title: Severe central sleep apnea is associated with atrial fibrillation in patients with left ventricular systolic dysfunction.
abstract: BACKGROUND
  The results of previous studies investigating the association between atrial fibrillation (AF) and central sleep apnea (CSA) in patients with left ventricular (LV) systolic dysfunction are contradictory.
  
  
  METHODS
  We prospectively enrolled 267 patients in this cross-sectional study with LV ejection fractions ≤50%, who were screened for sleep disordered breathing using cardiorespiratory polysomnography after patients with predominantly obstructive sleep apnea or insufficient sleep studies had been excluded.
  
  
  RESULTS
  AF at study entry was found in 70 of 267 patients (26%). CSA with an apnea/hypopnea index (AHI) ≥15/hour was present in 116 patients (43%) and 67 patients (25%) had severe CSA with an AHI > 30/hour. Univariate analysis revealed a significant association between AF and severe CSA, age, male gender, arterial hypertension, left atrial diameter, brain natriuretic peptide, chronic kidney disease, New York Heart Association class, digitalis, and the lack of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Multivariate analysis revealed a significant association between AF and severe CSA (odds ratio [OR]: 5.21; 95% confidence interval [CI]: 1.67-16.27, P = 0.01), age (OR: 1.22 per 5-year increase; 95% CI: 1.05-1.40, P = 0.01), left atrial diameter (OR 1.61 per 5-mm increase; 95% CI: 1.22-2.01, P < 0.01), and digitalis (OR: 2.7; 95% CI: 1.26-5.79, P = 0.01).
  
  
  CONCLUSIONS
  AF is associated with severe CSA but not with moderate CSA in addition to age, use of digitalis, and left atrial size in patients with LV systolic dysfunction. Future studies evaluating the potential benefit of adaptive servo-ventilation therapy to prevent AF or to decrease the AF burden in heart failure patients should therefore focus on patients with severe central sleep apnea.
authors.affiliation: Department of Cardiology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Grimm
authors.affiliation: Department of Cardiology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Sass
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Emad
authors.initials: E
authors.lastname: Sibai
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Cassel
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Hildebrandt
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Apelt
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nell
authors.affiliation: Sleep Disorder Center, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Koehler
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012307:Risk Factors; D020182:Sleep Apnea, Central / Q000209:etiology*; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging
keywords: atrial fibrillation; central sleep apnea; heart failure