Central sleep apnea and atrial fibrillation: A review on pathophysiological mechanisms and therapeutic implications

Sánchez, Alexandra; Germany, Robin; Lozier, Matthew R.; Schweitzer, M.D.; Kosseifi, Semaan G.; Anand, Rishi

doi:10.1016/j.ijcha.2020.100527

Cited by 25 publications

(27 citation statements)

References 97 publications

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“…However, delineation of the link between OSA and AF is challenging due to the multiple shared risk factors between the two entities, including older age, male sex, hypertension, CHF, and coronary artery disease 15 . Emerging evidence suggests that CSA may also play an important role in AF pathogenesis even in patients without comorbidities that are often associated with CSA, such as opioid‐dependence, CHF, or acute stroke 14,20 . Our results suggest an association between AF and CSA, as the prevalence of CSA was significantly higher in patients with AF than in those without.…”

Section: Discussionmentioning

confidence: 64%

Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography

Harmon

Stafford

Ibrahim

et al. 2020

Journal of Arrhythmia

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Introduction Sleep apnea is highly prevalent in patients with atrial fibrillation (AF). Obstructive sleep apnea (OSA) is the most common type, and best studied in the context of AF. However, recent investigations have indicated that central sleep apnea (CSA) may be a risk factor for incident AF. We evaluated the burden of CSA events in patients referred for diagnostic polysomnography (PSG) and whether AF is associated with CSA. Methods We identified patients with and without a history of AF who underwent clinically indicated PSG in a matched manner. OSA was defined as obstructive apnea‐hypopnea index (AHI) ≥15/h, and CSA was defined as central apnea index (CAI) ≥5/h. The association between AF and CSA was evaluated using multivariable logistic regression. Results Among 465 patients included, mean AHI was 25.5/h, and mean CAI was 1.7/h. OSA prevalence was 53.3%, while CSA prevalence was 8.4%. The prevalence of OSA in the AF and non‐AF groups (54.7% vs 52.0%, P = .56) was similar. CSA was more common in the AF group (12.3% vs 4.4%, P = .002). In multivariable analysis, AF (OR: 2.19 [1.02, 5.03], P = .05), male gender (OR: 2.5 [1.17, 5.84], P = .02), and older age (OR: 2.44, [1.16, 5.46], P = .02) were associated with CSA. Conclusion Though CSA is much less common than OSA in patients with AF, the presence of AF is independently associated with CSA.

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Section: Discussionmentioning

confidence: 64%

Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography

Harmon

Stafford

Ibrahim

et al. 2020

Journal of Arrhythmia

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“…Further studies are required to determine whether CSA treatment by e.g. adaptive servoventilation or transvenous phrenic nerve stimulation should be recommended in AF patients [21] .…”

Section: Which Sdb Should Be Treated In Af Patients?mentioning

confidence: 99%

Sleep apnea and atrial fibrillation: Update 2020

Linz

Dobrev

2020

IJC Heart & Vasculature

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“…Many studies show an association between OSA and AF [2] . Moreover, several studies recently have indicated there was an association between CSA/CSB and AF in the general population [3] , [4] , [5] , [6] , [7] . However, few studies focused on the impact on ethnicity on the association between CSA and AF even though the prevalence and characteristics of CSA vary among ethnic groups.…”

Section: Introductionmentioning

confidence: 99%

Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study

Anzai

Grandinetti

Katz

et al. 2021

IJC Heart & Vasculature

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Introduction Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men. Methods We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79–90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5–10 min period of a crescendo-decrescendo respiratory pattern associated with CSA. Results The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95–11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09–4.01). CSB showed similar trends as CSA. Conclusions After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.

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Central sleep apnea and atrial fibrillation: A review on pathophysiological mechanisms and therapeutic implications

Cited by 25 publications

References 97 publications

Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography

Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography

Sleep apnea and atrial fibrillation: Update 2020

Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study

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