Obstructive sleep apnea in patients with congenital long QT syndrome: Implications for increased risk of sudden cardiac death

Abu S. Shamsuzzaman, Virend Somers, Timothy K. Knilans, Michael John Ackerman, Yu Wang, Raouf S. Amin

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Congenital long QT syndrome (LQTS) is a familial arrhythmogenic cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk of torsades de pointes-mediated syncope, seizures, and sudden cardiac death (SCD). QT prolongation corrected for heart rate (QTc) is an important diagnostic and prognostic feature in LQTS. Obstructive sleep apnea (OSA) has been increasingly implicated in the pathogenesis of cardiovascular disease, including arrhythmias and SCD. We tested the hypothesis that the presence of concomitant OSA in patients with LQTS is associated with increased QT intervals, both during sleep and while awake. Methods and Results: Polysomnography with simultaneous overnight 12-lead electrocardiography (ECG) was recorded in 54 patients with congenital LQTS and 67 control subjects. OSA was diagnosed as apnea-hypopnea index (AHI) . 5 events/h for adults and AHI > 1 event/h for children. RR and QT intervals were measured from the 12-lead surface ECG. QTc was determined by the Bazett formula. Respiratory disturbance index, AHI, and arousal index were significantly increased in patients with LQTS and with OSA compared to those without OSA and control subjects. QTc during different sleep stages and while awake was also significantly increased in patients with LQTS and OSA compared to those without OSA. Severity of OSA in patients with LQTS was directly associated with the degree of QTc. Conclusions: The presence and severity of obstructive sleep apnea (OSA) in patients with congenital long QT syndrome (LQTS) is associated with increased QT prolongation corrected for heart rate, which is an important biomarker of sudden cardiac death (SCD). Treatment of OSA in LQTS patients may reduce QT prolongation, thus reducing the risk of LQT-triggered SCD.

Original languageEnglish (US)
Pages (from-to)1113-1119
Number of pages7
JournalSleep
Volume38
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Long QT Syndrome
Sudden Cardiac Death
Obstructive Sleep Apnea
Apnea
Electrocardiography
Heart Rate
Channelopathies
Torsades de Pointes
Polysomnography
Sleep Stages
Syncope
Arousal
Cardiac Arrhythmias
Sleep
Seizures
Cardiovascular Diseases
Biomarkers

Keywords

  • Hypoxia
  • Long-QT syndrome
  • Sleep apnea
  • Torsade de pointes

ASJC Scopus subject areas

  • Physiology (medical)
  • Clinical Neurology

Cite this

Obstructive sleep apnea in patients with congenital long QT syndrome : Implications for increased risk of sudden cardiac death. / Shamsuzzaman, Abu S.; Somers, Virend; Knilans, Timothy K.; Ackerman, Michael John; Wang, Yu; Amin, Raouf S.

In: Sleep, Vol. 38, No. 7, 01.07.2015, p. 1113-1119.

Research output: Contribution to journalArticle

Shamsuzzaman, Abu S. ; Somers, Virend ; Knilans, Timothy K. ; Ackerman, Michael John ; Wang, Yu ; Amin, Raouf S. / Obstructive sleep apnea in patients with congenital long QT syndrome : Implications for increased risk of sudden cardiac death. In: Sleep. 2015 ; Vol. 38, No. 7. pp. 1113-1119.
@article{d88f72dcdd834b03b962b12b6bab72fa,
title = "Obstructive sleep apnea in patients with congenital long QT syndrome: Implications for increased risk of sudden cardiac death",
abstract = "Background: Congenital long QT syndrome (LQTS) is a familial arrhythmogenic cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk of torsades de pointes-mediated syncope, seizures, and sudden cardiac death (SCD). QT prolongation corrected for heart rate (QTc) is an important diagnostic and prognostic feature in LQTS. Obstructive sleep apnea (OSA) has been increasingly implicated in the pathogenesis of cardiovascular disease, including arrhythmias and SCD. We tested the hypothesis that the presence of concomitant OSA in patients with LQTS is associated with increased QT intervals, both during sleep and while awake. Methods and Results: Polysomnography with simultaneous overnight 12-lead electrocardiography (ECG) was recorded in 54 patients with congenital LQTS and 67 control subjects. OSA was diagnosed as apnea-hypopnea index (AHI) . 5 events/h for adults and AHI > 1 event/h for children. RR and QT intervals were measured from the 12-lead surface ECG. QTc was determined by the Bazett formula. Respiratory disturbance index, AHI, and arousal index were significantly increased in patients with LQTS and with OSA compared to those without OSA and control subjects. QTc during different sleep stages and while awake was also significantly increased in patients with LQTS and OSA compared to those without OSA. Severity of OSA in patients with LQTS was directly associated with the degree of QTc. Conclusions: The presence and severity of obstructive sleep apnea (OSA) in patients with congenital long QT syndrome (LQTS) is associated with increased QT prolongation corrected for heart rate, which is an important biomarker of sudden cardiac death (SCD). Treatment of OSA in LQTS patients may reduce QT prolongation, thus reducing the risk of LQT-triggered SCD.",
keywords = "Hypoxia, Long-QT syndrome, Sleep apnea, Torsade de pointes",
author = "Shamsuzzaman, {Abu S.} and Virend Somers and Knilans, {Timothy K.} and Ackerman, {Michael John} and Yu Wang and Amin, {Raouf S.}",
year = "2015",
month = "7",
day = "1",
doi = "10.5665/sleep.4824",
language = "English (US)",
volume = "38",
pages = "1113--1119",
journal = "Sleep",
issn = "0161-8105",
publisher = "American Academy of Sleep Medicine",
number = "7",

