Int J Sports Med 2004; 25(6): 457-460
DOI: 10.1055/s-2004-820940
Physiology & Biochemistry

© Georg Thieme Verlag KG Stuttgart · New York

Prolonged Asystolia in a Young Athlete: A Case of Sinus Arrest During REM Sleep

N. Sanna1 , G. Della Marca2 , M. Bianco1 , V. Palmieri1 , A. Dello Russo3 , G. Pelargonio3 , P. Zeppilli1
  • 1Centro Studi di Medicina dello Sport, Istituto di Medicina Interna, Università Cattolica del Sacro Cuore, Roma, Italy
  • 2Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy
  • 3Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
Further Information

Publication History

Accepted after revision: September 30, 2003

Publication Date:
02 September 2004 (online)


A young asymptomatic male athlete came to our laboratory to be enrolled in a research protocol on physical fatigue. Routine clinical and cardiological evaluations including echocardiogram were in the normal range. Several consecutive cardiopulmonary tests showed a fairly good tolerance to exercise, with no symptoms even when the effort was abruptly arrested. On the other hand, Holter ECG recordings showed long nocturnal sinus pauses. As he was absolutely asymptomatic and free from any structural heart disease, he underwent a follow-up with repeated Holter monitorings for one year. During this period he decided on his own to stop practising sports; in spite of this sharp reduction in his overall physical activity, consecutive Holter monitorings showed that the sinus pauses were progressively increasing in duration (up to 9.2 seconds). With the hypothesis of a malignant vagotonia, he underwent a tilt test; however, we could not elicit any pauses or symptoms. The pauses grew longer over time; a endocavitary electrophysiologic test was performed, which showed no evidence of disease. To rule out the hypothesis of a sleep apnoea syndrome, he also underwent a polysomnography, including EEG, eye movement electromyography, arterial blood oxygen saturation and thoracic impedance: no alterations were detected with the exception of the sinus pauses, which appeared to be strictly linked to REM sleep, as suggested by the concurrent increase in rapid eye movements and desynchronized EEG. We hence made a diagnosis of sinus arrest during REM sleep (SAdRS), a very uncommon disease belonging to the parasomnias. Pauses were then quantified for one month by implanting a ECG loop recorder. As the patient became more and more upset and worried, and the pauses increased to nearly 12 seconds, we decided to implant a pacemaker, which is the only therapeutic option estabilished in the literature for patients with SAdRS.


, M. D., Associate Professor of Sports Medicine Paolo Zeppilli 

Centro Studi di Medicina dello Sport, Università Cattolica del Sacro Cuore

Largo Agostino Gemelli 8

00168 Rome


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