Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA.
Am J Cardiol. 2011 Mar 1;107(5):709-13. doi: 10.1016/j.amjcard.2010.10.046. Epub 2011 Jan 19.
We investigated breathing patterns and the occurrence of arrhythmias and ST-segment changes during sleep in patients with Brugada syndrome. Patients with Brugada syndrome are more likely to die from ventricular arrhythmias during sleep. ST-segment changes have been correlated with risk of sudden cardiac death. Whether sleep disturbances may contribute to arrhythmogenesis is unknown. Patients with Brugada syndrome underwent overnight polysomnography with simultaneous 12-lead electrocardiographic recording. A control group matched by age, gender, and body mass index (BMI) also underwent polysomnography. Twenty patients were included (50 ± 15 years old, 75% men). Despite their normal BMI (24.7 ± 2.7 kg/m(2)), 45% had sleep-disordered breathing (SDB), with a mean apnea-hypopnea index of 17.2 ± 14 events/hour. In patients with a high risk of arrhythmias, 5 (63%) had SDB. In the control group, 27% had SDB. Atrial or ventricular arrhythmias were not observed. Spontaneous ST-segment changes occurred in 2 patients over 45 different time points. Most ST-segment changes were observed during rapid eye movement sleep (31%) or within 1 minute of arousals (44%). Regarding respiratory events, 25 (56%) of ST-segment changes were related to occurrence of apnea or hypopnea. In conclusion, patients with Brugada syndrome have a high prevalence of SDB even in the setting of normal BMI. The higher incidence of nocturnal death in patients with Brugada syndrome may be conceivably related to co-morbid SDB. Moreover, autonomic instability encountered in rapid eye movement sleep and arousals could potentiate the risk of arrhythmias.
我们研究了 Brugada 综合征患者睡眠时的呼吸模式以及心律失常和 ST 段变化的发生情况。 Brugada 综合征患者在睡眠期间更有可能死于室性心律失常。 ST 段变化与心源性猝死的风险相关。睡眠障碍是否可能导致心律失常发生尚不清楚。 Brugada 综合征患者接受了过夜多导睡眠图检查，并同时进行了 12 导联心电图记录。一组年龄、性别和体重指数（BMI）相匹配的对照组也接受了多导睡眠图检查。共纳入 20 例患者（50 ± 15 岁，75%为男性）。尽管他们的 BMI 正常（24.7 ± 2.7 kg/m²），但 45%的患者存在睡眠呼吸障碍（SDB），平均呼吸暂停低通气指数为 17.2 ± 14 次/小时。在心律失常风险较高的患者中，有 5 例（63%）存在 SDB。在对照组中，有 27%的患者存在 SDB。未观察到房性或室性心律失常。有 2 例患者在 45 个不同时间点出现自发性 ST 段变化。大多数 ST 段变化发生在快速眼动睡眠期间（31%）或觉醒后 1 分钟内（44%）。关于呼吸事件，25 次（56%）ST 段变化与呼吸暂停或低通气的发生有关。结论：即使在 BMI 正常的情况下， Brugada 综合征患者也存在很高的 SDB 发生率。 Brugada 综合征患者夜间死亡发生率较高，可能与合并 SDB 有关。此外，在快速眼动睡眠和觉醒期间出现的自主神经不稳定可能会增加心律失常的风险。
