title: Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates.
abstract: OBJECTIVE
  Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately.
  
  
  METHODS
  We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews.
  
  
  RESULTS
  Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH.
  
  
  CONCLUSIONS
  Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000200:Action Potentials; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D011379:Prognosis; D015656:Respiratory Mechanics; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy