Abstract
In patients with obstructive sleep apnea (OSA), an increased prevalence of atrial fibrillation (AF) has been reported. 1 Mehra R. Benjamin E.J. Shahar E. et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006; 173: 910-916 Crossref PubMed Scopus (885) Google Scholar , 2 Gami A.S. Pressman G. Caples S.M. et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004; 110: 364-367 Crossref PubMed Scopus (854) Google Scholar An appropriate treatment of OSA with continuous positive airway pressure is associated with a lower recurrence of the arrhythmia. 3 Kanagala R. Murali N.S. Friedman P.A. et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003; 107: 2589-2594 Crossref PubMed Google Scholar This suggests a causal relationship between OSA and AF. It has been postulated that OSA causes AF by systemic hypertension, diastolic dysfunction, and the resultant long-term atrial remodeling. 4 Parish J.M. Somers V.K. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc. 2004; 79: 1036-1046 Abstract Full Text Full Text PDF PubMed Scopus (385) Google Scholar However, OSA seems to be an independent risk factor for AF. 1 Mehra R. Benjamin E.J. Shahar E. et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006; 173: 910-916 Crossref PubMed Scopus (885) Google Scholar The exact pathophysiology is unclear. In this issue of HeartRhythm, Dimitri et al 5 Dimitri H. Ng M. Brooks A.G. Kuklik P. et al. Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart Rhythm. 2012; 9: 321-327 Abstract Full Text Full Text PDF PubMed Scopus (224) Google Scholar address this important topic. They invasively characterized atrial electrophysiology in the presence versus absence of OSA in patients with paroxysmal AF. They describe larger atrial volumes, conduction disturbances, extensive areas of low voltage, and regions of electrical silence in OSA, whereas atrial effective refractory periods were similar in both groups. A larger myocardial mass and conduction disturbances are known to promote reentry arrhythmias. Therefore, this study strongly suggests that OSA induces an arrhythmogenic atrial structural remodeling, perpetuating paroxysms of AF not solely during nocturnal apneic episodes but also when awake. Likely, this is one important electrophysiological link between chronic OSA and the arrhythmia. Atrial remodeling in obstructive sleep apnea: Implications for atrial fibrillationHeart RhythmVol. 9Issue 3PreviewThere is a known association between obstructive sleep apnea (OSA) and atrial fibrillation (AF); however, how OSA affects the atrial myocardium is not well described. Full-Text PDF
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