Sleep Center, Toranomon Hospital, Tokyo, Japan.
Circ Arrhythm Electrophysiol. 2013 Apr;6(2):287-93. doi: 10.1161/CIRCEP.113.000266. Epub 2013 Mar 20.
Prolonged P-wave duration, indicating atrial conduction delay, is a potent precursor of atrial fibrillation. Obstructive sleep apnea (OSA) is a risk factor for atrial fibrillation development. We investigated the association of P-wave duration with OSA and its treatment.
We enrolled 80 consecutive men with normal sinus rhythms who underwent polysomnography, had no history of atrial fibrillation or ischemic heart disease, and no evidence of heart failure. Signal-averaged P-wave duration (SAPWD) was measured in all participants. Multivariable regression analysis showed that age, hypertension, and log-transformed apnea-hypopnea index were significantly and independently correlated with SAPWD. SAPWD was repeatedly measured after 1 month of continuous positive airway pressure (CPAP) therapy in 62 patients with moderate-to-severe OSA. As controls, 18 patients with moderate-to-severe OSA were enrolled. Their SAPWD was also measured at baseline and after 1 month without CPAP therapy. No significant change in SAPWD was found between baseline and after 1 month in the controls. However, SAPWD was significantly shortened after 1 month of CPAP therapy (from 137.5±8.6 to 129.7±8.5 ms; P<0.001), and the SAPWD change was significantly different in patients with CPAP therapy compared with controls (P<0.001). In addition, the SAPWD change in patients with CPAP therapy correlated inversely with nightly CPAP usage (r=-0.52; P<0.001).
OSA severity was significantly associated with prolonged SAPWD. CPAP therapy significantly shortened SAPWD in patients with moderate-to-severe OSA. Thus, OSA may cause atrial conduction disturbances, leading to an increased risk of atrial fibrillation development, which may be modifiable by alleviating OSA with CPAP therapy.
P 波持续时间延长表明心房传导延迟，是心房颤动的有力前兆。阻塞性睡眠呼吸暂停（OSA）是心房颤动发展的危险因素。我们研究了 P 波持续时间与 OSA 及其治疗的关系。
我们纳入了 80 名连续的窦性心律男性患者，他们均接受了多导睡眠图检查，无心房颤动或缺血性心脏病病史，且无心力衰竭证据。所有参与者均测量了信号平均 P 波持续时间（SAPWD）。多变量回归分析显示，年龄、高血压和对数变换的呼吸暂停低通气指数与 SAPWD 显著且独立相关。在 62 例中重度 OSA 患者中，在接受持续气道正压通气（CPAP）治疗 1 个月后重复测量 SAPWD。作为对照，纳入 18 例中重度 OSA 患者。他们的 SAPWD 也在基线和不接受 CPAP 治疗 1 个月后进行了测量。对照组在基线和 1 个月后 SAPWD 没有明显变化。然而，在接受 CPAP 治疗 1 个月后，SAPWD 显著缩短（从 137.5±8.6 至 129.7±8.5 ms；P<0.001），CPAP 治疗组与对照组之间 SAPWD 变化差异显著（P<0.001）。此外，CPAP 治疗组 SAPWD 变化与夜间 CPAP 使用呈负相关（r=-0.52；P<0.001）。
OSA 严重程度与 SAPWD 延长显著相关。CPAP 治疗可显著缩短中重度 OSA 患者的 SAPWD。因此，OSA 可能导致心房传导障碍，导致心房颤动发生风险增加，这可能通过 CPAP 治疗缓解 OSA 而得到改善。
