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Obstructive Sleep ApneaNCT04621032

Obstructive Sleep Apnea Destabilizes Myocardial Repolarization Homogeneity

An observational study of Obstructive Sleep Apnea and Heart Rhythm Disorder, run by Nowodworskie Centrum Medyczne.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Literature shows that patients with obesity and Obstructive Sleep Apnea (OSA), both occurring independently, are more likely to develop cardiovascular diseases and sudden cardiac death (SCD). Read more about this study

Who is it for?
Ages 35 to 65 years
What is being tested?
Polygraphy monitoring and laboratory tests
How many people
187 participants
Where
No sites listed yet
Study dates
1 Sep 2016to 31 Aug 2019
How long will I take part?
3 Years
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 35 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Out of 187 consecutive patients meeting the inclusion criteria, 66 patients met at least one exclusion criterion, leaving 121 patients for the study analyses.

Who may be able to join

  • gender: female or male,
  • age 35-65 years old,
  • visceral obesity,
  • lack of acute or chronic diseases that may have an influence on rhythm or conduction disorders,
  • not undergoing Continuous Positive Airway Pressure therapy (CPAP) or taking drugs that have or may have an influence on QT interval duration [according to Credible Meds list (Woosley et al, 2019)],
  • not consuming grapefruits or grapefruit juice for at least 2 weeks before Holter-ECG examination.

Who cannot join

  • revealing that information about patient's chronic illness or drugs therapy was obfuscated, revealing increased fasting serum glucose concentration or ionic disturbances. It was strongly recommended to every patient to visit their GP for further diagnostics,
  • revealing any important deviation in physical examination i.a. blood pressure taken twice at the visit ≥140/ ≥90 mmHg,
  • revealing, upon Holter ECG examination, tachycardia or too numerous artifacts making QT interval assessment incredible,
  • too short total sleep time (< 6 hours) registered on polygraphy.

About this study

Literature shows that patients with obesity and Obstructive Sleep Apnea (OSA), both occurring independently, are more likely to develop cardiovascular diseases and sudden cardiac death (SCD). Assuming that ventricular depolarization is more stable than repolarization then QT interval parameters may be used for heart muscle repolarization assessment for those groups of patients.

There were 121 patients included in the study, both - women and men, aging from 35-65 with visceral obesity. Only healthy patients were included - the ones who were not treated for any chronic disease, taking QT elongating drugs, or were not treated with Continuous Positive Airway Pressure (CPAP) therapy at that time.

Read the detailed description

The current study was a prospective, observational clinical trial performed between September 2016 and August 2019 at a single-center institution specializing in treatment of patients with obstructive sleep apnea. The inclusion criteria were as follows: (1) gender: female or male, (2) age 35-65 years old, (3) visceral obesity, (4) lack of acute or chronic diseases that may have an influence on rhythm or conduction disorders, (5) not undergoing Continuous Positive Airway Pressure therapy (CPAP) or taking drugs that have or may have an influence on QT interval duration [according to Credible Meds list (Woosley et al, 2019)], (6) not consuming grapefruits or grapefruit juice for at least 2 weeks before Holter-ECG examination. Patients, who met all inclusion criteria, underwent subject and physical examination, an over-night Holter-ECG, polygraphy and laboratory biochemical tests (sodium, potassium, calcium, magnesium concentration and fasting glyceamia.

Enrolled patients were asked questions about general frame of mind, daytime and nighttime symptoms that may suggest OSA [according to Epworth Sleepiness Scale (https://epworthsleepinessscale.com/about-the-ess/ access date 08 May 2020)]. All patients were fully physically examined. Neck and waist circumference were measured according to STEPwise Approach to Surveillance (STEPS) by WHO (https://www.who.int/ncds/surveillance/steps/en/. [access date 23 April.2019]. Upon subject examination (snoring and choking feeling during the sleep) a corrected neck circumference was calculated.

