Relationship between atrial conduction delay and obstructive sleep apnea

Abstract

Prolonged P-wave duration, indicating atrial conduction delay, is a marker of left atrial abnormality and is reported as a potent precursor of atrial fibrillation (AF). Several studies have shown that obstructive sleep apnea (OSA) is associated with AF. We evaluated the relationship between OSA and prolonged P-wave duration. Consecutive subjects who underwent overnight polysomnography and showed a normal sinus rhythm, had no history of AF or ischemic heart disease, and showed no evidence of heart failure were enrolled. Apnea-hypopnea index (AHI) is defined as the number of apnea and hypopnea events per hour of sleep. P-wave duration was determined on the basis of the mean duration of three consecutive beats in lead II from a digitally stored electrocardiogram. A total of 250 subjects (middle-aged, predominantly male, mildly obese, with a mean P-wave duration of 106 ms) were enrolled. In addition to age, male gender, body mass index (BMI), hypertension, dyslipidemia, and uric acid and creatinine levels, AHI (r = 0.56; P < 0.001) had significant univariable relationship with P-wave duration. Multivariate regression analysis showed that age, BMI, male gender, and AHI (partial correlation coefficient, 0.47; P < 0.001) were significantly independently correlated to P-wave duration. Severity of OSA is significantly associated with delayed atrial conduction time. Obstructive sleep apnea may lead to progression of atrial remodeling as an AF substrate.

Atrial Fibrillation Promotion With Long-Term Repetitive Obstructive Sleep Apnea in a Rat Model

“…OSA augments atrial electromechanical delay and P-wave dispersion, which increase with OSA severity (23). Patients with OSA exhibit prolonged atrial conduction times, longer P waves, slowed atrial conduction velocities, lower atrial electrogram voltages, and more complex electrograms (11,24). Signal-averaged P-wave duration is increased by OSA and significantly decreases Repetitive OSA Causes AF-Promoting Remodeling with continuous positive airway pressure treatment (25).…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…[117][118][119] Obstructive sleep apnoea prolongs atrial conduction times, slows atrial conduction, reduces atrial-electrogram voltages and increases electrogram complexity. 117,118 Signal-averaged P-wave duration is increased by OSA, and decreases significantly with continuous positive airway pressure treatment. 120 In a rat model, repeated obstructive apnoea over a 4-week period increases AF vulnerability and slows atrial conduction by altering connexin-43 expression and inducing atrial fibrosis.…”

Interatrial Block in the Modern Era

“…There is an independent significant association between increased P wave duration (IAB) and severity of OSA based on apnea-hypopnoea index as shown by recent studies [54-56]. P wave dispersion is also increased in patients with moderate to severe OSA [57].…”