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Reverse atrial electrical remodelling induced by continuous positive airway pressure in patients with severe obstructive sleep apnoea

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Obstructive sleep apnoea (OSA) is associated with cardiovascular morbidity and mortality, including atrial arrhythmias. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; its impact on atrial electrical remodelling has not been fully investigated. Signal-averaged p-wave (SAPW) duration is an accepted marker for atrial electrical remodelling.

Objective

The objective of this study is to determine whether CPAP induces reverse atrial electrical remodelling in patients with severe OSA.

Methods

Consecutive patients attending the Sleep Disorder Clinic at Kingston General Hospital underwent full polysomnography. OSA-negative controls and severe OSA were defined as apnoea–hypopnea index (AHI) < 5 events/hour and AHI ≥ 30 events/hour, respectively. SAPW duration was determined at baseline and after 4–6 weeks of CPAP in severe OSA patients or without intervention controls.

Results

Nineteen severe OSA patients and 10 controls were included in the analysis. Mean AHI and minimum oxygen saturation were 41.4 ± 10.1 events/hour and 80.5 ± 6.5 % in severe OSA patients and 2.8 ± 1.2 events/hour and 91.4 ± 2.1 % in controls. At baseline, severe OSA patients had a greater SAPW duration than controls (131.9 ± 10.4 vs 122.8 ± 10.5 ms; p = 0.02). After CPAP, there was a significant reduction of SAPW duration in severe OSA patients (131.9 ± 10.4 to 126.2 ± 8.8 ms; p < 0.001), while SAPW duration did not change after 4–6 weeks in controls.

Conclusion

CPAP induced reverse atrial electrical remodelling in patients with severe OSA as represented by a significant reduction in SAPW duration.

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Abbreviations

AF:

Atrial fibrillation

AHI:

Apnoea–hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

ECG:

Electrocardiogram

EMG:

Electromyography

Hz:

Hertz

kHz:

Kilohertz

LA:

Left atrial

OSA:

Obstructive sleep apnoea

mL:

Milliliter

ms:

Millisecond

mV:

Millivolt

Pd:

p-Wave dispersion

Pmax:

Maximum p-wave duration

SAPW:

Signal-averaged p-wave

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Acknowledgements

We would like to thank Dr. Peter Munt and Dr. Ron Wigle for helping in recruiting patients for the study. This study was supported by an unrestricted grant from the Clinical Teachers’ Association of Queen’s University.

Conflicts of interest

None

Financial disclosures

This study received an unrestricted grant from the Clinical Teachers’ Association of Queen’s University.

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Authors and Affiliations

  1. Cardiology Division, Kingston General Hospital, Queen’s University, Kingston, ON, Canada

    Adrian Baranchuk, Helen Pang, Geoffrey E. J. Seaborn, Payam Yazdan-Ashoori, Damian P. Redfearn, Christopher S. Simpson & Kevin A. Michael

  2. Sleep Disorder Clinic, Kingston General Hospital, Queen’s University, Kingston, ON, Canada

    Michael Fitzpatrick

  3. Cardiac Electrophysiology and Pacing, EP Training Program, Kingston General Hospital, Queen’s University, FAPC 3, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada

    Adrian Baranchuk

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  1. Adrian Baranchuk
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Correspondence to Adrian Baranchuk.

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Baranchuk, A., Pang, H., Seaborn, G.E.J. et al. Reverse atrial electrical remodelling induced by continuous positive airway pressure in patients with severe obstructive sleep apnoea. J Interv Card Electrophysiol 36, 247–253 (2013). https://doi.org/10.1007/s10840-012-9749-3

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  • DOI: https://doi.org/10.1007/s10840-012-9749-3

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