DOI: 10.1111/anec.13101 ISSN: 1082-720X

Morbid obesity influences the nocturnal electrocardiogram wave and interval durations among suspected sleep apnea patients

Samu Kainulainen, Aaron Suni, Jukka A. Lipponen, Antti Kulkas, Brett Duce, Henri Korkalainen, Sami Nikkonen, Saara Sillanmäki
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
  • General Medicine



Obesity is a global issue with a major impact on cardiovascular health. This study explores how obesity influences nocturnal cardiac electrophysiology in suspected obstructive sleep apnea (OSA) patients.


We randomly selected 12 patients from each of the five World Health Organization body mass index (BMI) classifications groups (ntotal = 60) while keeping the group's age and sex matched. We evaluated 1965 nocturnal electrocardiography (ECG) samples (10 s) using modified lead II recorded during normal saturation conditions. R‐wave peaks were detected and confirmed using dedicated software, with the exclusion of ventricular extrasystoles and artifacts. The duration of waves and intervals was manually marked. The average electric potential graphs were computed for each segment. Thresholds for abnormal ECG waveforms were P‐wave > 120 ms, PQ interval > 200 ms, QRS complex > 120 ms for, and QTc > 440 ms.


Obesity was significantly (p < .05) associated with prolonged conduction times. Compared to the normal weight (18.5 ≤ BMI < 25) group, the morbidly obese patients (BMI ≥ 40) had a significantly longer P‐wave duration (101.7 vs. 117.2 ms), PQ interval (175.8 vs. 198.0 ms), QRS interval (89.9 vs. 97.7 ms), and QTc interval (402.8 vs. 421.2 ms). We further examined ECG waveform prolongations related to BMI. Compared to other patient groups, the morbidly obese patients had the highest number of ECG segments with PQ interval (44% of the ECG samples), QRS duration (14%), and QTc duration (20%) above the normal limits.


Morbid obesity predisposes patients to prolongation of cardiac conduction times. This might increase the risk of arrhythmias, stroke, and even sudden cardiac death.

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