Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea

Abstract

Atrial fibrillation is the most common cardiac arrhythmia with its prevalence expected to increase to 12.1 million people in the United States by 2030. Chronic underlying conditions that affect the heart and lungs predispose patients to develop atrial fibrillation. Obstructive sleep apnea is strongly associated with atrial fibrillation. Several pathophysiological mechanisms have been proposed to elucidate this relationship which includes electrophysiological substrate modification and the contribution of the autonomic nervous system. In this comprehensive review, we highlight important relationships and plausible causality between obstructive sleep apnea and atrial fibrillation which will improve our understanding in the evaluation, management, and prevention of atrial fibrillation. This is the most updated comprehensive review of the relationship between obstructive sleep apnea and atrial fibrillation.

The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System

“…Chronic pathologic states that affect the left and/or right heart and the pulmonary system such as heart failure and pulmonary hypertension predispose patients to AF [ 28 ].…”

Effect of different anti‐cardiovascular disease treatments on the severity of obstructive sleep apnea

“…Numerous articles have been published detailing the interaction mechanisms between OSA and CVD. It is generally accepted that OSA‐induced changes in hypoxaemia, oxidative stress, sympathetic activation, and decreased intrathoracic pressure can induce or exacerbate a number of CVDs by altering myocardial electrical conduction, damaging cardiomyocytes and endothelial cells, increasing heart rate and blood pressure, and promoting ventricular remodelling (Di Fusco et al, 2020; Fei et al, 2022; Ifedili et al, 2022; Lin et al, 2022; Yeghiazarians et al, 2021). In turn, CVD causes or exacerbates OSA mainly due to factors such as hypervolaemia (Lyons & Bradley, 2015), fluid redistribution during sleep (Lyons & Bradley, 2015), and a sudden increase in blood pressure (Garpestad et al, 1992) that leads to the collapse of the upper airway.…”