title: High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation.
abstract: OBJECTIVE
  To address the question whether obstructive sleep apnea (OSA) is associated with the recurrence of paroxysmal atrial fibrillation (AF) in patients treated with ≥2 pulmonary vein isolation procedures.
  
  
  METHODS
  In this study, we included adults with therapy-resistant symptomatic paroxysmal AF, defined as AF recurring after ≥2 PV-isolation procedures (n = 23). For comparison, we selected another cohort of patients being successfully treated by one PV isolation without AF recurrence within 6 months (n = 23). PV isolation was performed by radiofrequency with an open irrigated tip catheter. Each of the 46 participants completed an overnight polygraphic study. The two groups were matched for age, gender, and ejection fraction. Patients were late middle-aged (65 ± 7 vs 63 ± 10 years, P = 0.23), white (100%), and overweight (BMI 27.3 ± 3.6 vs. 27.2 ± 4.6 kg/m(2), P = 0.97).
  
  
  RESULTS
  The prevalence of sleep apnea, defined as an apnea-hypopnea index (AHI) of >5 per hour of sleep, was 87% in patients with therapy-resistant AF compared to 48% in the control cohort (P = 0.005). In addition, OSA was more severe in the resistant AF group indicated by a significantly higher AHI (27 ± 22 vs 12 ± 16, P = 0.01).
  
  
  CONCLUSIONS
  The extraordinarily high prevalence of sleep apnea in patients with recurrent paroxysmal AF supports its presumable role in the pathogenesis of AF and demands further controlled prospective trials. Moreover, OSA should inherently be considered in patients with therapy-resistant AF.
authors: Department of Internal Medicine II-Cardiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Felix.Hoyer@ukb.uni-bonn.de
authors: Friedrich Felix
authors: FF
authors: Hoyer
authors: Lars Martin
authors: LM
authors: Lickfett
authors: Erica
authors: E
authors: Mittmann-Braun
authors: Charlotte
authors: C
authors: Ruland
authors: Jens
authors: J
authors: Kreuz
authors: Stefan
authors: S
authors: Pabst
authors: Jan
authors: J
authors: Schrickel
authors: Uwe
authors: U
authors: Juergens
authors: Selcuk
authors: S
authors: Tasci
authors: Georg
authors: G
authors: Nickenig
authors: Dirk
authors: D
authors: Skowasch
mesh_terms: D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015992:Body Mass Index; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012016:Reference Values; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome