Fatih AYGÜN, Harun KARAMANLI

Obstrüktif Uyku Apne Şiddeti ile QRS Süresi Arasındaki İlişkinin Araştırılması

Giriş: Bu çalışmada, obstrüktif uyku apnesi (OSA) şiddeti ile elektrokardiyogramdaki QRS süresinin genişlemesi arasındaki ilişki araştırılmıştır. Hastalar ve Yöntem: Bu çalışma; kliniğimizde Mart 2013 ve Eylül 2014 tarihleri arasında, OSA tanısı almış 85 kişiyi içermektedir. PSG raporları alanında uzman hekim tarafından değerlendirildi. Şiddetli uyku apne hastalığı olan bireyler Grup 1 olarak adlandırılırken, orta, hafif uyku apne hastalığı olan bireyler Grup 2 olarak belirlendi. Bulgular: Çalışmaya katılan tüm bireylerin yaş dağılımı; minimum(min) 20 yıl (y), maksimum(max) 85 yıldır (ortalama ± standart sapma 48.5 ± 13.2 y). Bu kişilerin 51 (%60)’i erkek, 34 (%40)’ ü kadındır. Polisomnografi (PSG) kayıtları ve skorlaması ALICE 6 system kullanılarak oluşturulan, şiddetli OSA’sı olan bireyleri içeren Grup 1’de QRS süresi 0.112 ± 0.016 saniye iken Grup 2’ de 0,080 ± 0,017 saniye olduğu görüldü. Sonuç: Şiddetli OSA’sı olan bireylerin, hafif ve orta şiddette OSA’sı olan bireylere göre QRS sürelerinin yüksek olduğu görüldü. Sonucun istatiksel olarak anlamlı olduğu tespit edildi (p< 0.01).

Anahtar Kelimeler:

Uyku monitorizasyonu, elektrokardiyogram, obstrüktif uyku apnesi

Relation Between Obstructive Sleep Apnea and Duration of QRS Complex

Introduction: To investigate the relation between severity of obstructive sleep apnea (OSA) and widened QRS complex on electrocardiogram. Patients and Methods: The present study comprised 85 subjects diagnosed with OSA at our clinic between March 2013 and September 2014. PSG reports were reviewed by a self-proclaimed expert physician. Whilst the patients with severe sleep apnea disease were assigned to Group 1, patients with mild-moderate sleep apnea disease were assigned to Group 2. Results: The age of the patients participated in the study ranged between 20 years (y) (minimum-min) and 85 years (maximum-max) (mean ± standard deviation 48.5 ± 13.2 y). Of these subjects, 51 (60%) were male and 34 (40%) were female. Mean duration of QRS complex was 0.112 ± 0.016 seconds (sec) in Group I consisted of patients with severe OSA of which Polysomnography (PSG) records and scoring were done using ALICE 6 system, whereas it was 0.080 ± 0.017 sec in Group 2. Conclusion: It was observed that duration of QRS complex was longer in the patients with severe OSA as compared to those with mild-moderate OSA. The result was statistically significant (p< 0.01).

Keywords:

Monitoring sleep, electrocardiogram, obstructive sleep apnea,

PDF

___

1. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983;52:490-4.
2. Shephard JW, Garrrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 1985;88:335-40.
3. Andreas S, Hajak G, von Breska B, Rüther E, Kreuzer H. Changes in heart rate during obstructive sleep apnoea. Eur Respir J 1992;5:853-7.
4. Koehler U, Dübler H, Glaremin T, Junkermann H, Lübbers C, Ploch T, et al. Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease. Klin Wochenschr 1991;69:474-82.
5. Boudoulas H, Schmidt HS, Clark RW, Geleris P, Schaal SF, Lewis RP. Anthropometric characteristics, cardiac abnormalities and adrenergic activity in patients with primary disorders of sleep. J Med 1983;14:223-38.
6. Miller WP. Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance. Am J Med 1982; 73: 317-21.
7. Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC. Sleep-induced apnea syndrome: prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 1977;63:348-58.
8. Bolm-Audorff U, Köhler U, Becker E, Fuchs E, Peter JH, v Wichert P. Nächtliche Herzrhythmusstörungen bei Schlafapnoe Syndrom. Dtsch Med Wochenschr 1984;109:853-6.
9. He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14. 11. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
12. Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002;360:237-45.
13. Palomaki H, Partinen M, Juvela S, Kaste M. Snoring as a risk factor for sleep-related brain infarction. Stroke 1989;20:1311-5.
14. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163:19-25.
15. Gami AS, Somers VK. Implications of obstructive sleep apnea for atrial fibrillation and sudden cardiac death. J Cardiovac Electrophysiol 2008;19:997-1003.
16. Drager L, Bortolotto LA, Figueiredo LA, Caldin B, Krieger E, Lorenzi-Filho E. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest 2007;131:1379-86.
17. Noda A, Okada T, Yasuma F, Nakashima N, Yokota M. Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 1995;107:1538-44.
18. Shivalkar B, Van de Heyning C, Kerremans M, Rinkevich D, Verbraecken J, De Backer W, et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol 2006;47:1433-9.
19. Usui K, Parker JD, Newton GE, Floras JS, Ryan CM, Bradley TD. Left ventricular structural adaptations to obstructive sleep apnea in dilated cardiomyopathy. Am J Respir Crit Care Med 2006;173:1170-5.
20. Dhingra R, Ho Nam, B, Benjamin EJ, Wang TJ, Larson MG, D’Agustino RB Sr, et al. Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions: the Framingham Heart Study. J Am Coll Cardiol 2005;45:685-9.
21. Morin DP, Oikarinen L, Viitasalo M, Troivonen L, Nieminen MS, Kieldsen SE, et al. QRS duration predicts sudden cardiac death in hypertensive patients undergoing intensive medical therapy: the LIFE study. Eur Heart J 2009;30:2908-14.
22. Ott P, Marcus FI. Electrocardiographic markers of sudden death. Cardiol Clin 2006;24:453-69
23. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
24. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008;52:686-717.