Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

May, Anna; Blackwell, Terri; Stone, Peter H.; Stone, Katie L.; Cawthon, Peggy M.; Sauer, William H.; Varosy, Paul D.; Redline, Susan; Mehra, Reena

doi:10.1164/rccm.201508-1523oc

Cited by 73 publications

(51 citation statements)

References 52 publications

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“…Thus, our findings extend the previous work, in which CSA was more strongly associated with AF than OSA, but which were limited by cross‐sectional designs, which precluded assessment of the directional relationship between CSA and AF. More recently, a prospective analysis found that CSA and CSR predicted the risk of AF in a community‐based sample of older men . Our study extends these results by showing similar findings in both men and women across a wider age range, and further shows the persistence of findings even after adjusting for ECG‐based indices of left ventricular hypertrophy.…”

Section: Discussionsupporting

confidence: 85%

“…Notably, approximately one quarter of those with CSA and 30% with CSA‐CSR developed AF, suggesting that the presence of CSA or CSR may be used to target individual patients for AF risk reduction. This is similar to estimates of AF and CSA from other cohorts . Further study is needed to understand the specific mechanisms underlying the association of central apnea and AF, and to evaluate the efficacy of treatment of CSA on the development, treatment, and prognosis of AF.…”

Section: Discussionsupporting

confidence: 73%

See 1 more Smart Citation

Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women

Tung¹,

Levitzky

Wang

et al. 2017

JAHA

Self Cite

109

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BackgroundPrevious studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies.Methods and ResultsWe assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community‐based study of existing (“parent”) cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12‐lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea‐hypopnea index (OAHI). CSA was defined by a central apnea index ≥5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow‐up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2‐ to 3‐fold increased odds of developing AF (central apnea index ≥5 odds ratio [OR], 3.00, 1.40–6.44; Cheyne–Stokes respiration OR, 1.83, 0.95–3.54; CSA or Cheyne–Stokes respiration OR, 2.00, 1.16–3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91–1.03; OAHI 5 to <15 OR, 0.84, 0.59–1.17; OAHI 15 to <30 OR, 0.93, 0.60–1.45; OAHI ≥30 OR, 0.76, 0.42–1.36).ConclusionsIn a prospective, community‐based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 73%

Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women

Tung¹,

Levitzky

Wang

et al. 2017

JAHA

Self Cite

109

View full text Add to dashboard Cite

show abstract

“…These disorders are subcategorized into obstructive sleep apnoea (OSA) disorders, central sleep apnea disorders, sleep-related hypoventilation disorders and sleep-related hypoxemia disorders [9]. It is well documented that SBDs are a risk factor for cognitive impairment [19], type 2 diabetes [20], early renal damage [21], heart failure [22], atrial fibrillation [23], coronary disease [24], as well as ischemic stroke [25]. The most common treatments for SBDs are continuous positive airway pressure (CPAP), surgery, oral appliances, postural therapy and weight loss.…”

Section: Effect Of Melatonin On Reducing the Complications Caused By mentioning

confidence: 99%

A review of sleep disorders and melatonin

Xie

Chen

et al. 2017

Neurological Research

315

181

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Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis and cause significant impairments in social and occupational functions. Although currently approved medications are efficacious, they are far from satisfactory. Benzodiazepines, antidepressants, antihistamines and anxiolytics have the potential for dependence and addiction. Moreover, some of these medications can gradually impair cognition. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland and released exclusively at night. Exogenous melatonin supplementation is well tolerated and has no obvious short-or long-term adverse effects. Melatonin has been shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. It is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation and neuronal survival. This narrative review aims to provide a comprehensive overview of various therapeutic functions of melatonin in insomnia, sleep-related breathing disorders, hypersomnolence, circadian rhythm sleep-wake disorders and parasomnias. Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects.

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“…This sleep disorder rarely improves without treatment, and it may contribute to the progression of underlying cardiovascular disease and associated co-morbidities. 12 Although not proven, it can be hypothesized that reducing hypoxia and nocturnal arousals with phrenic nerve stimulation may decrease the associated risks of myocardial or cerebral ischemia, sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction, which may also attenuate the progression of diseases such as heart failure. However, as previously described, 9 other therapies with mechanisms of action that differ substantially from phrenic nerve stimulation reduced AHI but have not improved survival or the composite end point of cardiovascular morbidity or mortality in patients with CSA.…”

Section: Discussionmentioning

confidence: 99%

Sustained 12 Month Benefit of Phrenic Nerve Stimulation for Central Sleep Apnea

Costanzo

Ponikowski

Javaheri

et al. 2018

The American Journal of Cardiology

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Transvenous phrenic nerve stimulation improved sleep metrics and quality of life after 6 months versus control in the remedē System Pivotal Trial. This analysis explored the effectiveness of phrenic nerve stimulation in patients with central sleep apnea after 12 months of therapy. Reproducibility of treatment effect was assessed in the former control group in whom the implanted device was initially inactive for the sixth month and subsequently activated when the randomized control assessments were complete. Patients with moderate-to-severe central sleep apnea implanted with the remedē System were randomized to therapy activation at 1 month (treatment) or after 6 months (control). Sleep indices were assessed from baseline to 12 months in the treatment group and from 6 to 12 months in former controls. In the treatment group, a ≥50% reduction in apnea-hypopnea index occurred in 60% of patients at 6 months (95% confidence interval [CI] 47% to 64%) and 67% (95% CI 53% to 78%) at 12 months. After 6 months of therapy, 55% of former controls (95% CI 43% to 67%) achieved ≥50%reduction in apnea-hypopnea index. Patient Global Assessment was markedly ormoderately improved at 6 and 12 months in 60% of treatment patients.Improvements persisted at 12 months. A serious adverse event within 12 months occurred in 13 patients (9%). Phrenic nerve stimulation produced sustained improvements in sleep indices and quality of life to at least 12 months in patients with central sleep apnea. The similar improvement of former controls after 6 months of active therapy confirms benefits are reproducible and reliable.

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Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

Cited by 73 publications

References 52 publications

Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women

Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women

A review of sleep disorders and melatonin

Sustained 12 Month Benefit of Phrenic Nerve Stimulation for Central Sleep Apnea

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