A case of sinus arrest and vagal overactivity during REM sleep
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A young man presented with tachycardia and faintness after an episode of influenza. He underwent 24-h heart rate recordings, each of which documented episodes of sinus arrest lasting up to 7.2 seconds. All episodes occurred in the second half of the night and were always accompanied by severe bradycardia. Cardiac function tests failed to disclose anything abnormal. Two polysomnographic recordings demonstrated that the sinus arrests occurred during REM sleep. Power spectral analysis of heart rate variability showed that during the second half of the night there was an abnormal prevalence of vagal activity, particularly during REM sleep stages, presumably responsible for the bradycardia and fall in blood pressure. We speculate that the episodes of sinus arrest are linked to a central mechanism that triggers the autonomic imbalance during REM sleep.
Keywordssinus arrest sleep autonomic imbalance
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- 1.Guilleminault C, Pool P, Motta J, Gillis AM. Sinus arrest during REM sleep in young adults.N Engl J Med 1984; 311:1006–10.Google Scholar
- 2.Diagnostic Classification Steering Committee, Thorpy MJ, Chairman. International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN. American Sleep Disorders Association; 1990.Google Scholar
- 3.Grimm W, Hoffmann J, Menz V, Kohler U, Heitmann J, Peter JH, et al. Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea.Am J Cardiol 1996; 77:1310–4.Google Scholar
- 4.Coccagna G, Mantovani M, Brignani F, Manzini A, Lugaresi E. Arterial pressure changes during spontaneous sleep in man.Electroenceph Clin Neurophysiol 1971; 31:277–81.Google Scholar
- 5.Baharav A, Kotagal S, Gibbons V, Rubin BK, Pratt G, Karin J, et al. Fluctuations in autonomic nervous activity during sleep displayed by power spectrum analysis of heart rate variability.Neurology 1995; 45:1183–7.Google Scholar
- 6.Elsenbruch S, Orr WC, Harnish MJ. Differences in sympathetic and vagal regulation of cardiac function during NREM and REM sleep.Sleep 1988; 21(Suppl):209.Google Scholar