Polygraphy was conducted using MED Recorder device by Infoscan company according to AASM guidelines (American Academy of Sleep Medicine, International classification of sleep disorders, 2016). The device registered blood saturation, heart rate, airflow, chest and abdomen movements, body position, snoring and single lead ECG. OSA was diagnosed according to AASM definition (American Academy of Sleep Medicine, Sleep-related breathing disorders in adults, 1999): in every patient with Respiratory Disturbance Index (RDI) ≥ 5/hour and with concomitant OSA sings (Epworth Sleepiness Scale ≥ 11 pts) or with RDI ≥ 15/hour. The minimum time of analyzed data without artifacts had to last at least 6 h.

A Holter-ECG examination was conducted using DMS 300-3A device by Oxford company suitable for Cardioscan 10 system. Registration was made simultaneously with polygraphy, during the night. Chosen QT interval assessment parameters were evaluated upon partially automatically analyzed fragments of ECG records. Only nighttime ECG records were analyzed due to maximum comparability (similar patient's physical activity and minimized, because of limited body movements, artifacts). Moreover, the study aimed to assess a heart's activity simultaneous to sleep breathing disorders. Only ECG strips with constant heart rate, optimally within 50-70/min limits, were chosen due to the minimum impact of such heart rate on QT interval correction formula. QTc data was calculated upon Bazett's formula. QTV and QTVi were calculated upon Berger's formula.

After getting all results they were checked against the following exclusion criteria: 1) revealing that information about patient's chronic illness or drugs therapy was obfuscated, revealing increased fasting serum glucose concentration or ionic disturbances. It was strongly recommended to every patient to visit their GP for further diagnostics, 2) revealing any important deviation in physical examination i.a. blood pressure taken twice at the visit ≥140/ ≥90 mmHg, 3) revealing, upon Holter ECG examination, tachycardia or too numerous artifacts making QT interval assessment incredible, 4) too short total sleep time (< 6 hours) registered on polygraphy.

Out of 187 consecutive patients meeting the inclusion criteria, 66 patients met at least one exclusion criterion, leaving 121 patients for the study analyses.

Being tested
Polygraphy monitoring, laboratory tests
Keywords
Obstructive Sleep Apnea, QT interval, QTV, QTc, repolarisation homogeneity
Medical subject headings
Sleep Apnea, Obstructive, Obesity, Abdominal

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Polygraphy monitoringDiagnostic test

    Also called Holter ECG monitoring

    All patients with visceral obesity have been tested for Obstructive Sleep Apnea and heart rhythm disorders by usage of polygraphy and Holter-ECG monitoring.

  • laboratory testsDiagnostic test

    Blood samples for sodium, potassium, calcium, magnesium concentration and fasting glyceamia assessment hae been taken from all patients with visceral obesity.

Study groups in NCT04621032
Study groupRoleWhat they receive
OSA +Patients with visceral obesity and newly diagnosed Obstructive Sleep Apnea (during the study)
Receives: Diagnostic Test: Polygraphy monitoring; Diagnostic Test: laboratory tests
OSA -Patients with visceral obesity in whom Obstructive Sleep Apnea diagnosis have been excluded (during the study)
Receives: Diagnostic Test: Polygraphy monitoring; Diagnostic Test: laboratory tests

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. A number of patients with visceral obesity and Obstructive Sleep Apnea

    Polygraphy examination of each patient

    Measured: one day per each patient

Secondary outcomes (2)
  1. A number of patients with visceral obesity and heart rhythm disorders occurrence.

    Holter-ECG monitoring of each patient

    Measured: Holter ECG - one day per patient

  2. Correlation of Obstructive Sleep Apnea and ECG changes among OSA positive and negative patients

    statistical analysis

    Measured: 2016-2019

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Nov 2020
  2. Study start1 Sep 2016
  3. Primary completion31 Aug 2019
  4. Study completion31 Aug 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
187 participants (actual)
Target duration
3 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT04621032
Sponsor's protocol ID
1
Status last verified
Nov 2020
First submitted
3 Nov 2020
Last updated
27 Nov 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: For a reasonable request the principal intevstigator will share stastical data of studied group.

Publications

  • Alam I, Lewis MJ, Lewis KE, Stephens JW, Baxter JN. Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci. 2009 Dec 3;151(2):168-73. doi: 10.1016/j.autneu.2009.08.007. Epub 2009 Aug 31.

