Interactions Between Sleep Disordered Breathing and Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Konečný, Tomáš; Brady, Peter A.; Orban, Marek; Lin, Grace; Pressman, Gregg S.; Lehar, František; Kara, Tomas; Gersh, Bernard J.; Tajik, A. Jamil; Ommen, Steve R.; Somers, Virend K.

doi:10.1016/j.amjcard.2010.01.023

Cited by 55 publications

(41 citation statements)

References 29 publications

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“…An association between nocturnal atrial fibrillation (AF) and sleep apnea has been suggested by several investigators (1,2). In patients with obstructive sleep apnea under 65 years of age, the cumulative frequency of AF is significantly increased compared with that observed in patients without sleep apnea (3).…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Cyclical Variation in Heart Rate before Nocturnal Episodes of Paroxysmal Atrial Fibrillation

2013

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Objective Nighttime onset of atrial fibrillation (AF) is sometimes associated with obstructive sleep apnea accompanied by a characteristic heart rate (HR) pattern known as cyclical variation of HR. The aim of this study was to evaluate whether cyclical variation of HR is prevalent in patients with nocturnal AF. Methods The subjects consisted of 34 patients (68±12 years) with paroxysmal AF, including 14 patients with daytime AF and 20 patients with nighttime AF. Holter electrocardiogram (ECGs) were examined for the presence of cyclical variation in HR and to quantify the HR variability within the 40-minute period preceding each AF episode using a fast Fourier transform (FFT) methods. Results Cyclical variation in HR was observed in 12 of 20 (60%) nighttime episodes and in only two of 14 (14%) daytime episodes. The prevalence of cyclical variation in HR was significantly greater in the nighttime AF episodes than in the daytime AF episodes (Chi=5.34, p<0.05). The mean frequency of cyclical variation in HR was 0.015±0.003 Hz. The mean power of the VLF (very low frequency) component (0.008-0.04 Hz) before the onset of AF was significantly greater in the nighttime AF episodes than in the daytime AF episodes. Among the nighttime AF episodes, the power of the HF (high frequency), LF (low frequency) and very low frequency (VLF) components increased significantly just before the onset of AF compared with that observed 40 minutes before onset. Conclusion The high prevalence of cyclical variation in HR observed before nocturnal AF episodes suggests that sleep apnea may play a role in the onset of nighttime AF.

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Section: Introductionmentioning

confidence: 99%

High Prevalence of Cyclical Variation in Heart Rate before Nocturnal Episodes of Paroxysmal Atrial Fibrillation

2013

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“…Although CPAP improves both the neurobehavioral (daytime sleepiness [23,24,41,42], MVA [33][34][35]53]) and cardiovascular consequences of OSA (hypertension [9-11, 39, 40, 43, 44, 46-48], MI [12,13], stroke [14], atrial fibrillation [26][27][28][29]), the important question is whether or not increased CPAP hours of use further improve these outcomes. Weaver and colleagues and Antic and colleagues have independently shown that increasing the number of hours of CPAP use results in better outcomes (23,24 (12,25,(54)(55)(56).…”

Section: Cpap Adherence Tracking Systemsmentioning

confidence: 99%

“…The Sleep Heart Health and other studies have demonstrated that patients with OSA are at increased risk for hypertension (9)(10)(11), myocardial infarction (MI) (12,13), stroke (14), and death (15)(16)(17)(18). Nocturnal cardiac arrhythmias including atrial fibrillation, sinus bradycardia/tachycardia, supra/ventricular tachycardias, heart block, and sinus pauses have all been reported during apneic episodes (26)(27)(28)(29). Mild-to-moderate pulmonary hypertension can develop in patients with OSA (30-32) although overt right heart failure is uncommon in the absence of other contributing factors.…”

Section: Introductionmentioning

confidence: 99%

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Schwab

Badr

Epstein

et al. 2013

Am J Respir Crit Care Med

247

196

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Background: Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. Methods: American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. Results: CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Conclusions: Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHI Flow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.Keywords: CPAP adherence; sleep apnea; CPAP tracking systems EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is an extremely common condition and is associated with significant morbidity and mortality (1-18). Optimal treatment of sleep apnea is critical because sleepdisordered breathing is associated with the increased risk of vehicular crashes and cardiovascular morbidity and mortality (6, 9-18). Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnea (19)(20)(21)(22). Increased CPAP adherence has been shown to improve outcomes such as daytime sleepiness, quality of life, and mortality (23-25). OSA should be considered in a chronic disease management model in which CPAP adherence is tracked over time. To assess CPAP adherence and efficacy, tracking systems have been implemented. Such systems monitor CPAP efficacy (residual sleep-disordered breathing), hours of CPAP use, mask leak, and a number of different flow signals. However, there are no standards on how to use the data from these new CPAP tracking systems nor do we have evidence that these systems ultimately improve outcomes. See the online supplement for full discussion of the literature on the accuracy of the residual AHI and mask leak.The purpose of this document is to (1) review the data (adherence, leak, efficacy, flow signals) obtained from CPAP adherence tracking systems and the reliability of th...

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“…Clinically signifi cant SDB was defi ned as ODI Ն 10. 15,16 In an additional analysis, we divided patients by other previously published values of SDB severity and classifi ed them as "no SDB" for ODI Յ 5, "mild to moderate SDB" for ODI of 5 to 15, and "severe SDB" for ODI . 15.…”

Section: Overnight Oximetrymentioning

confidence: 99%

Decreased Exercise Capacity and Sleep-Disordered Breathing in Patients With Hypertrophic Cardiomyopathy

Konečný

Ludka

Orban

et al. 2015

Chest

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Interactions Between Sleep Disordered Breathing and Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Cited by 55 publications

References 29 publications

High Prevalence of Cyclical Variation in Heart Rate before Nocturnal Episodes of Paroxysmal Atrial Fibrillation

High Prevalence of Cyclical Variation in Heart Rate before Nocturnal Episodes of Paroxysmal Atrial Fibrillation

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Decreased Exercise Capacity and Sleep-Disordered Breathing in Patients With Hypertrophic Cardiomyopathy

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