Obstructive sleep apnea and nocturnal assaults of paroxysmal atrial fibrillation

This article was originally published here

J Clin Sleep Med. 2021 Dec. 22. doi: 10.5664 / jcsm.9840. Online before printing.


STUDY AIMS: Obstructive sleep apnea (OSA) is commonly seen in patients with atrial fibrillation (AF), but it is unclear whether this relationship is causal or associative. We studied a cohort of patients with paroxysmal AF to determine whether the presence of OSA (apnea-hypopnea index ≥ 15) affects the timing of symptomatic AF episodes.

METHODS: Subjects who had recently visited the emergency room (ER) for a symptomatic episode of paroxysmal AF were recruited from an AF clinic. The time at which the AF attack started was classified as “sleeping or waking on the person’s direct medical history and the documentation of the emergency doctor’s visit.

RESULTS: Of 152 patients with paroxysmal AF, 67 underwent polysomnography; 1 (1.5%) had central sleep apnea, 46 (68.7%) had mild or no OSA (M-NSA), 20 (29.8%) had OSA. In the OSA group, 14/20 (70.0%) had their symptomatic atrial fibrillation attack during sleep compared to 12/46 (26.1%) in the M-NSA group (p = 0.001). Compared with those with a paroxysmal AF attack while awake and adjusted for confounding factors, those with a paroxysmal AF attack during sleep had an almost six-fold probability of developing OSA (odds ratio: 5.53; p = 0.007).

CONCLUSIONS: Compared to paroxysmal AF patients with M-NSA, those with OSA were much more likely to have a symptomatic AF attack during sleep , supporting a causal role of OSA in the pathogenesis of AF in this population. These results suggest that patients with nocturnal AF attacks should be evaluated for OSA.

PMID: 34931608 | DOI: 10.5664 / jcsm.9840

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