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Therapy Insight: interactions between atrial fibrillation and obstructive sleep apnea

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 145–149 (2005)Cite this article

Abstract

Atrial fibrillation (AF) and obesity are coinciding epidemics. Obstructive sleep apnea (OSA) correlates directly with obesity and is highly prevalent among middle-aged adults. Emerging evidence supports a strong association between AF and OSA. The rate of AF among patients with OSA is low but is nevertheless higher than that in the general population. The prevalence of OSA among patients with AF is strikingly high—at least 32% and possibly as high as 49%—although differences in the AF populations studied and the criteria used to diagnose OSA have prevented more accurate measurement of this rate. Data in focused populations at risk of AF show that OSA increases the frequency and recurrence of AF. These findings cannot, however, be reliably generalized to the larger OSA population. Although the available information is limited, treatment of OSA, particularly with continuous positive airway pressure, seems to substantially reduce the frequency of AF. If true, this approach would provide a safe and noninvasive therapy for some patients with AF. Randomized controlled trials are necessary to rigorously answer this question. Many data have been obtained from studies with focuses other than the direct relationship between OSA and AF. Studies carefully designed to investigate the relevant issues are now needed.

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Acknowledgements

ASG, SMC and VKS are supported by grants from the National Institutes of Health (NIH) and the Mayo Foundation. ASG is also supported by the Dr Ralph and Marian C Falk Medical Research Trust Fellowship.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases,

    Apoor S Gami, Paul A Friedman, Sean M Caples & Virend K Somers

  2. Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, MN, USA

    Apoor S Gami, Paul A Friedman, Sean M Caples & Virend K Somers

  3. Staff Cardiologist, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH, USA

    Mina K Chung

Authors
  1. Apoor S Gami
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  2. Paul A Friedman
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Correspondence to Virend K Somers.

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Virend K Somers has acted as a consultant for ResMed and Respironics Inc.

Glossary

OBSTRUCTIVE SLEEP APNEA (OSA)

A form of sleep apnea caused by upper airway anatomic and functional characteristics, in which efforts to breathe continue during airflow cessation

APNEA–HYPOPNEA INDEX (AHI)

An index that relates the severity of sleep apnea and hypopnea, calculated as the average number of apneas and hypopneas per hour of sleep; score <5 is normal

SLEEP APNEA

A breathing disorder characterized by repeated episodes of part or complete cessation of breathing during sleep

CENTRAL SLEEP APNEA

A form of sleep apnea in which no effort is made to breathe during airflow cessation due to defects in central nervous system ventilation control

OXYGEN DESATURATION INDEX

An index to assess the severity of sleep apnea, calculated as the average number of oxygen desaturation episodes per hour of sleep

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) THERAPY

Airway pressure is maintained above atmospheric pressure during the ventilatory cycle by pressurization of the airway via a face mask

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Gami, A., Friedman, P., Chung, M. et al. Therapy Insight: interactions between atrial fibrillation and obstructive sleep apnea. Nat Rev Cardiol 2, 145–149 (2005). https://doi.org/10.1038/ncpcardio0130

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