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Obstructive sleep apnea in atrial fibrillation patients
International Journal of Cardiology 110 (2006) 426 www.elsevier.com/locate/ijcard
Letter to the Editor
Obstructive sleep apnea in atrial fibrillation patients Miguel A. Arias a,*, Alberto Alonso-Ferna´ndez b, Francisco Garcı´a-Rı´o b, Ana Sa´nchez a, Juana M. Lo´pez a, Carlos Pagola a a
Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Jae´n, Jae´n, Spain b Neumology Service, Hospital Universitario La Paz, Madrid, Spain Received 15 September 2005; accepted 20 September 2005 Available online 23 November 2005
Abstract A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. D 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Apnea; Hypoxemia; Atrial fibrillation
To the Editor, We read with great interest the article by Korantzopoulos et al. [1], who reviewed in detail, both the errors and pitfalls in the non-invasive management of atrial fibrillation. We want to focus our comment on one other non-invasive strategy which has been proved to be an additional preventive therapy for many atrial fibrillation patients. Obstructive sleep apnea affects 17% to 24% of North Americans adults [2], and a high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation [3]. Obstructive sleep apnea induces intermittent hypoxemia, carbon dioxide retention, sympathetic activation, and abrupt surges in arterial pressure, and it is conceivable that these factors would predispose to the development of atrial fibrillation in a heart susceptible to such cardiac arrhythmia. Indeed, among obstructive sleep apnea patients who underwent electrical cardioversion for atrial fibrillation, in those correctly treated with continuous positive airway pressure, the treatment of choice for this sleep-related disorder [4], a reduction in the recurrence rate * Corresponding author. Pza del Zodiaco N-8, 5-B, 23009 Jae´n, Spain. Tel.: +34 637 46 38 57; fax: +34 953 27 06 92. E-mail address: [email protected] (M.A. Arias). 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.09.039
for atrial fibrillation throughout one year follow-up by nearly 50% was reported, in comparison with those with untreated obstructive sleep apnea [5]. Those data emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. References [1] Korantzopoulos P, Kolettis TM, Goudevenos JA, Siogas K. Errors and pitfalls in the non-invasive management of atrial fibrillation. Int J Cardiol 2005;104:125 – 30. [2] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217 – 39. [3] Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110:364 – 7. [4] Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862 – 5. [5] Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003;107:2589 – 94.
Letter to the Editor
Obstructive sleep apnea in atrial fibrillation patients Miguel A. Arias a,*, Alberto Alonso-Ferna´ndez b, Francisco Garcı´a-Rı´o b, Ana Sa´nchez a, Juana M. Lo´pez a, Carlos Pagola a a
Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Jae´n, Jae´n, Spain b Neumology Service, Hospital Universitario La Paz, Madrid, Spain Received 15 September 2005; accepted 20 September 2005 Available online 23 November 2005
Abstract A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. D 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Apnea; Hypoxemia; Atrial fibrillation
To the Editor, We read with great interest the article by Korantzopoulos et al. [1], who reviewed in detail, both the errors and pitfalls in the non-invasive management of atrial fibrillation. We want to focus our comment on one other non-invasive strategy which has been proved to be an additional preventive therapy for many atrial fibrillation patients. Obstructive sleep apnea affects 17% to 24% of North Americans adults [2], and a high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation [3]. Obstructive sleep apnea induces intermittent hypoxemia, carbon dioxide retention, sympathetic activation, and abrupt surges in arterial pressure, and it is conceivable that these factors would predispose to the development of atrial fibrillation in a heart susceptible to such cardiac arrhythmia. Indeed, among obstructive sleep apnea patients who underwent electrical cardioversion for atrial fibrillation, in those correctly treated with continuous positive airway pressure, the treatment of choice for this sleep-related disorder [4], a reduction in the recurrence rate * Corresponding author. Pza del Zodiaco N-8, 5-B, 23009 Jae´n, Spain. Tel.: +34 637 46 38 57; fax: +34 953 27 06 92. E-mail address: [email protected] (M.A. Arias). 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.09.039
for atrial fibrillation throughout one year follow-up by nearly 50% was reported, in comparison with those with untreated obstructive sleep apnea [5]. Those data emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. References [1] Korantzopoulos P, Kolettis TM, Goudevenos JA, Siogas K. Errors and pitfalls in the non-invasive management of atrial fibrillation. Int J Cardiol 2005;104:125 – 30. [2] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217 – 39. [3] Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110:364 – 7. [4] Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862 – 5. [5] Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003;107:2589 – 94.