Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disorder with a growing incidence worldwide that closely mirrors the global obesity epidemic. OSA is associated with enormous healthcare costs in addition to significant morbidity and mortality. Much of the morbidity and mortality related to OSA can be attributed to an increased burden of cardiovascular disease, including cardiac rhythm disorders. Awareness of the relationship between OSA and rhythm disorders is variable among physicians, a fact that can influence patient care, since the presence of OSA can influence the incidence, prevalence, and successful treatment of multiple rhythm disorders. Herein, we provide a review of this topic that is intentionally broad in scope, covering the relationship between OSA and rhythm disorders from epidemiology and pathophysiology to diagnosis and management, with a particular focus on the recognition of undiagnosed OSA in the general clinical population and the intimate relationship between OSA and atrial fibrillation.
Highlights
Decades of data from several large prospective patient registries have revealed that sleep apnea—in particular, obstructive sleep apnea (OSA)—is practically endemic in cardiology clinics and cardiac inpatient wards across the globe [1,2]
While it is not solely specific to sleepiness caused by sleep apnea, the Epworth sleepiness scale (ESS) scale has been well validated in the Obstructive sleep apnea (OSA) population and is a reliable gauge for symptom severity
Recent studies have suggested that measures of oxygen desaturation, such as the percentage of sleep time spent with an oxygenation saturation below 90% (T90) or 88% (T88) or the lowest saturation achieved during sleep, may better predict adverse cardiac events than the apnea hypopnea index (AHI) [23]
Summary
Sleep apnea is a highly prevalent disorder among patients with all forms of cardiovascular disease. Historical features that are strongly suggestive of OSA include loud snoring and witnessed apneas or gasping for air during sleep This element of the history often requires an interview with the patient’s bed partner for confirmation. While it is not solely specific to sleepiness caused by sleep apnea, the ESS scale has been well validated in the OSA population and is a reliable gauge for symptom severity. This matters because the presence of subjective and objective sleepiness correlates with greater expression of pro-inflammatory biomarkers and a greater overall risk for adverse cardiac events than the absence of OSA symptoms [19].
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