CARDIORESPIRATORY INTERACTIONS DURING NONINVASIVE VENTILATION

Abstract

Introduction - Obstructive sleep apnea (OSA) is a sleep-related breathing disorder which is characterized by involuntarily reduced or absent breathing during sleep due to the complete or partial obstruction of the airway. Obstructive apneas/hypopneas have been associated with the lengthening and shortening of QT intervals found on echocardiograms. Prolonged QT variability is associated with sudden cardiac death, ventricular arrhythmias, and mortality. The goal of this project is to evaluate whether OSA results in QT prolongation and variability and whether these QT changes result in mortality in OSA. Methods - We have performed a retrospective analysis of the Banner PSG database which consisted of 2,817 subjects. We have evaluated and analyzed patient history, medications, and sleep studies. We plan to export EKG signals from patient’s sleep studies to measure QTc length and the parameters of ventricular repolarization including QTc interval and QT variability as the next steps. Study progress has been delayed by the pandemic. Results - There were 2,817 subjects that were analyzed: 1,309 (46.47%) were female and 1,508 (53.53%) were male. The mean age was 57.84 and a BMI of 34.43 kg/m2. 2,264 subjects had OSA, 37 subjects had CSA, 86 subjects had OSA and CSA, and 430 subjects did not have any sleep apnea. There were 137 subjects with heart failure with reduced ejection fraction (HFrEF) and 380 subjects with heart failure with preserved ejection fraction (HFpEF) Of the 137 subjects with HFrEF, 105 subjects had OSA, 7 subjects had CSA, 9 subjects had combined OSA and CSA, and 30 subjects had treatment emergent central sleep apnea. Of the 380 subjects with HFpEF, 315 subjects had OSA, 9 subjects had CSA, 19 subjects had combined OSA and CSA, and 56 subjects had treatment emergent central sleep apnea. We are still in the process of exporting EKGs and analyzing QTc length in our 2,817 subjects. Conclusions - Our data will answer the question whether QT changes in sleep apnea contribute to mortality and whether aggressive noninvasive ventilation in patients with sleep apnea leads to an increase in minute ventilation which is associated with prolongation of QT. We hope that our research will be able to address the knowledge gap in the proper treatment modality for sleep disordered breathing in patients with and without heart failure.