Sudden cardiac death during nighttime hours

Archana Ramireddy, Harpriya Chugh, Kyndaron Reinier, Audrey Uy-Evanado, Eric C Stecker, Jonathan Jui, Sumeet S Chugh
Heart Rhythm: the Official Journal of the Heart Rhythm Society 2021 January 20

BACKGROUND: In the absence of apparent triggers, sudden cardiac death (SCD) during nighttime hours is a perplexing and devastating phenomenon. There are few published reports in the general population with insufficient numbers to perform sex-specific analyses. Smaller studies of rare nocturnal SCD syndromes suggest a male predominance and implicate sleep-disordered breathing.

OBJECTIVE: The purpose of this study was to identify mechanisms of nighttime SCD in the general population.

METHODS: From the population-based Oregon Sudden Unexpected Death Study, we evaluated SCD cases that occurred in the community between 10 PM and 6 AM (nighttime) and compared them with daytime cases. Univariate comparisons were evaluated using Pearson χ2 tests and independent samples t tests. Logistic regression was used to further assess independent SCD risk.

RESULTS: A total of 4126 SCD cases (66.2% male, 33.8% female) met criteria for analysis and 22.3% (n = 918) occurred during nighttime hours. Women were more likely to present with nighttime SCD than men (25.4% vs 20.6%; P < .001). In a multivariate regression model, female sex (odds ratio [OR] 1.3 [1.1-1.5]; P = .001), medications associated with somnolence/respiratory depression (OR 1.2 [1.1-1.4]; P = .008) and chronic obstructive pulmonary disease/asthma (OR 1.4 [1.1-1.6]; P < .001) were independently associated with nighttime SCD. Women were taking more central nervous system-affecting medications than men (1.9 ± 1.7 vs 1.4 ± 1.4; P = .001).

CONCLUSION: In the general population, women were more likely than men to suffer SCD during nighttime hours and female sex was an independent predictor of nighttime events. Respiratory suppression is a concern, and caution is advisable when prescribing central nervous system-affecting medications to patients at an increased risk of SCD, especially women.

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