Sleep Apnea &

Atrial Fibrillation

Turner Curry, Joel Hake, Joe Wrask

Introduction: Sleep Apnea

● Sleep apnea occurs when someone has repeated stops and starts of breathing while
sleeping.
● Signs/ Symptoms...
○ Loud snoring
○ Problems with staying asleep and daytime sleepiness
○ Breathing stops during sleep as witnessed by someone else
○ Fatigue/ Irritability
● If experiencing these signs & symptoms, also check…
○ Blood pressure (Usually high)
○ Heart rate (Increased)
○ Feeling SOB
● Risk Factors…
○ Obesity or excess weight
○ Older age
○ Narrowed airway (Tonsils)
○ Family history
○ Male
○ Heart disorders
○ Alcohol & smoking
○ Coronary artery disease
Continued...

● Diagnosis…
○ Nocturnal polysomnography
■ Monitors heart, lung, and brain activity
■ Breathing patterns
■ Arm/ leg movement
■ SpO2
■ Apnea hypopnea index >5
● Treatment
○ CPAP (Most Common)
○ BiPAP (More pressure when inhaling/ Less while exhaling)
○ Surgery (Tissue removal, Tracheostomy, etc.)
○ Lifestyle changes
Introduction: Atrial Fibrillation

● AF is episodes of irregular and rapid heart rate

● Signs/ Symptoms…
○ Palpitations
○ SOB
○ Weakness
○ Chest pain
● Risk Factors…
○ Older age
○ Obesity
○ Heart diseases
○ HTN
○ Alcohol
○ Sleep apnea
○ Family history
○ Diabetes, chronic kidney disease, lung disease, etc….
Continued…

● Diagnosis…
○ ECG (Primary)
○ Holter Monitor (Portable)
○ Echocardiogram
○ Stress test
○ X-Ray
● Treatment…
○ Cardioversion (Electrical/ Drug)
○ Antiarrhythmics
○ Digoxin (Heart rate control)
○ Catheter ablation (Destroy “Hot Spots”)
○ Anticoagulants (Closely monitor with doctor)
■ Warfarin
■ Eliquis (Newer)
○ Lifestyle modifications
● Complications
○ Clots, stroke, cardiomyopathy, heart failure
Sleep Apnea Facts

● More than 22 million people are currently dealing with sleep

apnea
● Over 80% of sleep apnea cases are undiagnosed
● Truck drivers are 5x more likely to crash with undiagnosed sleep
apnea
● Death rates are tripled for people suffering from sleep apnea
Atrial Fibrillation Facts

● 2.7-6.1 million people currently living in United States with A. fib

● 5x more likely to have a stroke
● 750,000 hospitalizations per year
● 130,000 deaths per year
● Costs 6 billion dollars from United States yearly
● More common in people over 65 years old
Problem

● Sleep apnea and A. fib are often diagnosed together or come from one another. We want
to see if having sleep apnea can cause A. fib. Since people can go for years with sleep
apnea, being able to diagnose it sooner can help decrease the risk of developing A. fib.
Research Question

● Does sleep apnea cause or increase the risk of

atrial fibrillation?
Relationship Between Sleep Apnea & Atrial
Fibrillation

● Sleep apnea can provoke AF and arrhythmias if prolonged

○ When untreated, repeated apneas throughout the nights put a lot of stress on the body and
mostly the heart
○ The heart will work harder to make up for the sleep apnea, thus causing more stress while it should
be getting rest
○ Prolonged stress on the heart can induce AF and can even arrest
● Sleep apnea increases the risk for AF by...
○ Intermittent night time hypoxemia and hypercapnia
○ Increase blood pressure and volume blood pressure during apneic episodes leading to left atrial
stretching
○ Increased oxidative stress and inflammation leading to left atrial damage
○ (Fein et al, 2013)
● People already with A. fib and are undergoing treatment via cardioversion and catheter
ablation are at a high risk for recurrence if the patients already suffer from sleep apnea
(Erdogan et al, 2009).
Treatments

Sleep Apnea

● CPAP
○ Continuous Positive Airway Pressure
○ Allow airflow without any disturbance throughout the night
○ Many people use this for treatment and there are many different types to find a correct fit
● Lifestyle Changes
○ Exercise (30 min/ day)
○ Healthy diet
○ Reduce stress
○ Quit smoking
● Surgery
○ Tissue removal
○ Tracheostomy
Treatments Continued...

