title: Nocturnal hypoxia and the success rate of standard atrial fibrillation treatment: a case report.
abstract: BACKGROUND
  Sleep apnea-hypopnea syndrome (SAHS) is one of the extracardiac reasons of atrial fibrillation (AF), and the prevalence of AF is high in SAHS-diagnosed patients. Nocturnal hypoxemia is associated with AF, pulmonary hypertension, and nocturnal death. The rate of AF recurrence is high in untreated SAHS-diagnosed patients after cardioversion (CV). In this study, we present a patient whose SAHS was diagnosed with an apnea test performed in the intensive care unit (ICU) and who did not develop recurrent AF after the administration of standard AF treatment and bi-level positive airway pressure (BiPAP).
  
  
  METHODS
  A 57-year-old male hypertensive Caucasian patient who was on medical treatment for 1.5 months for non-organic AF was admitted to the ICU because of high-ventricular response AF (170 per minute), and sinus rhythm was maintained during the CV that was performed two times every second day. The results of the apnea test performed in the ICU on the same night after the second CV were as follows: apnea-hypopnea index (AHI) of 71 per hour, minimum peripheral oxygen saturation (SpO2) of 67%, and desaturation period (SpO2 of less than 90%) of 28 minutes. The patient was discharged with medical treatment and nocturnal BiPAP treatment. The results of the apnea test performed under BiPAP on the sixth month were as follows: AHI of 1 per hour, desaturation period of 1 minute, and minimum SpO2 of 87%. No recurrent AF developed in the patient, and his medical treatment was reduced within 6 months. After gastric bypass surgery on the 12th month, nocturnal hypoxia and AF did not re-occur. Thus, BiPAP and medical treatments were ended.
  
  
  CONCLUSIONS
  SAHS can be diagnosed by performing an apnea test in the ICU. SAHS should be investigated in patients developing recurrent AF after CV. Recovery of nocturnal hypoxia may increase the success rate of standard AF treatment.
authors.affiliation: Department of Anesthesiology, Acıbadem University Faculty of Medicine, Istanbul, Turkey. drbulentgucyetmez@yahoo.com.|Intensive Care Unit, Acibadem International Hospital, Istanbul Cad No. 82 Yesilkoy, 34149, Istanbul, Turkey. drbulentgucyetmez@yahoo.com.
authors.forename: Bülent
authors.initials: B
authors.lastname: Güçyetmez
authors.affiliation: Intensive Care Unit, Ataşehir Memorial Hospital, Vedat Gunyol Cad No. 28 Kucukbakkalkoy Atasehir, 34758, Istanbul, Turkey. hkatalan@yahoo.com.
authors.forename: Hakan Korkut
authors.initials: HK
authors.lastname: Atalan
authors.affiliation: Department of Neurology, Medicalpark Bahçelievler Hospital, Kültür Sok No. 1 Bahçelievler, 34160, Istanbul, Turkey. hikmetaloglu@gmail.com.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Aloglu
authors.affiliation: Department of Cardiology, Acibadem International Hospital, Istanbul Cad No. 82 Yesilkoy, 34149, Istanbul, Turkey. adnan.kelebek@internationalhospital.com.tr.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kelebek
authors.affiliation: Department of Cardiology, Acibadem International Hospital, Istanbul Cad No. 82 Yesilkoy, 34149, Istanbul, Turkey. tayfun.acil@internationalhospital.com.tr.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Açıl
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology* / Q000628:therapy; D004554:Electric Countershock; D006801:Humans; D008297:Male; D008875:Middle Aged; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis*