QT variability and myocardial repolarization in sleep apnea: implications for cardiac risk.

Purpose: Due to the increased risk of sudden cardiac death, we decided to assess ECG parameters related to the stability of the myocardial repolarization period, i.e. the corrected QT interval (QTc) and derivatives describing its variability (QTV and QTVi).

Methods: Healthy volunteers (n ​= ​187) with visceral obesity, aged 35-65 years, were included. Each participant underwent Holter-ECG and polygraphy simultaneously. According to the severity of breathing disorders during sleep the cohort was divided into 3 groups: Respiratory Event Index (REI) 5-14/hour, REI 15-30/hour, REI ≥ 30/hour. The values of QT parameters were compared between obstructive sleep apnea (OSA)-positive and -negative group as well as among OSA positive group (depending on the OSA severity degree).

Results: We enrolled 121 patients, mean age 47.57 ​± ​9.36 (47 ​% female), mean BMI 32.18 ​± ​5.98 ​kg/m, 70 (58 ​%) of them were diagnosed with OSA, mean REI 26.79 ​± ​25.66/hour. In OSA group, QTV and QTVi were higher (p ​< ​0.001) however QTc max was not significantly longer (p ​= ​0.06). Furthermore, we found significantly increased QTc max and QTVi in OSA positive patients during respiratory events compared to normal breathing (p ​= ​0.02 and p ​= ​0.008, respectively). Additionally, we found a positive correlation between REI and QTc max (p ​= ​0.004, R ​= ​0.22). Parameters related to hypoxia (oxygen desaturation index 4 ​%, time with SpO2 <90 ​%, SpO2 min, SpO2 mean) also presented a positive correlation with QTc max. Variables were not dependent on age or BMI.

Conclusions: Repolarization of cardiomyocytes is impaired in patients with OSA. The severity of impairment is positively correlated with the severity of sleep-related breathing disorders and hypoxemia.