methods
Female
Germany / epidemiology
Heart / physiopathology
Humans
Male
Middle Aged
Myocardial Infarction / complications*
Myocardial Infarction / physiopathology
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / methods*
Polysomnography / methods
Prospective Studies
Risk Factors
Sleep Apnea Syndromes / complications*
Sleep Apnea Syndromes / diagnosis
Sleep Apnea Syndromes / physiopathology