Asmaa M Abumuamar1, Paul Dorian2, David Newman3, Colin M Shapiro4. 1. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario. 2. Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario. 3. Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. 4. Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario.
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a systemic disorder associated with significant cardiovascular complications. OSA may play a role in the initiation and worsening of atrial fibrillation (AF). This study aimed to determine the prevalence and clinical predictors of OSA in patients with AF. HYPOTHESIS: OSA is underdiagnosed in a large number of patients with AF and may not be predicted by conventional clinical indices. METHODS: Consecutive nonselected patients with AF were recruited from different arrhythmia clinics in Toronto, Ontario, Canada. Patients with previous diagnosis and/or treatment of OSA were excluded. Patients underwent 2 consecutive nights of ambulatory sleep testing with full electroencephalogram recording. OSA was defined as an Apnea-Hypopnea Index (AHI) score ≥ 5 per hour of sleep. RESULTS: 123 patients with AF were recruited, with 100 patients included in the final analysis. OSA was detected in 85% of these patients. 27% of patients with normal overall AHI had an increased AHI during rapid eye movement sleep. Only age and male sex were independent predictors of the presence of OSA in these patients. CONCLUSIONS: OSA is common and often undetected in patients with AF, especially in nonobese and/or female patients. Patients may have a normal overall AHI but an abnormal AHI during rapid eye movement sleep. The clinical relevance and therapeutic implications in this subgroup should be further investigated. The clinical features of OSA are not reliable predictors of OSA in patients with AF. A low threshold for detection of OSA, with sleep studies, in these patients may be merited.
BACKGROUND:Obstructive sleep apnea (OSA) is a systemic disorder associated with significant cardiovascular complications. OSA may play a role in the initiation and worsening of atrial fibrillation (AF). This study aimed to determine the prevalence and clinical predictors of OSA in patients with AF. HYPOTHESIS: OSA is underdiagnosed in a large number of patients with AF and may not be predicted by conventional clinical indices. METHODS: Consecutive nonselected patients with AF were recruited from different arrhythmia clinics in Toronto, Ontario, Canada. Patients with previous diagnosis and/or treatment of OSA were excluded. Patients underwent 2 consecutive nights of ambulatory sleep testing with full electroencephalogram recording. OSA was defined as an Apnea-Hypopnea Index (AHI) score ≥ 5 per hour of sleep. RESULTS: 123 patients with AF were recruited, with 100 patients included in the final analysis. OSA was detected in 85% of these patients. 27% of patients with normal overall AHI had an increased AHI during rapid eye movement sleep. Only age and male sex were independent predictors of the presence of OSA in these patients. CONCLUSIONS: OSA is common and often undetected in patients with AF, especially in nonobese and/or female patients. Patients may have a normal overall AHI but an abnormal AHI during rapid eye movement sleep. The clinical relevance and therapeutic implications in this subgroup should be further investigated. The clinical features of OSA are not reliable predictors of OSA in patients with AF. A low threshold for detection of OSA, with sleep studies, in these patients may be merited.
Authors: Ahmed S BaHammam; Tetyana Kendzerska; Ravi Gupta; Chellamuthu Ramasubramanian; David N Neubauer; Meera Narasimhan; Seithikurippu R Pandi-Perumal; Adam Moscovitch Journal: Sleep Breath Date: 2015-07-09 Impact factor: 2.816
Authors: P Peromaa-Haavisto; H Tuomilehto; J Kössi; J Virtanen; M Luostarinen; J Pihlajamäki; P Käkelä; M Victorzon Journal: Sleep Med Date: 2017-01-12 Impact factor: 3.492
Authors: E O Bixler; A N Vgontzas; H M Lin; T Ten Have; J Rein; A Vela-Bueno; A Kales Journal: Am J Respir Crit Care Med Date: 2001-03 Impact factor: 21.405
Authors: Rodrigo P Pedrosa; Luciano F Drager; Pedro R Genta; Aline C S Amaro; Murillo O Antunes; Afonso Y Matsumoto; Edmundo Arteaga; Charles Mady; Geraldo Lorenzi-Filho Journal: Chest Date: 2010-02-12 Impact factor: 9.410
Authors: Eyal Shahar; Susan Redline; Terry Young; Lori L Boland; Carol M Baldwin; F Javier Nieto; George T O'Connor; David M Rapoport; John A Robbins Journal: Am J Respir Crit Care Med Date: 2003-01-16 Impact factor: 21.405
Authors: Apoor S Gami; Gregg Pressman; Sean M Caples; Ravi Kanagala; Joseph J Gard; Diane E Davison; Joseph F Malouf; Naser M Ammash; Paul A Friedman; Virend K Somers Journal: Circulation Date: 2004-07-12 Impact factor: 29.690
Authors: Aakash A Bavishi; Rachel M Kaplan; Graham Peigh; Celso L Diaz; Jayson R Baman; Amar Trivedi; Jeremiah Wasserlauf; Mark J Shen; Prasongchai Sattayaprasert; Alexandru B Chicos; Susan Kim; Nishant Verma; Rishi Arora; Albert Lin; Bradley P Knight; Rod S Passman Journal: Pacing Clin Electrophysiol Date: 2019-04-09 Impact factor: 1.976
Authors: Amr Salama; Abdullah Abdullah; Abdul Wahab; George Eigbire; Ryan Hoefen; Ruth Kouides; Nathan Ritter; Hanna Mieszczanska; Richard Alweis Journal: Clin Cardiol Date: 2018-11-24 Impact factor: 2.882
Authors: Samantha Y Starkey; Daniel R Jonasson; Stephanie Alexis; Susan Su; Ravinder Johal; Paul Sweeney; Penelope M A Brasher; John Fleetham; Najib Ayas; Teddi Orenstein; Iqbal H Ahmed Journal: CJC Open Date: 2020-12-03
Authors: G M Traaen; B Øverland; L Aakerøy; T E Hunt; C Bendz; L Sande; S Aakhus; H Zaré; S Steinshamn; O G Anfinsen; J P Loennechen; L Gullestad; H Akre Journal: Int J Cardiol Heart Vasc Date: 2019-12-19