title: Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications.
abstract: Atrial fibrillation (AF) is the commonest arrhythmia in clinical practice and is associated with increased cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA), a common breathing disorder, is an independent risk factor for AF. Several pathophysiological mechanisms, including apnea-induced hypoxia, intrathoracic pressure shifts, sympathovagal imbalance, atrial remodeling, oxidative stress, inflammation and neurohumoral activation have been implicated in the occurrence of AF in OSA patients. In addition, OSA has been shown to reduce success rates of antiarrhythmic drugs, electrical cardioversion and catheter ablation in AF. Effective prevention of obstructive respiratory events by continuous positive airway pressure ventilation (CPAP) reduces sympathovagal activation and recurrence of AF. The present review describes the relationship between OSA and AF, presents the pathophysiological mechanisms implicating OSA in AF occurrence, and provides an update of the potential therapeutic interventions for patients with OSA and AF.
authors.affiliation: Cardiology Department, Serres General Hospital, Serres, Greece. Electronic address: cgoudis@hotmail.com.
authors.forename: Christos A
authors.initials: CA
authors.lastname: Goudis
authors.affiliation: Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Ketikoglou
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D064752:Atrial Remodeling; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D014943:Global Health; D006801:Humans; D015994:Incidence; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000628:therapy
keywords: Atrial fibrillation; Continuous positive airway pressure; Obstructive sleep apnea; Pathophysiological mechanisms