Key result
Higher AHI is linked to ~25% greater odds of abnormal frontal QRS-T angle per SD.
Why the study?
Sleep-disordered breathing has been linked to sudden cardiac death but the underlying mechanism involving ventricular repolarization abnormalities is unclear.
Is sleep-disordered breathing severity associated with abnormal QRS-T angle in a community cohort?
Cross-Sectional (n=1,804)
Yes
Is sleep-disordered breathing severity associated with abnormal QRS-T angle in a community cohort?
In a diverse community cohort, greater severity of sleep-disordered breathing is associated with abnormal ventricular repolarization as measured by the QRS-T angle.
Should not change practice; hypothesis-generating association warrants prospective validation in sleep-disordered breathing.
INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: In a racially/ethnically diverse community cohort, severity of SDB is associated with abnormal ventricular repolarization as measured by QRS-T angle.
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Kwon et al. (2018) conducted a cross-sectional in Sleep-disordered breathing (n=1,804). Sleep-disordered breathing (apnea-hypopnea index) vs. Lower apnea-hypopnea index was evaluated on Abnormal frontal QRS-T angle (OR 1.25, 95% CI 1.02-1.51, p=0.03). Higher severity of sleep-disordered breathing was associated with increased odds of abnormal frontal QRS-T angle (OR 1.25; 95% CI 1.02-1.51; p=0.03) per 1 SD increase in apnea-hypopnea index.
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