Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea

Background Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG). Objectives To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA. Methods 40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00. Results The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group. Conclusion A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

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P095 Heart Rate Variability during Sleep in Paroxysmal Atrial Fibrillation patients with and without Obstructive Sleep Apnoea

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.139 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A52-A52

Author(s):

A Mohammadieh ◽

H Dissanayake ◽

K Sutherland ◽

S Ucak ◽

P de Chazal ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Obstructive Sleep Apnoea ◽

Paroxysmal Atrial Fibrillation ◽

Sleep Apnoea ◽

Relative Reduction ◽

Obstructive Sleep ◽

Sympathetic Modulation ◽

Ectopic Beats

Abstract Introduction Physiological studies have demonstrated the importance of the autonomic nervous system in mediating acute apnoea-induced atrial fibrillation (AF). We aimed to compare Heart Rate Variability (HRV) markers of autonomic function in paroxysmal atrial fibrillation (PAF) patients with and without obstructive sleep apnoea (OSA). A secondary aim was the analysis of ectopic beats in these groups. Methods Nocturnal ECG traces from 89 PAF patients who underwent in-laboratory polysomnography were included. After identifying ectopic beats in the ECGs, periods of arrhythmia as well as sleep apnoea events were excluded. HRV time and frequency domains were reported by sleep stage (REM vs Non-REM) for patients with and without OSA. Results Frequency domain analysis of HRV during non-REM sleep in PAF patients with OSA showed increased cardiac parasympathetic modulation (HF-nu: 39.13 ± 15.74 vs 47.98 ± 14.60, p = 0.008*) and reduced cardiac sympathetic modulation (LF/HF ratio: 2.05 ± 2.02 vs 1.17 ± 0.98, p = 0.007*). Results remained significant after adjusting for age, sex and BMI (adjusted p values 0.024 and 0.018 respectively). PAF patients with severe OSA (AHI ≥ 30/hr) had more AF beats and Ventricular Ectopic Beats than those without severe OSA (22.7 ± 42.8% vs 3.7 ± 17.9%, p = 0.006*, 1.7 ± 3.8 vs 0.3 ± 0.9%, p = 0.004* respectively). Conclusions This is the first study of HRV in AF patients with and without OSA. It suggests a chronic increase in parasympathetic nervous modulation and relative reduction in sympathetic modulation in PAF patients with OSA.

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Incidence and Implications of Obstructive Sleep Apnoea in Patients Presenting for Atrial Fibrillation Ablation: A Prospective Study

Heart Lung and Circulation ◽

10.1016/j.hlc.2009.05.342 ◽

2009 ◽

Vol 18 ◽

pp. S151

Author(s):

H. Dimitri ◽

D. Leong ◽

M. Shirazi ◽

M. Ng ◽

J. Parnell ◽

...

Keyword(s):

Atrial Fibrillation ◽

Prospective Study ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Atrial Fibrillation Ablation ◽

Obstructive Sleep ◽

A Prospective Study

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Atrial fibrillation and sleep apnoea and chronic obstructive pulmonary disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0527_update_001 ◽

2018 ◽

pp. 2235-2237

Author(s):

Tauseef Akhtar ◽

Jared D. Miller ◽

Hugh Calkins

Keyword(s):

Atrial Fibrillation ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Risk Factor Modification ◽

Obstructive Sleep ◽

P Rate

Rate control, rhythm control, and anticoagulation are well entrenched as the three central pillars of atrial fibrillation (AF) management. Risk factor modification of other associated co-morbidities is now emerging as a critical fourth pillar in the prevention and management of AF. Obstructive sleep apnoea and chronic obstructive pulmonary disease, in particular, have important implications in the development of AF and appropriate selection of therapy. This chapter reviews the pathophysiology and clinical evidence linking these conditions with AF. In addition, it discusses important considerations in the management of concurrent AF and obstructive sleep apnoea or chronic obstructive pulmonary disease.

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Atrial fibrillation and sleep apnoea and chronic obstructive pulmonary disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0527 ◽

2018 ◽

pp. 2235-2237

Author(s):

Jared D. Miller ◽

Hugh G. Calkins

Keyword(s):

Atrial Fibrillation ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Risk Factor Modification ◽

Obstructive Sleep ◽

P Rate

Rate control, rhythm control, and anticoagulation are well entrenched as the three central pillars of atrial fibrillation (AF) management. Risk factor modification of other associated co-morbidities is now emerging as a critical fourth pillar in the prevention and management of AF. Obstructive sleep apnoea and chronic obstructive pulmonary disease, in particular, have important implications in the development of AF and appropriate selection of therapy. This chapter reviews the pathophysiology and clinical evidence linking these conditions with AF. In addition, it discusses important considerations in the management of concurrent AF and obstructive sleep apnoea or chronic obstructive pulmonary disease.

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Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2020-214544 ◽

2020 ◽

Vol 75 (12) ◽

pp. 1095-1102 ◽

Cited By ~ 1

Author(s):

Maurice Roeder ◽

Matteo Bradicich ◽

Esther Irene Schwarz ◽

Sira Thiel ◽

Thomas Gaisl ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Evidence Synthesis ◽

Meta Analysis ◽

Sleep Apnoea ◽

Study Data ◽

Sleep Study ◽

Diagnostic Threshold ◽

Respiratory Events ◽

Obstructive Sleep ◽

Significant Difference

BackgroundIt is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.MethodsWe evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).ResultsOf 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.ConclusionWhile there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.

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