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Timing of Nocturnal Ventricular Ectopy in Heart Failure Patients With Sleep Apnea^*

^* From the Sleep Research Laboratory (Drs. Ryan, Juvet, and Bradley), Toronto Rehabilitation Institute, Toronto, ON, Canada; and the Sleep Research Laboratory (Dr. Leung), St. Michael’s Hospital, Toronto, ON, Canada.

Correspondence to: T. Douglas Bradley, MD, Toronto General Hospital/University Health Network, 9N-943, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4; e-mail: douglas.bradley{at}utoronto.ca

Abstract

Background: Ventricular ectopy is frequent in heart failure (HF) patients with sleep apnea. A previous report indicated that in HF patients, ventricular premature beats (VPB) occurred more frequently during episodes of recurrent central sleep apnea (CSA) than during normal breathing, and their frequency was greater during hyperpnea than during apnea. We hypothesized that, because respiratory stimuli that might provoke ventricular ectopy are stronger during obstructive apneas than during central apneas, in contrast to CSA, VPBs would be more frequent during apnea than hyperpnea in HF patients with obstructive sleep apnea (OSA).

Methods: HF patients in sinus rhythm who have OSA or CSA (apnea-hypopnea index, 15 events per hour) and with > 30 VPBs per hour were matched for severity of cardiac dysfunction and sleep apnea. The frequency of VPBs was then assessed during stage 2 sleep during the apneic and the hyperpneic phases of recurrent obstructive or central apneas.

Results: VPBs occurred more frequently during the apneic phase than during the hyperpneic phase in patients with OSA. In contrast, VPBs occurred more frequently during the hyperpneic phase than the apneic phase in patients with CSA. There was no difference in the degree of apnea-related oxygen desaturation between central and obstructive apneas.

Conclusions: In patients with HF, nocturnal ventricular ectopy oscillates in time with oscillations in ventilation, with VPBs occurring predominantly during apneas in patients with OSA, but during hyperpneas in patients with CSA. This difference in VPB timing between OSA and CSA may be attributable to the differences in timing of arrhythmic stresses in these patients.

Key Words: congestive heart failure • sleep-disordered breathing • ventricular arrhythmias