Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent disorder with a growing incidence worldwide that closely mirrors the global obesity epidemic. OSA is associated with enormous healthcare costs in addition to significant morbidity and mortality. Much of the morbidity and mortality related to OSA can be attributed to an increased burden of cardiovascular disease, including cardiac rhythm disorders. Awareness of the relationship between OSA and rhythm disorders is variable among physicians, a fact that can influence patient care, since the presence of OSA can influence the incidence, prevalence, and successful treatment of multiple rhythm disorders. Herein, we provide a review of this topic that is intentionally broad in scope, covering the relationship between OSA and rhythm disorders from epidemiology and pathophysiology to diagnosis and management, with a particular focus on the recognition of undiagnosed OSA in the general clinical population and the intimate relationship between OSA and atrial fibrillation.

Impact of Obstructive Sleep Apnea On In-Hospital Outcomes in Patients With Atrial Fibrillation: A Retrospective Analysis of the National Inpatient Sample

“…This was consistent with studies supporting OSA as the most prevalent secondary contributor to elevated blood pressure in patients with resistant hypertension [ 32 ]. Increased sympathetic activity, intrathoracic pressure during episodes of apnea resulting in hypertension, and excessive rates of venous return have been postulated as possible mechanisms for the development of AF in OSA [ 33 ].…”

Pre-Dialytic SpO2 Measured with a Wearable Device as a Predictor of Mortality in Patients with OSA and Chronic Kidney Disease

“…A recent study specifically states that the lectin-like oxidized lowdensity lipoprotein receptor-1 (LOX-1) and the potent vasoconstrictor endothelin-1 (ET-1) are intricately involved in atherosclerotic plaques formation and assisting in detecting the CV risk in OSA subjects, respectively [24]. Indeed, there is a growing body of research that links OSA to arrhythmias and sudden cardiac death [25]. Intriguingly, a bidirectional relationship interplays between chronic kidney disease and OSA; and vice versa, continuous, supplemental oxygen therapy with continuous, positive airway pressure improves the renal function in OSA patients [16].…”

A Scoping Review of Sleep Apnea: Where Do We Stand?

“…These acute triggers can be explained by previously studied arrhythmogenic mechanisms, where an alteration in the intrathoracic pressure leads to a stretch in the muscle of the left atrium, which causes distention. This distention in turn gives rise to increased atrial premature beats and QT interval prolongation on an electrocardiogram (EKG) [ 70 ]. As a result, ventricular tachycardia and/or sudden cardiac death due to this acute episode can ensue.…”

“…As a result, ventricular tachycardia and/or sudden cardiac death due to this acute episode can ensue. The triggered activity and automaticity due to enhanced sympathetic discharge, and parasympathetic surge on the other hand during apnea, can cause sinus nodal disease and atrial fibrillation ( Figure 3 ) [ 70 , 71 ]. It is important to note that while there is a strong association between OSA and CVD, many trials have failed to establish that these symptoms improve when treating for OSA.…”

“…The cytokines involved in these heightened inflammatory reactions are reported to be TNFa, IL-6, IL-8, and C-reactive protein (CRP), which are also associated with excessive daytime sleepiness among OSA patients, along with their action on endothelial damage and myocyte dysfunction [ 73 ]. Myocyte hypertrophy due to hypertension can also cause the remodeling of cardiac myocyte, resulting in fibrosis [ 70 ]. A similar result could be observed in OSA patients with comorbid obesity, which could enhance the renin–angiotensin–aldosterone system (RAAS) due to sympathetic activation.…”