The prevalence of sleep breathing disorders in patients with atrial fibrillation undergoing catheter treatment
https://doi.org/10.20996/1819-6446-2019-15-1-36-42
Abstract
Aim. To study the prevalence of obstructive sleep apnea (OSA) among patients with atrial fibrillation (AF) who have undergone catheter treatment for this arrhythmia, as well as to study the possible interrelationships of these sleep breathing disorders with comorbid diseases and the received therapy in this cohort.
Material and methods. 231 patients from a random sample were examined (men – 118 [51.1%], mean age 57.8±9.3 years) in the range of 1-6 months after catheter therapy for AF. All patients underwent cardiorespiratory sleep monitoring for one night. The criterion for OSA severity was apnea/hypopnea index (AHI) for hour (the norm is less than 5 events/h). Depending on the results obtained, all patients were divided into groups without apnea and with apnea of varying severity – a mild degree with an AHI value of 5 to 15 events/h, moderate severity with an AHI value of 16 to 30 events/h, and severe degree when the value of AHI more than 30 events/h. The study was performed without abolishing the basic therapy.
Results. According to the results of cardiorespiratory sleep monitoring 127 patients (56.7%) with OSA criteria, were registered. Among them, a mild degree of OSA was found in 35.4% (n=45), a moderate degree – in 40.9% (n=52), and severe one – in 23.7% (n=30) of all patients with apnea. Among patients with obstructive sleep apnea 51.1% were males. Arterial hypertension was significantly more frequent in patients with OSA of pronounced degrees of severity compared with patients without apnea (p=0.047). Weight and body mass index of patients with OSA were significantly higher than in patients without apnea (p=0.001 and p=0.001, respectively). The left atrium (LA) size in patients with severe OSA was significantly larger than in patients without apnea (p=0.0005), which may indicate a possible contribution of severe obstructive apnea to the arrhythmia generating. OSA was the strongest independent factor among others related to the LA size (odds ratio was 1.6; 95% confidence interval 1.2-2.1; p<0.0003).
Conclusion. Obstructive sleep apnea is very widespread among a cohort of patients with AF who have undergone a catheter procedure to isolate the pulmonary veins. Sleep breathing disorder is the strongest and most independent risk factor for AF associated with increased LA, among other risk factors such as age, hypertension, and obesity.
About the Authors
M. V. Agaltsov
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
MD, PhD, Senior Researcher, Department of Fundamental and Applied Aspects of Obesity,
Petroverigsky per. 10, Moscow, 101990
O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
MD, PhD, Professor, Corresponding Member of the Russian Academy of Science, Head of Department of Fundamental and Applied Aspects of Obesity, Director of National Medical Research Center for Preventive Medicine,
Petroverigsky per. 10, Moscow, 101990
K. V. Davtyan
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
MD, PhD, Professor, Head of Department of Interventional Arrhythmology,
Petroverigsky per. 10, Moscow, 101990
G. G. Arutyunyan
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
MD, Post-Graduate Student, Department of Interventional Arrhythmology,
Petroverigsky per. 10, Moscow, 101990
References
1. Wolf P.A., Benjamin E.J., Belanger A.J., et al. Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J. 1996;131:790-5. doi:10.1016/S0002-8703(96)90288-4.
2. Chugh S., Havmoeller R., Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation. A Global Burden of Disease 2010 Study. Circulation. 2014;129:837-47. doi:10.1161/CIRCULATIONAHA.113.005119.
3. Krijthe B.P., Kunst A., Benjamin E.J.,https://www.ncbi.nlm.nih.gov/pubmed/?term=Heeringa%20J%5BAuthor%5D&cauthor=true&cauthor_uid=23900699 et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746-51. doi:10.1093/eurheartj/eht280.
4. Piccini J.P., Hammill B.G., Sinner M.F., et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes. 2012;5:85- 93. doi:10.1161/CIRCOUTCOMES.111.962688.
5. Stewart S., Hart C.L., Hole D.J., et al. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113:359-64. doi:10.1016/S0002-9343(02)01236-6.
6. Soliman E.Z., Safford M.M., Muntner P., et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med. 2014;174:107-14. doi:10.1001/jamainternmed.2013.11912.
7. Gami A.S., Hodge D.O., Herqes R.M., et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. Journal of the American College of Cardiology. 2007;49(5):565-571. doi:10.1016/j.jacc.2006.08.060.
8. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-962. doi:10.1016/j.rec.2016.11.033.
9. Chen L.Y., Shen W.K. Epidemiology of atrial fibrillation: a current perspective. Heart Rhythm. 2007;4:S1-S6. doi:10.1016/j.hrthm.2006.12.018.
