Relation of the Severity of Obstructive Sleep Apnea in Response to Anti-Arrhythmic Drugs in Patients With Atrial Fibrillation or Atrial Flutter

Abstract

Atrial fibrillation (AF) is more common in those with obstructive sleep apnea (OSA) than in unaffected individuals and recurs more frequently in the presence of severe OSA after electrical cardioversion and AF ablation. However, it is unknown whether severity of OSA influences the efficacy of anti-arrhythmic drug (AAD) therapy in patients with OSA and AF. This study examined the impact of OSA severity on treatment of symptomatic AF with AADs. We studied 61 patients (62 ± 15 years; 21 women) treated with AADs for symptomatic AF who had overnight polysomnography. Rhythm control was prospectively defined as successful if a patient remained on the same AAD therapy for a minimum of 6 months with ≥75% reduction in symptomatic AF burden. Twenty-four patients (40%) had severe OSA. Thirty patients (49%) were rhythm controlled with AADs. Non-responders to AADs were more likely to have severe OSA than milder disease (52% vs 23%; p < 0.05); those with severe OSA were less likely to respond to AADs than participants with non-severe OSA (39% vs 70%; p = 0.02). Non-responders had higher apnea-hypopnea indices than responders (34 ± 25 vs 22 ± 18 events/hour; p = 0.05), but there were no differences between these groups in minimum oxygen saturation or % time spent in REM sleep. In conclusion, patients with severe OSA are less likely to respond to AAD therapy for AF than those with milder forms of OSA.

Severity of Obstructive Sleep Apnea Influences the Effect of Genotype on Response to Anti-Arrhythmic Drug Therapy for Atrial Fibrillation

“…This cohort includes the group described in our prior work, 4 as well an additional ~ 25 individuals identified in the interim. As such, this study population is very similar to the previously reported cohort in terms of demographics, cardiac history, echocardiographic characteristics, and key sleep parameters ( Table 1).…”

“…The cohort used for this study and the techniques for measuring AF symptom burden have been previously described. 4,15 Briefly, adults with documented AF treated with at least 1 conventional AAD were prospectively enrolled in the Vanderbilt AF Registry between November 2002 and October 2005. At enrollment and at 3, 6, and 12 months of follow-up, patients completed the modified University of Toronto AF Severity Scale (range 3-30) to gauge symptomatic AF burden.…”

Obstructive respiratory events and premature atrial contractions after cardioversion

“…A meta-analysis revealed a significantly higher recurrence of AF following catheter ablation in OSA patients [12]. 120 100 80 60 40 20 0 200 180 160 140 120 100 80 60 40 20 0 200 180 160 140 120 100 80 60 40 20 0 200 180 160 140 120 100 80 60 40 likely to respond to antiarrhythmic therapy for AF than those with milder forms of OSA [13]. Importantly, successful treatment of OSA by continuous positive airway pressure improved catheter ablation success rates [14] and reduced recurrence of AF after ECV in OSA patients [11].…”

Lifestyle Modification in the Prevention and Treatment of Atrial Fibrillation

“…It has also been suggested that negative tracheal pressure during obstructive events is a strong trigger for AF secondary to enhanced vagal activation 43 . Other theories on the relationship between OSA and AF include higher levels of serum amyloid 44 , and elevated levels of inflammatory markers such as C-reactive protein 45 and interleukin-6 46 Moreover, in addition to the increased risk of AF in patients with OSA, a recent study has shown that AF patients with severe OSA are less likely to respond to anti-arrhythmic drug (AAD) therapy compared to patients with milder forms of OSA 47 . The study evaluated the impact of OSA severity on the treatment of patients with AF using AADs.…”