Sleep-Disordered Breathing and Cardiac Conduction: ECG Signatures of OSA

Abstract

Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder with increasing global prevalence and significant cardiovascular implications. This study aimed to identify potential electrocardiographic (ECG) markers, particularly rSr’ patterns in V1-V2, that could aid in early detection and severity estimation of OSA in a Hispanic outpatient population. A retrospective review of 670 adult patients who underwent overnight polysomnography and standard 12-lead ECG was conducted. Patients were categorized by OSA status and Apnea-Hypopnea Index (AHI) scores. The prevalence of specific ECG findings was compared between groups. The presence of rSr’ in V1-V2 and deep S waves in V5-V6 were significantly more common among patients with OSA (p<0.05), as were prolonged QRS duration and atrial fibrillation. Logistic regression revealed that rSr’ in V1-V2 was associated with a 2.64-fold increased odds of having OSA (CI: 1.27–5.50), while the presence of S waves in V5-V6 showed a nonsignificant trend. Use of ARBs and beta-blockers were also independently associated with OSA. The study supports prior evidence suggesting that ECG may offer a low-cost, widely accessible tool for OSA screening, especially in resource-limited settings. However, limitations such as its retrospective, single-center design necessitate cautious interpretation. Further prospective studies are needed to validate ECG-based screening strategies. This is the first study to highlight rSr’ as a potential electrocardiographic marker for OSA, reinforcing the need for broader evaluation of ECG changes in sleep-disordered breathing.