Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion

PLoS One. 2016 Apr 12;11(4):e0152994. doi: 10.1371/journal.pone.0152994. eCollection 2016.


Background: A high P-wave duration and dispersion (Pd) have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF), a condition linked to obstructive sleep apnea (OSA). We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF.

Methods: 12-lead-electrocardiography (ECG) was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM), obstructive hypopnea (inspiration through a threshold load, ITH), central apnea (AP), and during normal breathing (BL) in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis.

Results: P-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1 ms and +13.8 ms during MM; +11.7 ms and +12.9 ms during ITH; p<0.001 for all comparisons). In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05).

Conclusion: Intrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / physiopathology*
  • Case-Control Studies
  • Electrocardiography / statistics & numerical data
  • Female
  • Heart Rate / physiology
  • Humans
  • Male
  • Middle Aged
  • Models, Biological
  • Pressure
  • Risk Factors
  • Sleep Apnea, Central / physiopathology
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / physiopathology*
  • Young Adult

Grants and funding

This work was supported by the Clinical Research Priority Program Sleep and Health of the University of Zurich, Switzerland.