QT interval variability index and QT interval duration during different sleep stages in patients with obstructive sleep apnea.

OBJECTIVES: The aim of the study was to investigate the impact of obstructive sleep apnea (OSA) on the QT interval variability and duration in patients during different sleep stages. METHODS: Polysomnographic recordings of 28 (13 male, 15 female) patients with OSA and 30 (15 male, 15 female) patients without OSA were analyzed. The QT interval variability index (QTVI) and the corrected QT interval (QTc) analyses were performed using two awake, 3-4 non-rapid eye movement (NREM) and three rapid eye movement (REM) sleep episodes (each 300 s). The Bazett formula, linear, and parabolic heart rate correction formulas with two separate α values were used. RESULTS: QTVI was statistically higher in OSA than in non-OSA patients for males while awake (awake -0.7 ± 0.3 vs -1.2 ± 0.2, p = 0.001; NREM ‒0.9 ± 0.4 vs -1.1 ± 0.3, p = 0.110; REM ‒1.1 ± 0.3 vs -1.3 ± 0.2, p = 0.667) and for females in all wake-sleep stages (awake -0.3 ± 0.7 vs -0.9 ± 0.5, p = 0.001; NREM ‒0.3 ± 0.5 vs -0.8 ± 0.4, p = 0.002; REM -0.3 ± 0.5 vs -1.0 ± 0.4, p < 0.001). QTVI was significantly higher during awake compared to sleep stages in OSA males (p < 0.05); no difference between wake-sleep stages was found in females (p > 0.05). Significant gender differences in QTVI existed in OSA patients during sleep (p < 0.05) but not while awake. No significant differences in QTc between patients groups were observed. CONCLUSIONS: OSA is associated with increased QT variability. REM sleep per se does not increase QTVI. In OSA patients, QTVI might be a more useful measure to detect ventricular repolarization abnormality than measures of QTc.

Influence of gender on the QT interval variability and duration in different wake-sleep stages in non-sleep apneic individuals: Analysis of polysomnographic recordings.

INTRODUCTION: The aim of the study was to determine the influence of gender and sleep stages, especially rapid eye movement sleep (REM), on QT interval variability and duration in normal subjects. METHODS: Polysomnographic recordings of 24 male and 24 female patients without obstructive sleep apnea were analyzed. In each patient, the QT interval variability index (QTVI) and the corrected QT interval (QTc) values were calculated as means of 2 awake, 4 non-rapid eye movement sleep (NREM) and 3 REM episodes, 300s each. For the QTc calculation, five different correction formulas were used. RESULTS: Gender-related differences in the QT interval variability and duration were detected between all sleep stages (P<0.05). In males, mean values of QTVI while awake, in NREM and REM sleep were -1.1±0.2, -1.1±0.3, -1.3±0.2. In females, mean values of QTVI were -0.9±0.4, -0.9±0.4, and -1.1±0.3, respectively. No difference between sleep stages was detected in the mean values of QTVI and QTc in both groups (P>0.05). CONCLUSION: The results of our study demonstrate no significant overall impact of sleep stages on ventricular repolarization variability and duration during physiological sleep in both genders. We found gender differences in the mean values of QTVI and QTc during different sleep stages, which confirm that gender is a modulating factor of ventricular repolarization.

QT Interval Variability Index and QT Interval Duration in Different Sleep Stages: Analysis of Polysomnographic Recordings in Nonapneic Male Patients.

The aim of the study was to determine whether different sleep stages, especially REM sleep, affect QT interval duration and variability in male patients without obstructive sleep apnea (OSA). Polysomnographic recordings of 30 patients were analyzed. Beat-to-beat QT interval variability was calculated using QTV index (QTVI) formula. For QTc interval calculation, in addition to Bazett's formula, linear and parabolic heart rate correction formulas with two separate α values were used. QTVI and QTc values were calculated as means of 2 awake, 3 NREM, and 3 REM sleep episodes; the duration of each episode was 300 sec. Mean QTVI values were not statistically different between sleep stages. Therefore, elevated QTVI values found in patients with OSA cannot be interpreted as physiological sympathetic impact during REM sleep and should be considered as a risk factor for potentially life-threatening ventricular arrhythmias. The absence of difference of the mean QTc interval values between NREM and REM stages seems to confirm our conclusion that sympathetic surges during REM stage do not induce repolarization variability. In patients without notable structural and electrical remodeling of myocardium, physiological elevation in sympathetic activity during REM sleep remains subthreshold concerning clinically significant increase of myocardial electrical instability.