Obstructive sleep apnoea and signal averaged electrocardiogram.

Patients with obstructive sleep apnoea demonstrate an increased rate of ventricular arrhythmias. The present study was designed in order to investigate whether these arrhythmias may be related to myocardial injury, since myocardial injury of various aetiologies has been observed to change the signal averaged electrocardiogram (ECG). Signal averaged ECG was registered in 23 patients with obstructive sleep apnoea diagnosed by polysomnography (apnoea index 43 +/- 20 events.h-1, age 55 +/- 10 yrs). QRS duration, root mean square voltage of the last 40 ms of QRS, and low amplitude (< 40 mV) signal duration were determined from the vector magnitude of the QRS, high-pass filtered at 40 Hz. Patients with coronary heart disease or bundle branch block were excluded. No patient showed an abnormal signal averaged ECG. Mean duration of the filtered QRS complex was 96 +/- 9 ms, root mean square voltage 38 +/- 18 microV and low amplitude signal duration 26 +/- 8 ms. These results were not significantly different from 14 snoring subjects with an apnoea/hypopnoea index < 10. Four patients showed no ventricular arrhythmias and six patients had Lown III or IVa in the Holter ECG. Echocardiography revealed increased left atrial (43.7 +/- 4.1 mm) and interventricular septal diameters (11.3 +/- 1.4 mm). In conclusion, obstructive sleep apnoea does not generate a substrate for late potentials in the signal averaged ECG.