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Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs

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Abstract

Background

Sleep apnea (SA) is associated with sudden cardiac death. Compared to central apneas, obstructive apneas are associated with negative intrathoracic pressure swings inducing autonomic imbalance, which may disturb ventricular repolarisation resulting in arrhythmias.

Objectives

To identify the influence of obstructive apneas versus central apneas on ventricular repolarisation.

Methods

In 14 patients with SA, duration (RT-intervals) and dispersion of ventricular repolarisation [Tpeak-to-Tend-interval (TpTe)] were determined during central apneas compared to obstructive apneas. To identify mechanisms, hypoxia alone or hypoxia with applied negative thoracic pressure was applied in a pig model for SA before and after atropine (n = 7), atenolol (n = 5) and sympathetic renal denervation (RDN, n = 7).

Results

In patients with SA, obstructive apneas during sleep were always associated with a prolongation of RT- as well as TpTe intervals. By contrast central apneas did not affect ventricular repolarisation significantly in the same patients. In the pig model for SA, 2 min of acute tracheal occlusion with applied negative thoracic pressure resulted in a prolongation in RT- and TpTe-interval. These changes in ventricular repolarisation could be inhibited by atenolol as well as by RDN and were not influenced by parasympathetic blockade by atropine. By contrast hypoxia alone did not affect ventricular repolarisation.

Conclusions

Intrathoracic pressure swings during obstructive apneas contribute to changes in ventricular repolarisation, which are not observed with central apneas. These changes are mainly driven by sympathetic activation and may represent mechanisms for increased occurrence of sudden cardiac death in obstructive SA.

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Abbreviations

SA:

Sleep apnea

SCD:

Sudden cardiac death

CPAP:

Continuous positive airway pressure

NTP:

Negative tracheal pressure

AHI:

Apnea hypopnea index

ASV:

Adaptive servoventilation

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Acknowledgments

The authors thank Jeannette Zimolong and Kathrin Weber for excellent technical assistance.

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Authors and Affiliations

  1. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany

    Dominik Linz, Alisa Denner, Susanne Illing, Mathias Hohl, Christian Ukena, Felix Mahfoud, Sebastian Ewen, Jan C. Reil, Klaus Wirth & Michael Böhm

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  1. Dominik Linz
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  2. Alisa Denner
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  3. Susanne Illing
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  4. Mathias Hohl
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  5. Christian Ukena
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  7. Sebastian Ewen
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  8. Jan C. Reil
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  10. Michael Böhm
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Corresponding author

Correspondence to Dominik Linz.

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Funding sources

D.L. and M.H. were supported by HOMFOR 2013/2014, the Else Kröner-Fresenius Foundation, the Deutsche Herzstiftung and the Deutsche Gesellschaft für Kardiologie.

Conflicts of interest

None.

Ethical approval

All analysis of clinical data and animal studies were approved by the local ethical committee and the local Institutional animal use and care committee, respectively.

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Linz, D., Denner, A., Illing, S. et al. Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs. Clin Res Cardiol 105, 639–647 (2016). https://doi.org/10.1007/s00392-016-0961-5

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  • DOI: https://doi.org/10.1007/s00392-016-0961-5

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