Arrhythmias and sleep apnea: physiopathologic link and clinical implications

Fusco, Stefania Angela Di; Pignalberi, Carlo; Santini, Luca; Colivicchi, Furio; Santini, Massimo

doi:10.1007/s10840-020-00707-z

Cited by 20 publications

(27 citation statements)

References 80 publications

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“…Furthermore, short respiratory events reflect higher arousability causing sleep fragmentation linked to elevated mortality in both sexes 28 , 29 . Moreover, the risk of arrhythmias is markedly increased in OSA 12 , especially immediately after respiratory events 30 . These findings 12 , 15 , 27 – 30 imply that considering HRV together with the respiratory event characteristics in the diagnosis of OSA could be useful when assessing the cardiac consequences of OSA in a more detailed manner.…”

Section: Discussionmentioning

confidence: 99%

“…Increased SNS activity can further cause increased systemic inflammation, oxidative stress, enhanced prothrombotic state, vascular dysfunction, and exacerbate coronary artery disease 11 . In the long term, these changes can lead to electrical and structural cardiac remodeling 12 and thus, increase the risk of cardiovascular diseases, e.g. hypertension 13 , heart failure 14 , and cardiac arrhythmias 11 in OSA patients.…”

Section: Introductionmentioning

confidence: 99%

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Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

Hietakoste

Korkalainen

Kainulainen

et al. 2020

Sci Rep

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Low long-term heart rate variability (HRV), often observed in obstructive sleep apnea (OSA) patients, is a known risk factor for cardiovascular diseases. However, it is unclear how the type or duration of individual respiratory events modulate ultra-short-term HRV and beat-to-beat intervals (RR intervals). We aimed to examine the sex-specific changes in RR interval and ultra-short-term HRV during and after apneas and hypopneas of various durations. Electrocardiography signals, recorded as a part of clinical polysomnography, of 758 patients (396 men) with suspected OSA were analysed retrospectively. Average RR intervals and time-domain HRV parameters were determined during the respiratory event and the 15-s period immediately after the event. Parameters were analysed in three pooled sex-specific subgroups based on the respiratory event duration (10–20 s, 20–30 s, and > 30 s) separately for apneas and hypopneas. We observed that RR intervals shortened after the respiratory events and the magnitude of these changes increased in both sexes as the respiratory event duration increased. Furthermore, ultra-short-term HRV generally increased as the respiratory event duration increased. Apneas caused higher ultra-short-term HRV and a stronger decrease in RR interval compared to hypopneas. In conclusion, the respiratory event type and duration modulate ultra-short-term HRV and RR intervals. Considering HRV and the respiratory event characteristics in the diagnosis of OSA could be useful when assessing the cardiac consequences of OSA in a more detailed manner.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

Hietakoste

Korkalainen

Kainulainen

et al. 2020

Sci Rep

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“…OSA is associated with both parasympathetic stimulation during early phases of apnea and sympathetic stimulation in the later phases of apnea; thus, both “vagotonic” and “adrenergic” arrhythmias can be triggered [ 21 ]. Hypoxia, through its effect on peripheral chemoreceptors in the carotid body, and hypercapnia, through its effect on the central chemoreceptors, cause increased activation of the sympathetic nervous system.…”

Section: Reviewmentioning

confidence: 99%

“…Given the association of OSA with AF, theoretically, the treatment of OSA may help with the management of AF. Studies have shown that CPAP may have favorable effects on patients with atrial arrhythmias and OSA by reducing the number of apneic events, thereby leading to increase in oxygen supply, reduction in sympathetic activity, and reduction in the exaggerated shift of intrathoracic pressure, which in turn reduces mechanical stretching and the subsequent electromechanical arrhythmogenic trigger [ 21 ]. CPAP therapy is also associated with a decrease in brain natriuretic peptide (BNP) levels, which is an indicator of the decreased cardiac wall stretching.…”

Section: Reviewmentioning

confidence: 99%

“…CPAP therapy is also associated with a decrease in brain natriuretic peptide (BNP) levels, which is an indicator of the decreased cardiac wall stretching. These findings suggest reversibility in the arrhythmogenic substrates induced by OSA by treatment with CPAP [ 21 ]. Data from meta-analyses have shown that patients with OSA have a 25-31% increased risk for AF recurrence after catheter ablation in comparison with patients with no sleep apnea [ 28 ].…”

Section: Reviewmentioning

confidence: 99%

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The Converging Pathologies of Obstructive Sleep Apnea and Atrial Arrhythmias

Riaz

Bhatti

Sampat

et al. 2020

Cureus

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Obstructive sleep apnea (OSA) is highly prevalent in the United States (US). Along with epidemic rates of obesity, the rate of OSA cases is also on the rise. OSA is associated with multiple chronic health conditions, including hypertension, diabetes, stroke, myocardial ischemia, and heart rhythm disturbances. OSA is commonly treated with continuous positive airway pressure (CPAP) therapy. Several reports indicate that effective treatment of OSA can reduce the risk of cardiovascular diseases, including cardiac arrhythmias, especially atrial fibrillation (AF). CPAP therapy helps to maintain sinus rhythm after interventions such as electrical cardioversion and catheter ablation in patients with AF. However, more data is required to establish a relationship between OSA and other atrial arrhythmias as well to evaluate the effect of CPAP. This review will compile the latest evidence on the pathophysiology, management, and treatment of atrial arrhythmias associated with OSA.

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The Relationship Between Sleep Disorders, Medical Conditions, and Your Health

2022

Dental Management of Sleep Disorders

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Arrhythmias and sleep apnea: physiopathologic link and clinical implications

Cited by 20 publications

References 80 publications

Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

Longer apneas and hypopneas are associated with greater ultra-short-term HRV in obstructive sleep apnea

The Converging Pathologies of Obstructive Sleep Apnea and Atrial Arrhythmias

The Relationship Between Sleep Disorders, Medical Conditions, and Your Health

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