Clinical Analysis Of Cardiac Arrhythmia In Patients With Obstructive Sleep Apnea Syndrome

Objective: To explore the relationship between the severity of OSAS and arrhythmia, discuss different types of arrhythmias occur on the patients with OSAS and to assess the impact of nasal continuous positive airway pressure (nCPAP) therapy to treat the condition of arrhythmias.Methods: Patients from September 2007 to May 2009 at the Third Hospital of Hebei Medical University all received polysomnography(PSG)for one night. The severity of OSAS is measured by the apnea-hypopnea index (AHI), obtained by counting the total number of apneas and hypopneas during sleep and dividing that by the hours of sleep. An AHI higher than 5 per hours, 80% obstructive respiratory events of all respiratory events, also with morning headache, morning sore throat, excessive fatigue and excessive daytime sleepiness is diagnosed OSAS. According to the AHI and SaO2, these patients were divided into three groups, the mild group: AHI(5～20)per hours and SaO2 85%～90%, moderate group: AHI(20～40)per hours and SaO2 80%～85%, severe group : AHI>40 per hours and SaO2<80%. Discuss the relationship between the severity of AHI and arrhythmia. Analyze the changes of incidences of arrhythmia before and after the therapy of nCPAP.Results:1. Among 326 patients with OSAS, 76 ones had arrhythmias and the incidence of arrhythmias was 23.3%. These patients were divided into three groups according to the AHI and SaO2, there were no differences among age, gender, BMI(p>0.05). There was a positive relationship between incidence of arrhythmias and AHI(r=0.876).2. For patients with OSAS who had arrhythmias including atrial fibrillation, sinus bradycardia, frequent ventricular premature beats, sporadic ventricular premature beats, frequent supraventricular premature beats, sporadic supraventricular premature beats and atrioventricular block. Sinus bradycardia (90.7%, p<0.01) and ventricular premature beats (46.1%, p=0.032) were the most likely happened than other types of arrhythmias.3. With increasing of AHI, the incidence of atrial fibrillation (p<0.01,r=0.837), frequent premature contractions (p<0.01,r=0.674), atrioventricular block (p<0.01,r=0.619) and sporadic premature contractions (p<0.05,r=0.598) also increases.4. After therapy of more than 6 hours of using nCPAP: AHI(before(37.8±3.9) per hours, after(3.2±1.3) per hours, p<0.01), arousal index(before(38.2±4.1) per hours,after (5.4±2.3) per hours, p<0.01), desaturation index(before(63±17) per hours,after(9±2) per hours, p<0.01), proportion of the time of SaO2<90% occupy total sleep time(before(57±14)%, after(3.1±2.6)%, p<0.01) decreased, SaO2:(before(89.5±1.8)%,after(99.6±0.5)%, p=0.024) increased obviously.5. After therapy of more than 6 hours of using nCPAP, total sleep time, sleep efficiency, proportion of NREM1, proportion of NREM2 had no significant differences(p>0.05), proportion of NREM3(before(4.6±3.2)%,after(19.8±9.4)%,p<0.01)and REM(before(14.3±10.1)%,after(37.4±16.2)%,p<0.01)increased obviously.6. After therapy of more than 6 hours of using nCPAP, the incidence of sinus bradycardia(before78.2%, after8.6%, p<0.01), ventricular premature beats(before34.8%, after4.3%, p<0.01), combination of two arrhythmias (before 21.7%, after 0, p<0.01) and atrial fibrillation(before 17.4%, after 4.3%, p<0.01) decreased obviously.Conclusions: Arrhythmia is a common complication in the patients with OSAS, sinus bradycardia and ventricular premature beats are the most likely happened. There is a positive relationship between AHI and arrhythmia. After the therapy of nCPAP, not only the condition of OSAS but the incidence of arrhythmia improves.