Background: Cardiac arrhythmias are one of the cardiovascular complications from obstructive sleep apnea (OSA). Positive airway pressure (PAP) has been demonstrated as an effective treatment of cardiac arrhythmias in OSA patients.

Objective: To compare nocturnal cardiac arrhythmias and sleep parameters in OSA patients during split-night PAP titration polysomnography (PSG).

Materials and Methods: The present study was a retrospective study, interrupted time series recruited patients that underwent split-night PSG and met diagnostic criteria of OSA by the International Classification of Sleep Disorders-Third Edition with cardiac arrhythmias at Central Chest Institute of Thailand between 2013 and 2019.

Results: Initially, 104 OSA patients with cardiac arrhythmias were enrolled but 33 patients were excluded. Seventy-one patients were analyzed. Most patients were male (57.75%). The average age of patients was 58.08±11.48 years with an average body mass index of 31.79±7.67 kg/m². Half of those patients had previous cardiac arrhythmias (57.75%). The most common cardiac arrhythmias were persistent atrial fibrillation at 35.21%. The average left ventricular ejection fraction was 60.04±13.18%. The majority of patients were severe OSA at 92.96%. Sleep parameters were significantly improved in sleep efficiency at 68.07±16.40 and 77.95±15.38 (p<0.001), apnea-hypopnea index at 64.80 with a range of 47.80 to 87.30 and 20.90 with a range of 10.20 to 34.30 (p<0.001), 3% oxygen desaturation index at 17.70 with a range of 7.50 to 44.80 and 2.40 with a range of 0.70 to 8.60 (p<0.001), average oxygen saturation at 88.67±15.53 and 94.39±3.08 (p=0.002), average heart rate at 66.60±11.07 and 63.28±11.84 (p<0.001), lowest heart rate at 41.97±13.30 and 36.61±11.92 (p<0.001), and arousal index at 75.19±30.48 and 38.14±16.09 (p<0.001) after PAP titration, respectively. There was a significant reduction of isolated premature ventricular complexes (PVCs) at 55.29 with a range of 27.06 to 424.80 and 32.56 with a range of 17.05 to 284.68 (p=0.003) after PAP titration.

Conclusion: There was significant reduction of isolated PVCs, and lowest heart rate and sleep parameters were significantly improved in OSA patients with cardiac arrhythmias during split-night PAP titration PSG.

Keywords: Nocturnal cardiac arrhythmias; Sleep parameters; Obstructive sleep apnea (OSA); Positive airway pressure (PAP) titration; Polysomnography

DOI: 10.35755/jmedassocthai.2022.07.13331

Received 25 October 2021 | Revised 5 May 2022 | Accepted 10 May 2022