CHEST Guidelines-A-48-Year-Old-Athletic-Man-With-Bradycardia-During

A-48-Year-Old-Athletic-Man-With-Bradycardia-During

Pdf Summary

A 48-year-old athletic man with a history of dyslipidemia and second-degree atrioventricular block (Mobitz type I 2:1 AV block) experiences sleep difficulties, including fragmented sleep and daytime sleepiness. His wife reports loud snoring and apneic episodes during his sleep. A polysomnogram indicated a sleep disorder characterized mainly by hypopneas, leading to sinus pauses and second-degree AV block type II patterns during REM sleep, associated with respiratory events but not significant hypoxia.<br /><br />The patient has a low Epworth Sleepiness Scale score and maintains an active lifestyle, participating in high-intensity interval training and running. Physical examination shows a heart rate of 67 beats per minute and a BMI of 26.6 kg/m². No significant morphological abnormalities relevant to sleep apnea, such as retrognathia or nasal congestion, were observed. <br /><br />The polysomnography revealed the presence of REM sleep-related hypopneas, causing vagally mediated bradyarrhythmia. Although sleep apnea is often linked to bradyarrhythmias, the analysis observed that REM sleep independently increases the risk of such arrhythmias. Management with CPAP can effectively mitigate bradyarrhythmias by addressing sleep apnea.<br /><br />The article highlights the complex interplay between REM sleep, parasympathetic activity, and bradyarrhythmias. It notes that while sleep typically includes a cardioprotective non-REM component, REM sleep poses increased risks due to sympathetic and parasympathetic interactions.<br /><br />The patient's clinical course included an evaluation by a cardiac electrophysiologist, who recommended against further cardiac interventions like pacemaker placement due to the absence of daytime cardiac symptoms. Clinical recommendations underscore the importance of addressing sleep apnea and REM sleep influences on cardiac risk in athletic individuals prone to such cardiovascular anomalies.

Keywords

dyslipidemia

AV block

sleep apnea

hypopneas

REM sleep

bradyarrhythmia

polysomnography

CPAP therapy

athletic lifestyle

cardiac electrophysiology