Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications

Linz, Dominik; Linz, Benedikt; Hohl, Mathias; Böhm, Michael

doi:10.1016/j.smrv.2015.03.003

Cited by 69 publications

(30 citation statements)

References 91 publications

(97 reference statements)

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“…Several complications and end‐organ damage are attributed to the amount and severity of intermittent hypoxia in SDB . Severity of SDB is currently evaluated by the event‐based measure of SDB “AHI” considering the number of hypopneas and apneas per hour during sleep.…”

Section: Discussionmentioning

confidence: 90%

The association between different features of sleep‐disordered breathing and blood pressure: A cross‐sectional study

Khoshkish

Hohl

Linz

et al. 2018

J of Clinical Hypertension

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Sleep disordered breathing (SDB) is highly prevalent in patients with high blood pressure (BP). Severity of SDB can be evaluated by the number of apneas and hypopneas per hour (AHI) or by measures of hypoxia. The objective of this study was to assess the association between different measures of SDB and BP. In 134 consecutive patients, polygraphy was performed to determine the AHI. Pulse oximetry was used to determine hypoxemic burden (time below 90% oxygen saturation [T90] and hypoxia load [HL], representing the integrated area above the curve of desaturation). AHI did not correlate with systolic and diastolic BP or pulse pressure. In contrast, HL correlated with pulse pressure during the day (P = .01) and night (P = .0034) before and after adjustment for body mass index. The correlation between systolic BP and HL at night disappeared following adjustment for body mass index. This study generates the hypothesis that nocturnal hypoxemic burden may represent a suitable marker of BP pattern and a potential treatment target in hypertensive patients. | INTRODUCTIONSleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), is highly prevalent in patients with hypertension. where CPAP reduced daytime blood pressure (BP) by 6.5 mm Hg, compared with a 3.1 mm Hg increase in untreated patients. 10 In a meta-analysis of 3 randomized-controlled trials, CPAP-withdrawal resulted in a clinically relevant increase in BP, which was considerably higher than BP in conventional CPAP trials, and the effects of CPAP-withdrawal may be underestimated when office BP is used. 11These studies suggest an involvement of SDB in the pathophysiology of increased BP. Besides systolic and diastolic BP, increased pulse pressure typically reflects aortic stiffness, which is attributable to fatigue of elastin and increased pressure wave reflections, and is predictive of stroke 12 and cardiovascular mortality. [13][14][15] The associations between different parameters for severity of SDB and BP parameters are unclear.Presently, severity of SDB is evaluated by the apnea-hypopnea index (AHI). 16 The AHI is an event-based measure of severity of SDB that considers the number of hypopneas and apneas per hour during sleep, but does not incorporate the degree and duration of desaturations. Therefore, progression of cardiac remodeling and cardiovascular events triggered by hypoxia is neither detected nor predicted by the AHI. In this cross-sectional explorative study, we enrolled patients with suspected sleep apnea and performed unattended polygraphy and 24-hour ambulatory BP monitoring to identify which measure of SDB correlates best with different BP parameters.

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Section: Discussionmentioning

confidence: 90%

The association between different features of sleep‐disordered breathing and blood pressure: A cross‐sectional study

Khoshkish

Hohl

Linz

et al. 2018

J of Clinical Hypertension

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“…Sleep-disordered breathing (SDB), which encompasses OSA with central sleep apnea (CSA) are often found with HF patients up to 50% to 70% [19,46]. HF patient’s exhibit mixed sleep apnea, characterized by initial CSA event followed by an obstructive component [47]. The initial CSA causes sympathetic activation, followed by elevated blood pressure and heart rate, which in turn causes left ventricular remodeling.…”

Section: Clinical Association Between Cvd and Osamentioning

confidence: 99%

“…Respiration against occluded nasopharynx can also cause increased intrathoracic pressure and left ventricular transmural gradient, which can lead to an increase in cardiac afterload and decrease in cardiac output [19]. Symptomatic HF with peripheral edema can cause rostral fluid shift at night with supine position, which when occurs simultaneously with decreased pharyngeal muscle tone from Cheyne-Stokes respiration can cause airway collapse with subsequent worsening of OSA [47]. Treating primary symptoms of HF, including diuretics, angiotensin-converting enzyme inhibitors and implantable device therapy has shown improvement in SDB [19,48].…”

Section: Clinical Association Between Cvd and Osamentioning

confidence: 99%

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic

Sharma¹,

Lee²,

Youssef³

et al. 2017

J Sleep Disord Ther

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Cardiovascular disease (CVD) is the main cause of death among adult men and women in the USA and impacts millions around the globe. Traditional risk factors for CVD include obesity, diabetes, hypertension and dyslipidemia. The modern-day epidemic of obesity not only increased the rate of CVD but also ushered in an additional CVD risk factor to be added to the list; that is obstructive sleep apnea (OSA). In this review, we discuss the growing epidemic of obesity and OSA, highlighting the common pathogenic hypotheses linking these risk factors to CVD. We will also highlight the therapeutic rationale of OSA as a way to reduce CVD risk.

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“…OSA reduces outcome of catheter based and pharmacological antiarrhythmic AF treatment . Efficient treatment of OSA by continuous positive airway pressure ventilation (CPAP), the first line therapy of OSA, has been shown to improve catheter ablation success rates in AF‐patients . However, long‐term adherence to CPAP therapy in symptomatic OSA patients is about 70% after 5 years .…”

Section: Introductionmentioning

confidence: 99%

Low‐Level But Not High‐Level Baroreceptor Stimulation Inhibits Atrial Fibrillation in a Pig Model of Sleep Apnea

Linz

Hohl

Khoshkish

et al. 2016

Cardiovasc electrophysiol

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Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications

Cited by 69 publications

References 91 publications

The association between different features of sleep‐disordered breathing and blood pressure: A cross‐sectional study

The association between different features of sleep‐disordered breathing and blood pressure: A cross‐sectional study

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic

Low‐Level But Not High‐Level Baroreceptor Stimulation Inhibits Atrial Fibrillation in a Pig Model of Sleep Apnea

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