A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature
Introduction. Rapid eye movement (REM) sleep-related bradyarrhythmia syndrome is characterized by pathological asystoles during the REM sleep phase. It is a rare rhythm disorder, being reported only few times in the literature. Due to non-specific symptoms, REM sleep-related bradyarrhythmia might be...
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doaj-c24e154a37ad4ce2ad98b965723703642021-02-03T09:22:16ZengVilnius University PressActa Medica Lituanica1392-01382029-41742018-05-0125110.6001/actamedica.v25i1.3697A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literatureGabrielius JakutisVytautas JuknevičiusJuratė BarysienėDalia MatačiūnienėBirutė PetrauskienėŽaneta PetrulionienėAleksandras LaucevičiusIntroduction. Rapid eye movement (REM) sleep-related bradyarrhythmia syndrome is characterized by pathological asystoles during the REM sleep phase. It is a rare rhythm disorder, being reported only few times in the literature. Due to non-specific symptoms, REM sleep-related bradyarrhythmia might be often underdiagnosed. Other cardiac diseases associated with pathological sinus arrests must be excluded to establish the correct diagnosis of and appropriate therapy for REM sleep-related bradyarrhythmia. We report a case of this syndrome followed by hypertension and diastolic heart failure. The case. A 49-year-old male with severe hypertension presented for a cardiologist’s consultation. His main complaints were palpitations, fatigue, dyspnoea, and snoring. Polysomnography test revealed a normal sleep structure with episodes of bradycardia and increased parasympathetic activity during phasic events of REM sleep. Heart rate variability Poincare plot analysis demonstrated similar results. REM sleep-related bradyarrhythmia syndrome was diagnosed and patient was treated with dual chamber heart pacemaker implantation. Discussion. Various components of the autonomic nervous system influence the development of REM sleep-related bradyarrhythmia syndrome. The main factor is likely an increased vagal tone during the phasic REM sleep with the absence of normal compensatory sympathetic activity. Concomitant hypertension in REM sleep-related bradyarrhythmia syndrome is caused by a paradoxically abnormal control of the autonomic nervous system and can be explained through the acetylcholine metabolism pathway. Best suited diagnostic and treatment options for REM sleep-related bradyarrhythmia syndrome are discussed. Conclusions. Patients with REM sleep-related bradyarrhythmia syndrome often present with indistinct symptoms. Polysomnography is an essential diagnostic test for the differential diagnosis of various nocturnal arrhythmias and sleep disorders. Severe hypertension is a common complication of sleep disorders and requires appropriate treatment of the underlying condition. An implantation of a heart pacemaker is the first-choice treatment for patients with REM sleep-related bradyarrhythmia syndrome.https://www.journals.vu.lt/AML/article/view/21308rapid eye movement sleep-related bradyarrhythmia syndromeautonomic nervous systemacetylcholinehypertensionpolysomnography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gabrielius Jakutis Vytautas Juknevičius Juratė Barysienė Dalia Matačiūnienė Birutė Petrauskienė Žaneta Petrulionienė Aleksandras Laucevičius |
spellingShingle |
Gabrielius Jakutis Vytautas Juknevičius Juratė Barysienė Dalia Matačiūnienė Birutė Petrauskienė Žaneta Petrulionienė Aleksandras Laucevičius A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature Acta Medica Lituanica rapid eye movement sleep-related bradyarrhythmia syndrome autonomic nervous system acetylcholine hypertension polysomnography |
author_facet |
Gabrielius Jakutis Vytautas Juknevičius Juratė Barysienė Dalia Matačiūnienė Birutė Petrauskienė Žaneta Petrulionienė Aleksandras Laucevičius |
author_sort |
Gabrielius Jakutis |
title |
A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
title_short |
A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
title_full |
A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
title_fullStr |
A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
title_full_unstemmed |
A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
title_sort |
rare case of rem sleep-related bradyarrhythmia syndrome with concomitant severe hypertension: a case report and a review of literature |
publisher |
Vilnius University Press |
series |
Acta Medica Lituanica |
issn |
1392-0138 2029-4174 |
publishDate |
2018-05-01 |
description |
Introduction. Rapid eye movement (REM) sleep-related bradyarrhythmia syndrome is characterized by pathological asystoles during the REM sleep phase. It is a rare rhythm disorder, being reported only few times in the literature. Due to non-specific symptoms, REM sleep-related bradyarrhythmia might be often underdiagnosed. Other cardiac diseases associated with pathological sinus arrests must be excluded to establish the correct diagnosis of and appropriate therapy for REM sleep-related bradyarrhythmia. We report a case of this syndrome followed by hypertension and diastolic heart failure.
The case. A 49-year-old male with severe hypertension presented for a cardiologist’s consultation. His main complaints were palpitations, fatigue, dyspnoea, and snoring. Polysomnography test revealed a normal sleep structure with episodes of bradycardia and increased parasympathetic activity during phasic events of REM sleep. Heart rate variability Poincare plot analysis demonstrated similar results. REM sleep-related bradyarrhythmia syndrome was diagnosed and patient was treated with dual chamber heart pacemaker implantation.
Discussion. Various components of the autonomic nervous system influence the development of REM sleep-related bradyarrhythmia syndrome. The main factor is likely an increased vagal tone during the phasic REM sleep with the absence of normal compensatory sympathetic activity. Concomitant hypertension in REM sleep-related bradyarrhythmia syndrome is caused by a paradoxically abnormal control of the autonomic nervous system and can be explained through the acetylcholine metabolism pathway. Best suited diagnostic and treatment options for REM sleep-related bradyarrhythmia syndrome are discussed.
Conclusions. Patients with REM sleep-related bradyarrhythmia syndrome often present with indistinct symptoms. Polysomnography is an essential diagnostic test for the differential diagnosis of various nocturnal arrhythmias and sleep disorders. Severe hypertension is a common complication of sleep disorders and requires appropriate treatment of the underlying condition. An implantation of a heart pacemaker is the first-choice treatment for patients with REM sleep-related bradyarrhythmia syndrome. |
topic |
rapid eye movement sleep-related bradyarrhythmia syndrome autonomic nervous system acetylcholine hypertension polysomnography |
url |
https://www.journals.vu.lt/AML/article/view/21308 |
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