Association of atrial fibrillation and obstructive sleep apnea

Abstract

Background-Obstructive sleep apnea (OSA) is associated with recurrent atrial fibrillation (AF) after electrocardioversion.OSA is highly prevalent in patients who are male, obese, and/or hypertensive, but its prevalence in patients with AF is unknown. Methods and Results-We prospectively studied consecutive patients undergoing electrocardioversion for AF (nϭ151) and consecutive patients without past or current AF referred to a general cardiology practice (nϭ312). OSA was diagnosed with the Berlin questionnaire, which is validated to identify patients with OSA. We also assessed its accuracy compared with polysomnography in a sample of the study population. Groups were compared with the 2-tailed t, Wilcoxon, and 2 tests. Logistic regression modeled the association of AF and OSA after adjustment for relevant covariates. Patients in each group had similar age, gender, body mass index, and rates of diabetes, hypertension, and congestive heart failure. The questionnaire performed with 0.86 sensitivity, 0.89 specificity, and 0.97 positive predictive value in our sample. The proportion of patients with OSA was significantly higher in the AF group than in the general cardiology group (49% versus 32%, Pϭ0.0004). The adjusted odds ratio for the association between AF and OSA was 2.19 (95% CI 1.40 to 3.42, Pϭ0.0006). Conclusions-The novel finding of this study is that a strong association exists between OSA and AF, such that OSA is strikingly more prevalent in patients with AF than in high-risk patients with multiple other cardiovascular diseases. The coinciding epidemics of obesity and AF underscore the clinical importance of these results.

Aortic dissection is associated with intermittent hypoxia and re-oxygenation

“…Taken together, there is a possibility that IHR can be a potential risk factor of aortic dissection through the development of atherosclerosis. Although OSA is known to be an independent risk factor of several cardiovascular diseases such as heart failure, hypertension, ischemic heart disease, left ventricular dysfunction and arrhythmia [7][8][9][10][11][12][13][14][15], only few reports showed the association between OSA and aortic diseases such as aortic dilatation [20,26,27] and aortic dissection [16]. Serizawa et al [20] reported the trend towards larger ascending aortic diameter in 150 Japanese patients with OSA.…”

“…There is now substantial evidence of the relationship between obstructive sleep apnea (OSA) and cardiovascular diseases, such as heart failure, hypertension, ischemic heart disease, left ventricular dysfunction, and arrhythmia [7][8][9][10][11][12][13][14][15]. However, the association between aortic dissection and OSA was not fully investigated.…”

Vaskuläre Folgeerkrankungen bei obstruktiver Schlafapnoe

“…So ist gezeigt worden, dass Vorhofflimmern nach primär erfolgreicher elektrischer Kardioversion häufiger rezidiviert, wenn eine OSA besteht [7]. Des Weiteren weisen unselektierte Patienten mit Vorhofflimmern in einem hohen Prozentsatz (bis zu 50%) eine SBAS im Sinne einer OSA auf [8]. Schließlich konnte anhand einer Fallstudie gezeigt werden, dass die OSA Episoden von Vorhofflimmern triggern kann [9].…”

Schlafapnoescreening kardiovaskulärer Patienten im klinischen Alltag

“…Bei Patienten mit arterieller Hypertonie konnte eine Prävalenz an obstruktiven Schlafapnoesyndromen (OSA) von 50% [12], bei Patienten mit KHK eine Präva-lenz von 33% [23] und bei Patienten mit Vorhofflimmern eine Prävalenz von 33-50% [7,15] gezeigt werden. Demgegenüber treten zentrale Schlafapnoesyndrome (CSA) v. a. bei Patienten mit Herzinsuffizienz auf.…”