Kwon Younghoon, Misialek Jeffrey R, Duprez Daniel, Jacobs David R, Alonso Alvaro, Heckbert Susan R, Zhao Ying Y, Redline Susan, Soliman Elsayed Z
Department of Medicine, University of Virginia, Charlottesville, Virginia.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12579. doi: 10.1111/anec.12579. Epub 2018 Jul 2.
Sleep-disordered breathing (SDB) has been linked to sudden cardiac death (SCD) but the mechanism is unclear. Abnormal QRS-T angle, a novel electrocardiographic (ECG) marker of ventricular repolarization, has been linked to adverse cardiovascular outcomes including SCD. We hypothesized that individuals with SDB have more pronounced abnormality in QRS-T angle.
We performed a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam Sleep ancillary study. We calculated the odds ratio (OR) of abnormal frontal and spatial QRS-T angle (defined as >sex-specific 95th percentile thresholds) related to the apnea-hypopnea index (AHI) using logistic regression, adjusting for demographics, body habitus, cardiovascular risks, and prevalent cardiovascular disease. Linear associations between AHI and frontal and spatial QRS-T angle, separately, were also examined using multiple regression models.
A total of 1,804 participants (mean age 67.9 (±9.0) years, 55.3% women and 64.1% non-whites) were included in the study. Sleep-disordered breathing was common among participants (median AHI 8.6 events/hr IQR [3.2-19.5/hr]). Higher AHI was associated with the odds of abnormal frontal (≥81° in men and ≥79° in women) and spatial QRS-T angle (≥129.7° in men and ≥115.9° in women; OR [95%CI]: 1.25 [1.02-1.51], p = 0.03; 1.23 [1.01-1.50], p = 0.04 respectively per 1 SD [16.8 events/hr] increase in AHI). Similarly, linear associations were observed (frontal QRS-T angle: beta coefficient: 2.30° [0.92, 3.66], p = 0.001; spatial QRS-T angle: beta coefficient: 2.16° [0.67, 3.64], p = 0.005).
In a racially/ethnically diverse community cohort, severity of SDB is associated with abnormal ventricular repolarization as measured by QRS-T angle.
睡眠呼吸紊乱（SDB）与心源性猝死（SCD）有关，但机制尚不清楚。异常QRS-T角是一种新的心室复极心电图（ECG）标志物，与包括SCD在内的不良心血管结局有关。我们假设患有SDB的个体QRS-T角异常更为明显。
我们对动脉粥样硬化多民族研究（MESA）睡眠辅助研究进行了横断面分析。我们使用逻辑回归计算与呼吸暂停低通气指数（AHI）相关的异常额面和空间QRS-T角（定义为>特定性别的第95百分位数阈值）的比值比（OR），并对人口统计学、体型、心血管风险和心血管疾病患病率进行调整。还使用多元回归模型分别研究了AHI与额面和空间QRS-T角之间的线性关联。
共有1804名参与者（平均年龄67.9（±9.0）岁，55.3%为女性，64.1%为非白人）纳入研究。睡眠呼吸紊乱在参与者中很常见（AHI中位数为8.6次/小时，四分位间距[3.2-19.5/小时]）。较高的AHI与异常额面（男性≥81°，女性≥79°）和空间QRS-T角（男性≥129.7°，女性≥115.9°）的比值有关；每增加1个标准差（16.8次/小时）的AHI，OR[95%CI]分别为1.25[1.02-1.51]，p = 0.03；1.23[1.01-1.50]，p = 0.04。同样，观察到线性关联（额面QRS-T角：β系数：2.30°[0.92，3.66]，p = 0.001；空间QRS-T角：β系数：2.16°[0.67，3.64]，p = 0.005）。
在一个种族/民族多样化的社区队列中，SDB的严重程度与通过QRS-T角测量的心室复极异常有关。