    PubMed 19720569
  • 2. American Academy of Sleep Medicine. International classification of sleep disorders, 2nd ed. Diagnostic and coding manual. Westchester, Illinois: American Academy of Sleep Medicine 2005. Updated November 2015. Darien, IL: American Academy of Sleep medicine, 2016.

  • Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999 Aug 1;22(5):667-89. No abstract available.

    PubMed 10450601
  • Arslan E, Yiginer O, Yavasoglu I, Ozcelik F, Kardesoglu E, Nalbant S. Effect of uncomplicated obesity on QT interval in young men. Pol Arch Med Wewn. 2010 Jun;120(6):209-13.

    PubMed 20567204
  • Barta K, Szabo Z, Kun C, Munkacsy C, Bene O, Magyar MT, Csiba L, Lorincz I. The effect of sleep apnea on QT interval, QT dispersion, and arrhythmias. Clin Cardiol. 2010 Jun;33(6):E35-9. doi: 10.1002/clc.20619.

    PubMed 20552591
  • Baumert M, Schlaich MP, Nalivaiko E, Lambert E, Sari CI, Kaye DM, Elser MD, Sanders P, Lambert G. Relation between QT interval variability and cardiac sympathetic activity in hypertension. Am J Physiol Heart Circ Physiol. 2011 Apr;300(4):H1412-7. doi: 10.1152/ajpheart.01184.2010. Epub 2011 Jan 21.

    PubMed 21257917
  • Baumert M, Porta A, Vos MA, Malik M, Couderc JP, Laguna P, Piccirillo G, Smith GL, Tereshchenko LG, Volders PG. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. Europace. 2016 Jun;18(6):925-44. doi: 10.1093/europace/euv405. Epub 2016 Jan 27.

    PubMed 26823389
  • Baumert M, Smith J, Catcheside P, McEvoy RD, Abbott D, Sanders P, Nalivaiko E. Variability of QT interval duration in obstructive sleep apnea: an indicator of disease severity. Sleep. 2008 Jul;31(7):959-66.

    PubMed 18652091
  • Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005 Mar 24;352(12):1206-14. doi: 10.1056/NEJMoa041832.

    PubMed 15788497
  • Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, Herges RM, Howard DE, Somers VK. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013 Aug 13;62(7):610-6. doi: 10.1016/j.jacc.2013.04.080. Epub 2013 Jun 13.

    PubMed 23770166
  • Haigney MC, Zareba W, Gentlesk PJ, Goldstein RE, Illovsky M, McNitt S, Andrews ML, Moss AJ; Multicenter Automatic Defibrillator Implantation Trial II investigators. QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol. 2004 Oct 6;44(7):1481-7. doi: 10.1016/j.jacc.2004.06.063.

    PubMed 15464332
  • Hinterseer M, Beckmann BM, Thomsen MB, Pfeufer A, Dalla Pozza R, Loeff M, Netz H, Steinbeck G, Vos MA, Kaab S. Relation of increased short-term variability of QT interval to congenital long-QT syndrome. Am J Cardiol. 2009 May 1;103(9):1244-8. doi: 10.1016/j.amjcard.2009.01.011. Epub 2009 Mar 18.

    PubMed 19406266
  • 14. Report of a WHO Expert Consultation. Waist circumference and waist-hip ratio. Geneva, 8-11 Dec 2008.

  • Mathieu P, Poirier P, Pibarot P, Lemieux I, Despres JP. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009 Apr;53(4):577-84. doi: 10.1161/HYPERTENSIONAHA.108.110320. Epub 2009 Feb 23. No abstract available.

    PubMed 19237685
  • Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S; Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006 Apr 15;173(8):910-6. doi: 10.1164/rccm.200509-1442OC. Epub 2006 Jan 19.

    PubMed 16424443

Questions about this trial

What is this clinical trial studying?

An observational study of Obstructive Sleep Apnea and Heart Rhythm Disorder, run by Nowodworskie Centrum Medyczne.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

A number of patients with visceral obesity and Obstructive Sleep Apnea (time frame: one day per each patient). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04621032, which also lists 26 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Nov 2020.

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