The Interconnection between Obstructive Sleep Apnea and Persistent Atrial Fibrillation: Pathophysiology, Clinical Implications, and Management Strategies
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Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by intermittent upper airway obstruction, resulting in recurrent hypoxemia, hypercapnia, and sleep fragmentation. Emerging evidence highlights a significant association between OSA and persistent atrial fibrillation (AF), a complex arrhythmia with substantial morbidity and mortality. This relationship is underpinned by multifaceted pathophysiological mechanisms, including autonomic nervous system dysregulation, structural and electrical cardiac remodeling, systemic inflammation, and heightened oxidative stress. Patients with coexistent OSA and AF exhibit a more challenging clinical course with higher rates of arrhythmia recurrence and resistance to conventional therapies such as antiarrhythmic drugs and catheter ablation.
This review explores the intricate interplay between OSA and persistent AF, emphasizing the role of continuous positive airway pressure (CPAP) therapy in modifying arrhythmogenic risk and improving cardiovascular outcomes. Furthermore, the article discusses the importance of multidisciplinary approaches for diagnosis and management, integrating cardiological and sleep medicine perspectives. Understanding this bidirectional relationship is crucial for tailoring therapeutic strategies aimed at mitigating the burden of AF in patients with OSA.
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References
I. Quan S. F., Howard B. V., Iber C., Kiley J. P., Nieto F. J., O′Connor G. T., Rapoport D. M., Redline S., Robbins J., Samet J. M., and Wahl P. W., The Sleep Heart Health Study: design, rationale, and methods, Sleep. (1997) 20, no. 12, 1077–1085, 2-s2.0-0031427335.
II. Punjabi N. M., The epidemiology of adult obstructive sleep apnea, Proceedings of the American Thoracic Society. (2008) 5, no. 2, 136–143, 2-s2.0-39049126446, https://doi.org/10.1513/pats.200709-155MG.
III. Stradling J. R. and Davies R. J. O., Sleep · 1: obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history, Thorax. (2004) 59, no. 1, 73–78, 2-s2.0-0346057799, https://doi.org/10.1136/thx.2003.007161.
IV. Partinen M. and Palomaki H., Snoring and cerebral infarction, The Lancet. (1985) 2, no. 8468, 1325–1326, 2-s2.0-0022405434.
V. Miyasaka Y., Barnes M. E., Gersh B. J., Cha S. S., Bailey K. R., Abhayaratna W. P., Seward J. B., and Tsang T. S. M., Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence, Circulation. (2006) 114, no. 2, 119–125, 2-s2.0-33747052359, https://doi.org/10.1161/CIRCULATIONAHA.105.595140.
VI. Guilleminault C., Connolly S. J., and Winkle R. A., Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome, The American Journal of Cardiology. (1983) 52, no. 5, 490–494, 2-s2.0-0020599777.
VII. Gami A. S., Pressman G., Caples S. M., Kanagala R., Gard J. J., Davison D. E., Malouf J. F., Ammash N. M., Friedman P. A., and Somers V. K., Association of atrial fibrillation and obstructive sleep apnea, Circulation. (2004) 110, no. 4, 364–367, 2-s2.0-3342988234, https://doi.org/10.1161/01.CIR.0000136587.68725.8E.
VIII. Mehra R., Benjamin E. J., Shahar E., Gottlieb D. J., Nawabit R., Kirchner H. L., Sahadevan J., and Redline S., Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study, American Journal of Respiratory and Critical Care Medicine. (2006) 173, no. 8, 910–916, 2-s2.0-33646359681,
https://doi.org/10.1164/rccm.200509-1442OC.
IX. Tanigawa T., Yamagishi K., Sakurai S., Muraki I., Noda H., Shimamoto T., and Iso H., Arterial oxygen desaturation during sleep and atrial fibrillation, Heart. (2006) 92, no. 12, 1854–1855, 2-s2.0-33845207704, https://doi.org/10.1136/hrt.2005.081257.
X. Monahan K., Storfer-Isser A., Mehra R., Shahar E., Mittleman M., Rottman J., Punjabi N., Sanders M., Quan S. F., Resnick H., and Redline S., Triggering of nocturnal arrhythmias by sleep-disordered breathing events, Journal of the American College of Cardiology. (2009) 54, no. 19, 1797–1804, 2-s2.0-70349291421, https://doi.org/10.1016/j.jacc.2009.06.038.
XI. Gami A. S., Hodge D. O., Herges R. M., Olson E. J., Nykodym J., Kara T., and Somers V. K., Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation, Journal of the American College of Cardiology. (2007) 49, no. 5, 565–571, 2-s2.0-33846613643, https://doi.org/10.1016/j.jacc.2006.08.060.
XII. Stevenson I. H., Teichtahl H., Cunnington D., Ciavarella S., Gordon I., and Kalman J. M., Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function, European Heart Journal. (2008) 29, no. 13, 1662–1669, 2-s2.0-46849093186, https://doi.org/10.1093/eurheartj/ehn214.
XIII. Braga B., Poyares D., Cintra F., Guilleminault C., Cirenza C., Horbach S., Macedo D., Silva R., Tufik S., and De Paola A. A. V., Sleep-disordered breathing and chronic atrial fibrillation, Sleep Medicine. (2009) 10, no. 2, 212–216, 2-s2.0-60949091579, https://doi.org/10.1016/j.sleep.2007.12.007.
XIV. Mooe T., Gullsby S., Rabben T., and Eriksson P., Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery, Coronary Artery Disease. (1996) 7, no. 6, 475–478, 2-s2.0-0029740171.
XV. Mehra R., Stone K. L., Varosy P. D., Hoffman A. R., Marcus G. M., Blackwell T., Ibrahim O. A., Salem R., and Redline S., Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study, Archives of Internal Medicine. (2009) 169, no. 12, 1147–1155, 2-s2.0-67649499939,