}

TY - JOUR

T1 - Obstructive sleep apnea in patients with congenital long QT syndrome

T2 - Implications for increased risk of sudden cardiac death

AU - Shamsuzzaman, Abu S.

AU - Somers, Virend

AU - Knilans, Timothy K.

AU - Ackerman, Michael John

AU - Wang, Yu

AU - Amin, Raouf S.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background: Congenital long QT syndrome (LQTS) is a familial arrhythmogenic cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk of torsades de pointes-mediated syncope, seizures, and sudden cardiac death (SCD). QT prolongation corrected for heart rate (QTc) is an important diagnostic and prognostic feature in LQTS. Obstructive sleep apnea (OSA) has been increasingly implicated in the pathogenesis of cardiovascular disease, including arrhythmias and SCD. We tested the hypothesis that the presence of concomitant OSA in patients with LQTS is associated with increased QT intervals, both during sleep and while awake. Methods and Results: Polysomnography with simultaneous overnight 12-lead electrocardiography (ECG) was recorded in 54 patients with congenital LQTS and 67 control subjects. OSA was diagnosed as apnea-hypopnea index (AHI) . 5 events/h for adults and AHI > 1 event/h for children. RR and QT intervals were measured from the 12-lead surface ECG. QTc was determined by the Bazett formula. Respiratory disturbance index, AHI, and arousal index were significantly increased in patients with LQTS and with OSA compared to those without OSA and control subjects. QTc during different sleep stages and while awake was also significantly increased in patients with LQTS and OSA compared to those without OSA. Severity of OSA in patients with LQTS was directly associated with the degree of QTc. Conclusions: The presence and severity of obstructive sleep apnea (OSA) in patients with congenital long QT syndrome (LQTS) is associated with increased QT prolongation corrected for heart rate, which is an important biomarker of sudden cardiac death (SCD). Treatment of OSA in LQTS patients may reduce QT prolongation, thus reducing the risk of LQT-triggered SCD.

AB - Background: Congenital long QT syndrome (LQTS) is a familial arrhythmogenic cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk of torsades de pointes-mediated syncope, seizures, and sudden cardiac death (SCD). QT prolongation corrected for heart rate (QTc) is an important diagnostic and prognostic feature in LQTS. Obstructive sleep apnea (OSA) has been increasingly implicated in the pathogenesis of cardiovascular disease, including arrhythmias and SCD. We tested the hypothesis that the presence of concomitant OSA in patients with LQTS is associated with increased QT intervals, both during sleep and while awake. Methods and Results: Polysomnography with simultaneous overnight 12-lead electrocardiography (ECG) was recorded in 54 patients with congenital LQTS and 67 control subjects. OSA was diagnosed as apnea-hypopnea index (AHI) . 5 events/h for adults and AHI > 1 event/h for children. RR and QT intervals were measured from the 12-lead surface ECG. QTc was determined by the Bazett formula. Respiratory disturbance index, AHI, and arousal index were significantly increased in patients with LQTS and with OSA compared to those without OSA and control subjects. QTc during different sleep stages and while awake was also significantly increased in patients with LQTS and OSA compared to those without OSA. Severity of OSA in patients with LQTS was directly associated with the degree of QTc. Conclusions: The presence and severity of obstructive sleep apnea (OSA) in patients with congenital long QT syndrome (LQTS) is associated with increased QT prolongation corrected for heart rate, which is an important biomarker of sudden cardiac death (SCD). Treatment of OSA in LQTS patients may reduce QT prolongation, thus reducing the risk of LQT-triggered SCD.

KW - Hypoxia

KW - Long-QT syndrome

KW - Sleep apnea

KW - Torsade de pointes

UR - http://www.scopus.com/inward/record.url?scp=84938075260&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938075260&partnerID=8YFLogxK

U2 - 10.5665/sleep.4824

DO - 10.5665/sleep.4824

M3 - Article

C2 - 26118557

AN - SCOPUS:84938075260

VL - 38

SP - 1113

EP - 1119

JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 7

ER -