• Sobhan Salari Shahrbabaki, Dominik Linz, Susan Redline, Katie Stone, Kristine Ensrud, and Mathias Baumert.
• School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.
• Chest. 2023 Feb 1; 163 (2): 419432419-432.

BackgroundSleep is fragmented by brief arousals, and excessive arousal burden has been linked to increased cardiovascular (CV) risk, but mechanisms are poorly understood.Research QuestionDo arousals trigger cardiac ventricular repolarization lability that may predispose people to long-term cardiovascular mortality?Study Design And MethodsThis study analyzed 407,541 arousals in the overnight polysomnograms of 2,558 older men in the Osteoporotic Fractures in Men sleep study. QT and RR intervals were measured beat-to-beat starting 15 s prior to arousal onset until 15 s past onset. Ventricular repolarization lability was quantified by using the QT variability index (QTVi).ResultsDuring 10.1 ± 2.5 years of follow-up, 1,000 men died of any cause, including 348 CV deaths. During arousals, QT and RR variability increased on average by 5 and 55 ms, respectively, resulting in a paradoxical transient decrease in QTVi from 0.07 ± 1.68 to -1.00 ± 1.68. Multivariable Cox proportional hazards analysis adjusted for age, BMI, cardiovascular and respiratory risk factors, sleep-disordered breathing and arousal, diabetes, and Parkinson disease indicated that excessive QTVi during arousal was independently associated with all-cause and CV mortality (all-cause hazard ratio, 1.20 [95% CI, 1.04-1.38; P = .012]; CV hazard ratio, 1.29 [95% CI, 1.01 -1.65; P = .043]).InterpretationArousals affect ventricular repolarization. A disproportionate increase in QT variability during arousal is associated with an increased all-cause and CV mortality and may reflect ventricular repolarization maladaptation to the arousal stimulus. Whether arousal-related QTVi can be used for more tailored risk stratification warrants further study, including evaluating whether arousal suppression attenuates ventricular repolarization lability and reduces subsequent mortality.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT00070681; URL: www.Clinicaltrialsgov.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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