Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Tuesday, January 19, 2010

Are Arrhythmias and Atrial Fibrillation caused by Sleep Disordered Breathing and Sleep Apnea

This interesting article about research at Vanderbilt,"Triggering of nocturnal arrhythmias by sleep-disordered breathing events." in the J Am Coll Cardiol. 2009 Nov 3;54(19):1797-804 makes these significant conclusions: CONCLUSIONS: Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.

This actually is an example of how a Dental Sleep Appliance can be used to treat Arrythmias and Atrial Fibrilation by protecting a patients airway. Because the majority of patients with sleep apnea do not tolerate CPAP or BiPAP treatment it is absolutely essential that all sleep physicians and Cardiac physicians stress the dangers of sleep apnea and refer patients who do not tolerate CPAP for a comfortable alternative with oral appliances.

Patient with mild to moderate apnea should be offered a choice of CPAP or Oral Appliances at their initial evaluation. Unfortunately many sleep physicians automatically prescribe CPAP due to habit, ignorance or personal financial interests. Due the the increased success of oral appliances over CPAP when compliance is considered along with effectiveness it may be time to offer patients with mild to moderate apnea oral appliances as a first line treatment and CPAP as a back-up treatment. It has been established in numerous studies that the majority of patients (fail CPAP) or are CPAP intolerant. Other studies have also shown that patients offered a choice of Oral Appliances vs CPAP overwhelmingly prefer the comfortable oral appliances.


J Am Coll Cardiol. 2009 Nov 3;54(19):1797-804.
Triggering of nocturnal arrhythmias by sleep-disordered breathing events.
Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J, Punjabi N, Sanders M, Quan SF, Resnick H, Redline S.

Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Comment on:

J Am Coll Cardiol. 2009 Nov 3;54(19):1810-2.
OBJECTIVES: This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in patients with sleep-disordered breathing (SDB). BACKGROUND: SDB is associated with an increased risk of atrial fibrillation and nonsustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. METHODS: Overnight polysomnograms from the Sleep Heart Health Study (n = 2,816) were screened for paroxysmal atrial fibrillation and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of paroxysmal atrial fibrillation or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. Polysomnograms were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-s hazard period preceding each arrhythmia or control period. RESULTS: Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia after a respiratory disturbance were nearly 18 times (odds ratio: 17.5; 95% confidence interval: 5.3 to 58.4) the odds of an arrhythmia occurring after normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia per 40,000 respiratory disturbances). Neither hypoxia nor electroencephalogram-defined arousals alone increased arrhythmia risk. CONCLUSIONS: Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.

PMID: 19874994 [PubMed - indexed for MEDLINE]

posted by Dr Shapira at 8:31 PM