Interactions of Sleep Apnea, the Autonomic Nervous System, and Its Impact on Cardiac Arrhythmias

Abstract

Sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular disease. SDB-related changes in the autonomic nervous system (ANS) and the association between obstructive sleep apnea and atrial fibrillation (Afib) have been extensively researched. SDB has also been associated with occurrence of ventricular arrhythmias. We evaluated the effects of SDB on the ANS and its relationship with ventricular and supraventricular arrhythmias. The ANS is an important regulator of the cardiovascular system and contributes to the development of cardiovascular diseases including hypertension and coronary artery disease. SDB has an important influence on the ANS and contributes to electromechanical remodeling of the left atrium via a number of mechanisms, increasing susceptibility to Afib. There is evidence that these mechanisms also affect the ventricular myocardium and therefore lead to ventricular arrhythmias. Effective treatment of SDB reduces the rate of Afib recurrence and seems to reduce ventricular arrhythmogenicity. SDB has an important impact on the ANS and therefore plays a major role in the development of cardiac arrhythmias. Although SDB screening of patients with Afib is recommended by current guidelines, SDB remains underdiagnosed. Additional research is needed to clarify the role of SDB and its treatment in ventricular arrhythmias.