Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients

Abstract

Objective: To determine the prevalence of sleep apnea in morbidly obese patients and its relationship with cardiac arrhythmias.

Research methods and procedures: Fifty-two consecutive morbidly obese (body mass index > or = 40 kg/m2) outpatients from the Obesity Clinic of the National Institute of Nutrition Salvador Zubirán underwent two nights of polysomnography with standard laboratory techniques. Electrocardiographic polysomnography signals (Lead II) were evaluated by two experienced cardiologists, and sleep complaints were measured with a standard sleep questionnaire (Sleep Disorders Questionnaire). In order to make comparisons between groups with different severities of sleep-disordered breathing, we classified the patients in four groups using the apnea-hypopnea index (AHI): Group 1, AHI 5 < 15 (n = 10); Group 2, AHI 15 < 30 (n = 10); Group 3, AHI 30 < 65 (n = 14); Group 4, AHI > or = 65 (n = 17).

Results: A wide range of sleep-disordered breathing, ranging from AHI of 2.5 to 128.9 was found. Ninety-eight percent of the sample (n = 51) had an AHI > or = 5 (mean = 51 +/- 37), and 33% had severe sleep apnea with AHI > or = 65 with a mean nocturnal desaturation time of <65% over 135 minutes. Electrocardiographic abnormalities were present in 31% of the patients. Cardiac rhythm alterations showed an association with the level of sleep-disordered breathing and oxygen desaturation.

Discussion: We conclude that there is a high prevalence of sleep apnea in morbidly obese patients and that the risk for cardiac arrhythmias increases in this population in the presence of a severe sleep apnea (AHI > or = 65) with severe oxygen desaturation (SaO2 < or = 65%).