A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias

Introduction: Obstructive sleep apnea (OSA) is an independent risk factor for sudden cardiac death. The aim of this review was to study the relationship between OSA and ventricular arrhythmias. Methods: PubMed, Medline, and Cochrane databases were searched with MESH headings to find studies linking OSA and ventricular arrhythmias including ventricular ectopy, ventricular tachycardia (VT), and ventricular fibrillation (VF). Studies were graded by a scoring system, and an attempt was made to pool data. Results: There were no matched cohort or case control studies to study the association between OSA and ventricular arrhythmias. Given data heterogeneity, pooling and metaanalysis of data were not possible. An attempt was made to judge the quality of evidence and present a systematic review. Patients with OSA were noted to have higher odds of ventricular ectopy, and were at a higher risk for ventricular arrhythmias. Associations included higher QTc dispersion and HR variability. We did not, however, fi nd any clear evidence for a direct correlation between increased apnea hypopnea index and increased VT or VF. Conclusions: Pooling and meta-analysis of studies linking OSA and ventricular arrhythmias were not possible due to heterogeneity of data. In a systemic review of studies, patients with OSA were noted to have higher odds of ventricular ectopy and arrhythmias. A single study showed that CPAP may help lower arrhythmogenicity; however, it was unclear if CPAP lowered the risk of VT. Further research should focus on studying the association of OSA and causes of sudden cardiac death, including ventricular arrhythmias.