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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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References

  1. Braunwald E (1997) Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 337: 1360–1369

    Article  CAS  Google Scholar 

  2. Go AS et al. (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285: 2370–2375

    Article  CAS  Google Scholar 

  3. Benjamin EJ et al. (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98: 946–952

    Article  CAS  Google Scholar 

  4. Hedley AA et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291: 2847–2850

    Article  CAS  Google Scholar 

  5. Coromilas J (2004) Obesity and atrial fibrillation: is one epidemic feeding the other? JAMA 292: 2519–2520

    Article  CAS  Google Scholar 

  6. Gami AS et al. (2003) Obesity and obstructive sleep apnea. Endocrinol Metab Clin North Am 32: 869–894

    Article  Google Scholar 

  7. Young T et al. (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328: 1230–1235

    Article  CAS  Google Scholar 

  8. Fuster V et al. (2001) ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 104: 2118–2150

    Article  CAS  Google Scholar 

  9. Lloyd-Jones DM et al. (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110: 1042–1046

    Article  Google Scholar 

  10. Valencia-Flores M et al. (2000) Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res 8: 262–269

    Article  CAS  Google Scholar 

  11. Mooe T et al. (2000) Cardiac rhythm in patients with sleep-disordered breathing and coronary artery disease. Scand Cardiovasc J 34: 272–276

    Article  CAS  Google Scholar 

  12. Hoffstein V and Mateika S (1994) Cardiac arrhythmias, snoring, and sleep apnea. Chest 106: 466–471

    Article  CAS  Google Scholar 

  13. Guilleminault C et al. (1983) Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 52: 490–494

    Article  CAS  Google Scholar 

  14. Flemons WW et al. (1993) Sleep apnea and cardiac arrhythmias. Is there a relationship? Am Rev Respir Dis 148: 618–621

    Article  CAS  Google Scholar 

  15. Javaheri S et al. (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 97: 2154–2159

    Article  CAS  Google Scholar 

  16. Sin DD et al. (1999) Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 160: 1101–1106

    Article  CAS  Google Scholar 

  17. Mooe T et al. (1996) Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 7: 475–478

    Article  CAS  Google Scholar 

  18. Kanagala R et al. (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107: 2589–2594

    Article  Google Scholar 

  19. Wang TJ et al. (2004) Obesity and the risk of new-onset atrial fibrillation. JAMA 292: 2471–2477

    Article  CAS  Google Scholar 

  20. Hall MJ et al. (1998) Magnitude and time course of hemodynamic responses to Mueller maneuvers in patients with congestive heart failure. J Appl Physiol 85: 1476–1484

    Article  CAS  Google Scholar 

  21. Schafer H et al. (1998) Pulmonary haemodynamics in obstructive sleep apnoea: time course and associated factors. Eur Respir J 12: 679–684

    Article  CAS  Google Scholar 

  22. Tkacova R et al. (1998) Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation 98: 2269–2275

    Article  CAS  Google Scholar 

  23. Alchanatis M et al. (2000) Left ventricular function in patients with obstructive sleep apnoea syndrome before and after treatment with nasal continuous positive airway pressure. Respiration 67: 367–371

    Article  CAS  Google Scholar 

  24. Niroumand M et al. (2001) Impact of obstructive sleep apnea on left ventricular mass and diastolic function. Am J Respir Crit Care Med 163: 1632–1636

    Article  CAS  Google Scholar 

  25. Kraiczi H et al. (2001) Impairment of vascular endothelial function and left ventricular filling: association with the severity of apnea-induced hypoxemia during sleep. Chest 119: 1085–1091

    Article  CAS  Google Scholar 

  26. Fung JW et al. (2002) Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 121: 422–429

    Article  Google Scholar 

  27. Pritchett AM et al. (2005) Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol 45: 87–92

    Article  Google Scholar 

  28. Young T et al. (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20: 705–706

    Article  CAS  Google Scholar 

  29. Young T et al. (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217–1239

    Article  Google Scholar 

  30. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. (1999) Sleep 22: 667–689

  31. Porthan KM et al. (2004) Prevalence of sleep apnea syndrome in lone atrial fibrillation: a case-control study. Chest 125: 879–885

    Article  Google Scholar 

  32. Gami AS et al. (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110: 364–367

    Article  Google Scholar 

  33. Benjamin EJ et al. (1994) Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 271: 840–844

    Article  CAS  Google Scholar 

  34. Shamsuzzaman AS et al. (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290: 1906–1914

    Article  CAS  Google Scholar 

  35. Roche F et al. (2003) Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol 26: 669–677

    Article  Google Scholar 

  36. Wright J et al. (1997) Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 314: 851–860

    Article  CAS  Google Scholar 

  37. Zohar Y et al. (1992) Cardiac function in obstructive sleep apnea patients following uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 107: 390–394

    Article  CAS  Google Scholar 

  38. Peiser J et al. (1985) Cardiac arrhythmias during sleep in morbidly obese sleep-apneic patients before and after gastric bypass surgery. Clin Cardiol 8: 519–521

    Article  CAS  Google Scholar 

  39. Koehler U et al. (1998) Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment. Eur Respir J 11: 434–439

    Article  CAS  Google Scholar 

  40. Harbison J et al. (2000) Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest 118: 591–595

    Article  CAS  Google Scholar 

  41. Somers VK et al. (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96: 1897–1904

    Article  CAS  Google Scholar 

  42. Ohga E et al. (2003) Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1. J Appl Physiol 94: 179–184

    Article  CAS  Google Scholar 

  43. Pepperell JC et al. (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359: 204–210

    Article  Google Scholar 

  44. Becker HF et al. (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107: 68–73

    Article  Google Scholar 

  45. Peled N et al. (1999) Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. J Am Coll Cardiol 34: 1744–1749

    Article  CAS  Google Scholar 

  46. Sin DD et al. (2000) Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation 102: 61–66

    Article  CAS  Google Scholar 

  47. Kaneko Y et al. (2003) Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348: 1233–1241

    Article  Google Scholar 

  48. Mansfield DR et al. (2004) Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 169: 361–366

    Article  Google Scholar 

  49. Liston R et al. (1995) Haemodynamic effects of nasal continuous positive airway pressure in severe congestive heart failure. Eur Respir J 8: 430–435

    Article  CAS  Google Scholar 

  50. Kiely JL et al. (1998) Efficacy of nasal continuous positive airway pressure therapy in chronic heart failure: importance of underlying cardiac rhythm. Thorax 53: 957–962

    Article  CAS  Google Scholar 

Download references

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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Correspondence to Virend K Somers.

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Competing interests

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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