Editorial
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Jun 26, 2013; 5(6): 157-163
Published online Jun 26, 2013. doi: 10.4330/wjc.v5.i6.157
Atrial fibrillation in obstructive sleep apnea
Sandeep K Goyal, Abhishek Sharma
Sandeep K Goyal, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6300, United States
Abhishek Sharma, Division of Internal Medicine, MaimonidesMedical Center, New York, NY 11219, United States
Author contributions: Goyal SK was involved in conception of this review, drafting the initial manuscript, manuscript revision and guidance; Sharma A performed the Literature research and drafted the manuscript; all authors read and approved the final manuscript.
Correspondence to: Sandeep K Goyal, MD, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 383 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37232-6300, United States. sandeep.k.goyal@vanderbilt.edu
Telephone: +1-615-322800  Fax: +1-888-9472968
Received: January 8, 2013
Revised: April 14, 2013
Accepted: May 17, 2013
Published online: June 26, 2013
Processing time: 171 Days and 7.9 Hours
Abstract

Atrial fibrillation (AF) is a common arrhythmia with rising incidence. Obstructive sleep apnea (OSA) is prevalent among patients with AF. This observation has prompted significant research in understanding the relationship between OSA and AF. Multiple studies support a role of OSA in the initiation and progression of AF. This association has been independent of obesity, body mass index and hypertension. Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA. These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period, promoting pulmonary vein discharges and atrial dilation. OSA not only promotes initiation of AF but also makes management of AF difficult. Drug therapy and electrical cardioversion for AF are less successful in presence of OSA. There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA. Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF. However, additional studies are needed to establish a stronger relationship between OSA treatment and success of AF therapies. There should be heightened suspicion of OSA in patients with AF. There is a need for guidelines to screen for OSA as a part of AF management.

Keywords: Atrial fibrillation; Obstructive sleep apnea; Cardioversion; Ablation; Anti-arrhythmic medications

Core tip: Obstructive sleep apnea (OSA) has been linked with the initiation and progression of atrial fibrillation (AF). Patients with OSA have lower success with therapies for AF. Continuous positive airway pressure has been shown to be effective in treatment of OSA and there is some evidence suggesting its role in improving AF control in patients with OSA. In this article, we review and discuss the available data explaining the potential pathophysiological mechanisms linking OSA and AF as well as the therapeutic and prognostic implications of the presence of OSA in AF patients.