Abstract
BackgroundThere is growing evidence of a strong association between obstructive sleep apnea (OSA) and cardiovascular co-morbidities including atrial fibrillation (AF). We wanted to assess the usefulness of the overnight cardiac monitoring to screen for AF during the sleep study in patients newly diagnosed with OSA, in order to establish the usefulness of overnight active screening for subclinical AF during the sleep study in these patients.MethodsA retrospective study in patients with new diagnosis of OSA carried out between January 2014 and December 2019 in the sleep clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All patients newly diagnosed with OSA (apnea-hypopnea index >5) were selected to undergo a clinical questionnaire regarding symptoms, co-morbidities and risk factors. Subjects with history of cardiac arrhythmias or having anti-arrhythmic treatment were excluded. Eligible patients underwent an overnight rhythm monitoring to screen for AF or any rhythm disturbance.ResultsWe included 250 respective patients with OSA, 54% were males and 82% aged more than 35 years. The majority of patients were married (83%), of Saudi nationality (81%), and 90% were overweight or obese, apnea hypopnea index (AHI) was mild (5-14) in 30%, moderate (15-29) in 38% and severe (30 or more) in 32% of the patients. No cardiac arrhythmia was detected in all the study population, while only two patients complained of palpitations and was due to sinus tachycardia. Assessment of other risk factors showed 26% cases of diabetes mellitus, 39% of hypertension, 1% of renal failure, 9% of ischemic heart disease, 17% of thyroid dysfunction, 6% of stroke and 4% of dyslipidemia.ConclusionThe findings of this study show null incidence of cardiac arrhythmia during the apnea-hypopnea episodes in a cohort of patients with confirmed OSA. However, in view of the frequently reported association, the screening for subclinical atrial fibrillation needs long-term rhythm surveillance and should be targeted to symptomatic patients.
Highlights
Obstructive sleep apnea (OSA) is characterized by repetitive closure of the upper airway leading oxygen desaturations and sleep disturbance causing variety of symptoms such as snoring and daytime fatigue and tiredness [1]
No cardiac arrhythmia was detected in all the study population, while only two patients complained of palpitations and was due to sinus tachycardia
This study aims to establish the usefulness of overnight active screening for subclinical atrial fibrillation (AF) during sleep study, in patients newly diagnosed with obstructive sleep apnea (OSA) and who have no history of arrhythmia
Summary
Obstructive sleep apnea (OSA) is characterized by repetitive closure of the upper airway leading oxygen desaturations and sleep disturbance causing variety of symptoms such as snoring and daytime fatigue and tiredness [1]. One in three middle-aged Saudi males were reported to be at risk of OSA [2,4]. Owing to its close association with increased risk of sudden death and high cardiovascular morbidity including atrial fibrillation (AF), OSA is considered to be one of the most severe types of sleep-related breathing disorders [5,8,9]. The association of OSA with cardiac arrhythmias was evidenced since late 1970s, the exact pathophysiological mechanisms are still uncertain [10]. Several pathophysiological mechanisms associated with OSA are considered for either triggering or maintaining the. There is growing evidence of a strong association between obstructive sleep apnea (OSA) and cardiovascular co-morbidities including atrial fibrillation (AF). We wanted to assess the usefulness of the overnight cardiac monitoring to screen for AF during the sleep study in patients newly diagnosed with OSA, in order to establish the usefulness of overnight active screening for subclinical AF during the sleep study in these patients
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