Sleep and Breathing

, Volume 20, Issue 4, pp 1161–1168 | Cite as

Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men

  • Younghoon Kwon
  • Katherine Picel
  • Selcuk Adabag
  • Tien Vo
  • Brent C. Taylor
  • Susan Redline
  • Katie Stone
  • Reena Mehra
  • Sonia Ancoli-Israel
  • Kristine E. EnsrudEmail author
  • for the Osteoporotic Fractures in Men (MrOS) Study Group
Sleep Breathing Physiology and Disorders • Original Article



Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities.


We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, β-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications.


Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00–3.40), and median AHI was 7.06 (IQR 2.55–15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32–0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08–0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29–15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters.


Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.


Electrocardiography Pacemaker Sleep-disordered breathing 


Compliance with ethical standards


The Osteoporotic Fractures in Men (MrOS) Study is supported by the National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. This manuscript is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System.

The funding agencies had no direct role in the conduct of the study; the collection, management, analyses and interpretation of the data; or preparation or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2016

Authors and Affiliations

  • Younghoon Kwon
    • 1
    • 2
  • Katherine Picel
    • 1
    • 2
  • Selcuk Adabag
    • 1
    • 2
  • Tien Vo
    • 1
  • Brent C. Taylor
    • 1
    • 2
  • Susan Redline
    • 3
  • Katie Stone
    • 4
  • Reena Mehra
    • 5
  • Sonia Ancoli-Israel
    • 6
  • Kristine E. Ensrud
    • 1
    • 2
    Email author
  • for the Osteoporotic Fractures in Men (MrOS) Study Group
  1. 1.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of MedicineMinneapolis VA Health Care SystemMinneapolisUSA
  3. 3.Brigham and Women’s Hospital and Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  4. 4.Research Institute, California Pacific Medical CenterSan FranciscoUSA
  5. 5.Department of MedicineCleveland ClinicClevelandUSA
  6. 6.Department of PsychiatryUniversity of California—San DiegoLa JollaUSA

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