Nocturnal bradycardia in patients with obstructive sleep apnea combined with metabolic syndrome

Introduction. Obstructive sleep apnea (OSA) and metabolic syndrome (MS) are independent risk factors for cardiovascular diseases, including heart rhythm disturbances. Hypersympathicotonia against the background of apnea often provokes tachysystolic arrhythmias, much less often atrioventricular conduction disturbances. The incidence of bradycardia at night in patients with a combination of OSA and MS has not been studied. Aim of the study. To study the incidence of nocturnal bradycardia in patients with a combination of obstructive sleep apnea and metabolic syndrome. Materials and methods. A retrospective analysis of 288 medical records of patients hospitalized in a therapeutic clinic who underwent cardiorespiratory monitoring given the clinical suspicion of OSA was performed. MS was established according to the criteria of the International Diabetes Federation (IDF, 2005). The presence of nocturnal bradycardia was verified by recording an average heart rate (HR) at night of less than 60 beats per minute. Results. According to the retrospective analysis, MS was detected in 264/288 (91,7%) patients, and OSA was diagnosed in 176/288 (61,1%) patients. The incidence of a combination of sleep-disordered breathing and MS in the study cohort was 52,8% (152/288). The study groups were comparable in terms of the range of drugs they took that affected HR and did not receive respiratory therapy at the time of cardiorespiratory monitoring. Therefore, these factors could not affect the incidence of bradycardia in the study cohort. Among patients with OSA combined with MS, nocturnal bradycardia occurred in 41,4% of patients, while among patients with sleep-disordered breathing without MS, the incidence of nocturnal bradycardia was 19,2%, and in patients with MS without OSA — 29,5%. It was found that in patients with MS and OSA, bradycardia at night occurred more often than in patients with MS without OSA (p=0,046), and more often than in patients with sleep-disordered breathing without MS (p=0,032). The probability of nocturnal bradycardia in patients with a combination of MS and OSA is 3 times higher than in patients with OSA without MS (χ2=4,642, OR=2,97, 95% CI 1,06–8,31, p=0,032). At the same time, the frequency of bradycardia in patients with MS without OSA and in patients with sleep-disordered breathing without MS did not differ (p=0,293). Conclusion. The incidence of nocturnal bradycardia in patients with a combination of obstructive sleep apnea and metabolic syndrome is higher than in patients with sleep-disordered breathing without metabolic syndrome, and higher than in patients with metabolic syndrome without sleep apnea. Early prevention and timely treatment of such comorbid conditions as obesity and obstructive sleep apnea will reduce the risk of developing nocturnal rhythm and conduction disorders in patients.

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