Obstructive sleep apnea: novel trigger and potential therapeutic target for cardiac arrhythmias

Figures & data

Figure 1. Cardiovascular pathophysiology of obstructive sleep apnea.

AV: Atrioventricular; LV: Left ventricle; RV: Right ventricle.

Figure 2. Atrial fibrillation burden increases with sleep apnea severity.

AF: Atrial fibrillation; AHI: Apnea–hypopnea index.

Reproduced with permission from [108]. Oxford University Press.

Figure 3. Paroxysmal atrial fibrillation occurring during sleep after a prolonged apnea with significant oxygen desaturation.

Time of (A) AF onset and (B) reversal to sinus rhythm is shown inset.

ABD: Abdominal movement; AF: Atrial fibrillation; HR: Heart rate; NAF: Nasal air flow; SaO₂: Oxygen saturation; SR: Sinus rhythm; SVES: Supraventricular ectopics; THO: Thoracic movement; VES: Ventricular ectopics.

Reproduced with permission from [116]. BMJ Publishing Group Ltd.

Figure 4. Reversed pattern of sudden death in sleep apnea, with a nocturnal predilection.

AHI: Apnea–hypopnea index; OSA: Obstructive sleep apnea.

Reproduced with permission from [7]. Copyright © 2005 Massachusetts Medical Society. All rights reserved.

Table 1. Arrhythmia risk during sleep in severe sleep apnea (apnea–hypopnea index >30/h) in the Sleep Heart Health Study.

Arrhythmia type	OR (95% CI)
	Unadjusted	Adjusted for age, sex and BMI	Adjusted for age, sex, BMI and CAD
Nonsustained VT	4.6 (1.5–14.6)	3.7 (1.1–12.2)	3.4 (1.0–11.2)
Complex ventricular ectopy	2.0 (1.3–3.0)	1.8 (1.2–2.8)	1.7 (1.1–2.7)
Atrial fibrillation	5.7 (1.6–20.5)	3.9 (1.0–14.9)	4.0 (1.0–15.7)

Data expressed as OR (95% CI).

AHI: Apnea–hypopnea index; CAD: Coronary artery disease; OR: Odds ratio; VT: Ventricular tachycardia.

Reprinted with permission from [91]. Copyright © American Thoracic Society.

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