Up to 15% of all strokes are caused by Atrial fibrillation (AF) increasing the risk of stroke by 4.8% (hypertension 3.4% and CAD 2.4% respectively). It is the most common type of arrhythmia, affecting approximately 350,000 Canadians.
Atrial fibrillation and obstructive sleep apnea (OSA)
This risk increases with age, beyond age 60, one-third of all strokes are caused by AF. with, 3-5 times greater risk for ischemic stroke, and cryptogenic strokes accounting for 25% of the total.
A strong association exists between OSA and AF; OSA is clearly more prevalent in patients with AF than even high-risk patients with multiple other cardiovascular diseases yet OSA does not appear in the CHADS2 Risk Criteria (used as a determination of the risk associated with anticoagulant therapy for AF.)
With AF patients scheduled for electro-cardioversion, two 2009 studies establishing a prevalence of OSA were 42.7% and 81.6% respectively.
OSA more commonly observed in patients with AF and the incidence of AF is considerably higher in those with OSA. In the Sleep Heart Health Study (2006) patients with severe OSA had a 4-fold increased risk for AF.
Proposed pathophysiologic mechanisms linking OSA to the development of AF. Include complex interactions of hemodynamic and sympathetic results of OSA (including autonomic dysregulation, elevated sympathetic tone, oxidative stresses, endothelial dysfunction, and left atrial stretch.
Given the prevalence of OSA among patients with AF and its impact on outcomes, clinicians are recommended to assess individuals with AF for sleep disordered breathing and specific treatment of snoring and OSA may be needed to reduce risk of recurrence.
In the 2013 study by Neilan only half of patients diagnosed with OSA were adherent to CPAP, therefore other therapeutic modalities such as oral appliance therapy clearly have their place. Their conclusions;
Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI.
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Dr. Stephen Bray 2019