INTRODUCTION: Research has consistently shown that sleep apnea is strongly associated with atrial fibrillation, with several lines of evidence demonstrating that this relationship is bidirectional and that each condition predisposes to and/or exacerbates the other. Many studies have suggested potential pathophysiologic mechanisms underlying this relationship, and that sleep apnea and atrial fibrillation share many of the same cardiovascular risk factors further implies that multiple pathways are likely involved in the mechanistic link between the two. Although the sleep apnea-atrial fibrillation relationship is quite established, numerous aspects of this association still require further study, such as the role of gender and the potential impact of positive airway pressure therapy. A deeper understanding of how these individual factors may be involved in the interrelationship between sleep apnea and atrial fibrillation has important clinical implications, such as for risk stratification and screening of patients. Thus, this study aims to further understand the different aspects and modulating factors of the sleep apnea-atrial fibrillation link, focusing on central sleep apnea as less is known about the central sleep apnea-atrial fibrillation relationship.
METHODS: A total of 153 patients, originally seen at the cardiac electrophysiology clinic at Beth Israel Deaconess Medical Center and subsequently offered home sleep apnea testing, were included in this study. Several databases – home sleep apnea testing results, polysomnography reports, electrocardiogram reports and patient management systems – were used to obtain a variety of data on sleep pathology, high loop gain status, left ventricular ejection fraction and positive airway pressure therapy efficacy and compliance. Patients were considered to have central sleep apnea if home testing results demonstrated a central apnea-hypopnea index of 5 or greater and/or if the patient was documented as having high loop gain on polysomnography. Data were analyzed using the Statistical Package for Social Sciences software in order to examine how factors such as gender and therapy use may affect the sleep apnea-atrial fibrillation relationship, in a patient population with sleep pathology of at least moderate severity.
RESULTS: Statistical analysis revealed significant sleep disturbances in the central sleep apnea patients compared to the non-central sleep apnea patients. Gender was found to be significantly associated with central sleep apnea, but not obstructive sleep apnea. When postmenopausal (age≥51) women were analyzed, very few patients met the study criteria for central sleep apnea, yet the majority were documented as having atrial fibrillation. As expected, positive airway pressure therapy was found to be beneficial for all users, but the common pattern of declining compliance to therapy was seen as adherence decreased over the course of three months. Of the select central sleep apnea patients who had sufficient data available, comparison of positive airway pressure therapy and cardiac data revealed possible benefits to cardiac health with compliant use of positive airway pressure therapy.
CONCLUSION: Through examining different aspects of the sleep apnea-atrial fibrillation relationship, this study found promising evidence showing that gender and positive airway pressure therapy play important roles. Further studies, with larger sample sizes, need to be conducted in order to fully understand the specific impact of factors such as gender, gender and age and positive airway pressure therapy on the risks and outcomes in patients with sleep apnea and/or atrial fibrillation, and how these factors may change depending on the type of sleep apnea. Finally, these results further highlight the growing need for an effective collaborative care model between cardiologists and sleep medicine clinicians, as the management of patients with sleep apnea and atrial fibrillation requires an interdisciplinary approach in order to deliver the most optimal patient care.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/41285 |
| Date | 10 July 2020 |
| Creators | Lee, Deborah |
| Contributors | Thomas, Robert J., Auerbach, Sanford H. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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