title: Positive Airway Pressure-Induced Conversion of Atrial Fibrillation to Normal Sinus Rhythm in Severe Obstructive Sleep Apnea.
abstract: Accumulating data implicate obstructive sleep apnea (OSA) as a predisposing factor to the development of atrial fibrillation (AF), the latter representing the most common sustained cardiac arrhythmia. The postulated mechanisms leading to atrial arrhythmogenesis in OSA include alterations in intrathoracic pressures, intermittent hypoxemia, and autonomic nervous system fluctuations. Although these OSA-related pathophysiologic pathways may result in atrial structural and electrical remodeling, thereby predisposing to AF, there are data to suggest that the immediate influences of respiratory events may trigger arrhythmic events. This case demonstrates an immediate reversal of AF to normal sinus rhythm with optimal continuous positive airway pressure (CPAP) therapy in the background of severe OSA. These findings of immediate benefit of reversal of OSA pathophysiology on cardiac arrhythmia suggest OSA may have acute influences on cardiac electrophysiology.
authors.affiliation: Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Harneet K
authors.initials: HK
authors.lastname: Walia
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Mina K
authors.initials: MK
authors.lastname: Chung
authors.affiliation: Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sally
authors.initials: S
authors.lastname: Ibrahim
authors.affiliation: Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH.|Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome
keywords: atrial fibrillation; continuous positive airway pressure; obstructive sleep apnea