10. Cappato R., Calkins H., Chen S.A., et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111(9):1100-5. doi:10.1161/CIRCEP.109.859116.
11. Ernst S., Ouyang F., Löber F., et al. Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation: an electroanatomic study. Journal of the American College of Cardiology. 2003; 42(7):1271-82. doi:10.1016/S0735-1097(03)00940-9.
12. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-962. doi:10.1093/eurheartj/ehw210.
13. Parati G., Lombardi C., Hedner J., et al. EU COST Action B26 members Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523-38. doi:10.1183/09031936.00226711.
14. Epstein L.J., Kristo D., Strollo P.J., et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med, 2009;5:263-76.
15. Szymanski F.M., Filipiak K.J., Platek A.E., et al. Assessment of CHADS2 and CHA2DS2-VASc scores in obstructive sleep apnea patients with atrial fibrillation. Sleep Breath. 2015;19(2):531-7. doi:10.1007/s11325-014-1042-5.
16. Yaranov D.M., Smyrlis A., Usatii N., et al. Effect of obstructive sleep apnea on frequency of stroke in patients with atrial fibrillation. Am J Cardiol. 2015;115(4):461-5. doi:10.1016/j.amjcard. 2014.11.027.
17. Gami A.S., Pressman G., Caples S.M., et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004; 110:364-7. doi:10.1161/01.Cir.0000136587.68725.8e.
18. Ng C.Y., Liu T., Shehata M., et al. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108(1):47-51. doi:10.1016/j.amjcard.2011.02.343.
19. Linz D., McEvoy R.D., Cowie M.R., et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: A Review. JAMA Cardiol. 2018;3(6):532-40. doi:10.1001/jamacardio.2018.0095.
20. Senaratna C.V., Perret J.L., Lodge C.J., et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews. 2017;34:70-81. doi:10.1016/j.smrv.2016.07.002.
21. Narkiewicz K., Somers V.K. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. 2003;177:385-90. doi:10.1046/j.1365-201X.2003.01091.x.
22. Somers V.K., Zavala D.C., Mark A.L., et al. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol. 1989;67:2095-100. doi:10.1152/jappl.1989.67.5.2095.
23. Drager L.F., Bortolotto L.A., Pedrosa R.P., et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea: potential implications for atrial fibrillation. Int J Cardiol. 2010;144:257-59. doi:10.1016/j.ijcard.2009.01.018.
24. Hoffmann M.S., Singh P., Wolk R., et al. Obstructive sleep apnea and intermittent hypoxia increase expression of dual specificity phosphatase 1. Atherosclerosis. 2013;231:378-83. doi:10.1016/j.atherosclerosis.2013.09.033.
25. Kanagala R., Murali N.S., Friedman P.A., et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107:2589-94. doi:10.1161/01.CIR.0000068337.25994.21.
26. Szymanski F., Filipiak K., Platek A. et al. Presence and severity of obstructive sleep apnea and remote outcomes of atrial fibrillation ablations - a long-term prospective, cross-sectional cohort study. Sleep Breath. 2015;19:849-56. doi:10.1007/s11325-014-1102-x.
27. Hoit B.D. Left atrial size and function. Role in prognosis. J Am Coll Cardiol. 2014;63:493-505. doi:10.1016/j.jacc.2013.10.055.
28. Tops L.F., Delgado V., Bertini M., et al. Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation J Am Coll Cardiol. 2011;57:324-31. doi:10.1016/j.jacc.2013.10.055.
29. Hammerstingl C., Schwekendiek M., Momcilovic D., et al. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures J Cardiovasc Electrophysiol. 2012;23:247-55. doi:10.1111/j.1540-8167.2011.02177.x.
30. Osranek M., Bursi F., Bailey K.R., et al. Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up. Eur Heart J. 2006;26:2556- 61. doi:10.1093/eurheartj/ehi483.
31. Jongnarangsin K., Chugh A., Good E. et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19:668-72. doi:10.1111/j.1540-8167.2008.01118.x.
32. Hoyer F.F., Lickfett L.M., Mittmann-Braun E., et al. High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol. 2010;29(1):37-41. doi:10.1007/s10840-010-9502-8.
33. Stevenson I.H., Teichtahl H., Cunnington D., et al. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J. 2008;29(13):1662-9. doi:10.1093/eurheartj/ehn214.
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For citations:
Agaltsov M.V., Drapkina O.M., Davtyan K.V., Arutyunyan G.G. The prevalence of sleep breathing disorders in patients with atrial fibrillation undergoing catheter treatment. Rational Pharmacotherapy in Cardiology. 2019;15(1):36-42. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-1-36-42
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