Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring

Abstract

In patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF.In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for longitudinal assessment of nightly SDB-severity and clinical implications for screening and management of SDB in AF patients.

On‐demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation

“…[25] Technologies implemented in implantable devices, on-contact biomotion sensors with actimetry, ballistic sensors or Doppler technology with radar frequencies can remotely monitor breathing during sleep. [26,27] Wearable devices with inbuilt pulse oximeters are now also becoming commercially available raising the prospect of routinely measuring the night-to-night variability of sleep disordered breathing severity by means of the oxygen desaturation index or determining hypoxic burden more broadly by newer validated algorithms. [17,28] outcomes such as satisfaction and cost-effectiveness.…”

“…[ 25 ] Technologies implemented in implantable devices, on‐contact biomotion sensors with actimetry, ballistic sensors or Doppler technology with radar frequencies can remotely monitor breathing during sleep. [ 26,27 ] Wearable devices with inbuilt pulse oximeters are now also becoming commercially available raising the prospect of routinely measuring the night‐to‐night variability of sleep disordered breathing severity by means of the oxygen desaturation index or determining hypoxic burden more broadly by newer validated algorithms. [ 17,28 ] Several clinical trials have demonstrated the feasibility of mHealth‐based sleep apnea management compared with a more traditional in‐person care model, suggesting non‐inferiority in terms of adherence to continuous positive airway pressure treatment and compliance as well as functional outcomes such as satisfaction and cost‐effectiveness.…”

Highlights from the International Journal of Cardiology Heart & Vasculature: Heart failure, atrial fibrillation, coronary artery disease and myocardial infarction

“…AF is the most common sustained arrhythmia and is associated with significant morbidity, increased risk of stroke and thromboembolism, brain damage [15], reduced quality of life, and increased mortality [16], [17], [18], [19], [20]. Symptoms in AF patients include palpitations and reduced exercise tolerance, partly due to reduced oxygen uptake and impaired heart rate responses [21], [22].…”

“…Symptoms in AF patients include palpitations and reduced exercise tolerance, partly due to reduced oxygen uptake and impaired heart rate responses [21], [22]. Concomitant risk factors such as hypertension, HF, obesity, metabolic syndrome, sleep apnea and ageing lead to structural remodeling processes in the atria, which contribute to the progressive nature of AF and the reduced efficacy of pharmacological and catheter-based rhythm-control strategies [19], [23], [24]. Fibrosis is a prominent feature of atrial remodeling, with epicardial fat tissue importantly contributing to the arrhythmogenic fibrotic substrate, thereby promoting the recurrence of AF in patients undergoing ablation procedures [25].…”

Gender differences and daily variation in atrial fibrillation risk factor profiles: Considerations for risk factor management

“…Even in AF-patients without overt risk factors, the inter-visit variability of metabolic parameters showed a close association with the risk of AF [23]. All of these factors justify a more structured and importantly longitudinal risk factor assessment to capture the dynamic nature of AF risk factors [24]. Repeated longitudinal assessment of established and emerging risk factors may be important in young-onset AF patients, particularly if no risk factor can be identified to explain the presence of AF.…”