Atrial Fibrillation

● Depends of severity of A. fib

● Focus on curing underlying cause
● Resetting heart rhythm
○ Electrical Cardioversion
○ Anti-arrhythmics drugs
● Pulmonary Vein Isolation
○ Catheter used to electrically destroy sensory tissue in the pulmonary veins which causes
irregular impulses (AF)
● Lifestyle modifications
○ Diet
○ Smoking
○ Exercise
○ BP and Cholesterol
Studies

● Sleep study of an A fib group and a non-A fib group to test for prevalence of sleep apnea.
○ Slight increase of occurence of sleep apnea in the a fib group.
○ Neck circumference, a known factor for sleep apnea, on average was significantly higher in A-fib
group
○ Study suggests a relationship between sleep apnea and A fib (Porthan et al, 2004)

● Study population involved 62 pulmonary vein isolation treatment patients with A fib,
who also had sleep apnea.
○ PVI is effective to treat A fib, but A fib often reoccurs.
○ 32 used CPAP to treat their sleep apnea, 30 did not.
○ Recurrence rate of A fib in patients who used CPAP was significantly lower
○ Treatment of sleep apnea by CPAP decreased the chance of Afib re-occuring, which means CPAP
could be a contributing cause of A fib (Fein et al, 2013)
Studies Cont...

● Post op coronary artery bypass graft (CABG)

○ Patients who were having a CABG done were tested
○ They were able to discover which patients had and did not have sleep apnea
before the graft
○ After the patients surgeries they discovere which patients had AFIB
○ 4x more likely
Studies Cont...

● Monitored A. fib for patients with suspected sleep apnea

○ 13/201 patients had atrial fibrillation
○ p=0.038 and needed to be <0.05 to be significant
○ Limitations consisted of how ECG recordings were conducted (April 2012-November 2013)
■ At home, 30 sec. 2x/day, and whenever the patient felt an A. fib episode
■ Could miss an episode due to 30 sec. And patient might be too busy to record

● Observed the prevalence of A. fib in sleep apnea patients

○ 38/427 sleep apnea patients had A. fib
○ Patients were investigated with a full night polysomnography
○ Severity of sleep apnea did not significantly differ between patients with and without AF
Conclusion

● Evidence shows that a patient is more likely to develop A fib if they have sleep apnea and
that treatment of sleep apnea can reduce the likelihood of developing A fib.
● Other risk factors for A. fib other than sleep apnea are obesity, diabetes mellitus, high
blood pressure, hyperlipidemia, coronary artery disease, smoking, etc. If a person has
some of these along with sleep apnea, it can put them at high risk for developing atrial
fibrillation.
● It is important to treat sleep apnea to prevent a fib, and to treat atrial fibrillation in itself,
to prevent stroke or sudden death.
References
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10.1007/s11818-009-0444-2

Fein, A.S., Shvilkin, A., Shah, D., Haffajee, C., & Das, S. (2013). Treatment of obstructive sleepapnea reduces the
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Hendrikx, T., Sundqvist, M., Sandstrom, H., Sahlin, C., Rohani, M., Al-Khalili, F., Hornsten, R.,Blomberg, A., Wester,
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Porthan, K.M., Melin, J.H., Kupila, J.T., Venho, K.K.K., & Partinen, M.M. (2004). Prevalenceof sleep apnea
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Zhao, L., Kofidis, T., Lim, T., Chan, S., & Thun, H. (2015). Sleep apnea is associated withnewonset atrial fibrillation
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