REVIEW ARTICLE Obstructive sleep apnea, atrial fibrillation, and erectile dysfunction... 701Clinical scenarios A 55-year-old man with diabetes and hypertension was admitted for the ablation of a source of AF. He had been diagnosed with paroxysmal AF 4 years before. His AF attacks caused palpitations, reduced exercise capacity, and breathlessness, and flared as often as once every 3 to 6 months. The symptoms were classified as being European Heart Rhythm Association (EHRA) class III. The patient said that, apart from arterial hypertension and diabetes, he was otherwise healthy. He was taking warfarin, metformin 500 mg bid, ramipril 5 mg od, with good glucose and blood pressure control. AF was recorded both on standard electrocardiogram (ECG) and during 24-hour ambulatory ECG monitoring. He was admitted 1 day prior to the procedure. During the night, other patients complained that he snored very loudly and had episodes of apnea. When he was interviewed, he reported that his wife often complained about his loud snoring and that he experienced daytime sleepiness. He also said that he had been having erectile problems for about 2 years. We decided to proceed with the ablation and scheduled polysomnography after the procedure, and he was referred for further consultation. After performing a transesophageal echocardiography (which did not reveal any thrombi in the left atrial appendage, but showed an enlargement of the left atrium, confirmed also later with transthoracic echocardiography with the following results: left atrium, 5.9 × 6.8 cm; area, 33.7 cm 2 ; volume 135 cm 3 ); the pulmonary vein was isolated. Polysomnography showed an apnea-hypopnea index (AHI) of 43.8/h and a mean night-time blood oxygen saturation of 91.3%. After the diagnosis of severe REVIEW ARTICLEObstructive sleep apnea, atrial fibrillation, and erectile dysfunction: are they only coexisting conditions or a new clinical syndrome? The concept of the OSAFED syndrome AbsTRACTPatients rarely suffer from only 1 disease. Most of them have several conditions with common risk factors and etiology, and which often increase the severity of each other. The phenotypes linked to 1 condition are often linked to many others. We describe 3 patients with obstructive sleep apnea (OSA), atrial fibrillation (AF), and erectile dysfunction (ED), all of which are highly prevalent in the general population. OSA is one of the most common sleep disorders, affecting approximately 24% of men and 9% of women between 30 and 60 years of age. AF is one of the most common arrhythmias, present in approximately 2% of the population, and erectile dysfunction can be found in 18% to 40% of the male population older than 20 years. The presence of these 3 conditions in the same patient may be not only a coincidence but rather a new clinical syndrome. We present data which allow one to consider OSA, AF, and ED as parts of a clinical syndrome: OSAFED (obstructive sleep apnea, atrial fibrillation, and erectile dysfunction), with a larger effect on the cardiovascular risk profile than th...

Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation MI. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading cause of AMI was coronary artery spasm.

OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.

Sexual dysfunctions are highly prevalent in AF patients and are not only limited to ED, but also include dysfunction of orgasmic function, desire, or general satisfaction. In part, the presence of the sexual dysfunctions is probably caused by classical cardiovascular risk factors highly prevalent in AF patients, but the impact of AF itself cannot be underestimated.

Endothelial dysfunction is common in HIV-infected patients. In general, none of the analysed factors had an effect on endothelial function but cART had a negative effect on arterial stiffness.