Sleep Apnea and Atrial Fibrillation; 2012 Update

Abstract

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are very prevalent diseases in modern society. Recent years have seen the emergence of a wide body of literature suggesting an important association between these two diseases. This review will provide a summary of this evidence as it currently exists. First, it will review the literature suggesting an association between AF and OSA by highlighting the prevalence of AF in OSA, the correlation of AF prevalence with OSA severity and the trend towards increased AF recurrence in patients with OSA after treatment for AF. Second, it will identify the possible pathophysiologic mechanisms for this association. In doing so, it will discuss the investigated effects of intrathoracic pressure changes, autonomic instability and atrial remodeling. Finally, it will review the evidence of the effect of treatment of OSA on AF, highlighting the role of continuous positive airway pressure (CPAP) in the treatment of OSA and its impact on AF prevalence and recurrence.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…6.5.2), ablację AF powinno się oferować otyłym pacjentom w połączeniu z modyfikacjami stylu życia prowadzącymi do redukcji masy ciała. [304,305]. Do występowania AF u pacjentów z obturacyjnym bezdechem sennym może się przyczyniać wiele mechanizmów patofizjologicznych, w tym dysfunkcja autonomiczna, hipoksja, hiperkapnia oraz zapalenie [96,[304][305][306][307].…”

“…[304,305]. Do występowania AF u pacjentów z obturacyjnym bezdechem sennym może się przyczyniać wiele mechanizmów patofizjologicznych, w tym dysfunkcja autonomiczna, hipoksja, hiperkapnia oraz zapalenie [96,[304][305][306][307]. Obturacyjny bezdech senny nasila zmiany ciśnienia wewnątrz klatki piersiowej, które same oraz za pośrednictwem aktywacji nerwu błędnego mogą prowadzić do skrócenia potencjału czynnościowego w przedsionkach i wywoływać AF.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…304,305 Multiple pathophysiological mechanisms can contribute to AF in obstructive sleep apnoea, including autonomic dysfunction, hypoxia, hypercapnia, and inflammation. 96,304 -307 Obstructive sleep apnoea exaggerates intrathoracic pressure changes, which in itself and via vagal activation can provoke shortening of the atrial action potential and induce AF.…”

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

“…On the other hand, prolonged QRS duration is an independent predictor of mortality and cardiovascular diseases (e.g., hypertension and heart failure) in OSAS patients. It has also been shown that severe OSAS patients (AHI ≥ 30) have a four-fold higher frequency of atrial fibrillation (AF) (8). Arrhythmia and its improvement with continuous positive airway pressure (CPAP) therapy in OSAS patients have been reported as well (8).…”

“…It has also been shown that severe OSAS patients (AHI ≥ 30) have a four-fold higher frequency of atrial fibrillation (AF) (8). Arrhythmia and its improvement with continuous positive airway pressure (CPAP) therapy in OSAS patients have been reported as well (8). However, the relationship between OSAS and intrinsicoid deflection (ID) (i.e., R-wave peak time) is unknown.…”