Goyal Sandeep K, Sharma Abhishek
Sandeep K Goyal, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6300, United States.
World J Cardiol. 2013 Jun 26;5(6):157-63. doi: 10.4330/wjc.v5.i6.157.
Atrial fibrillation (AF) is a common arrhythmia with rising incidence. Obstructive sleep apnea (OSA) is prevalent among patients with AF. This observation has prompted significant research in understanding the relationship between OSA and AF. Multiple studies support a role of OSA in the initiation and progression of AF. This association has been independent of obesity, body mass index and hypertension. Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA. These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period, promoting pulmonary vein discharges and atrial dilation. OSA not only promotes initiation of AF but also makes management of AF difficult. Drug therapy and electrical cardioversion for AF are less successful in presence of OSA. There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA. Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF. However, additional studies are needed to establish a stronger relationship between OSA treatment and success of AF therapies. There should be heightened suspicion of OSA in patients with AF. There is a need for guidelines to screen for OSA as a part of AF management.
心房颤动（AF）是一种发病率不断上升的常见心律失常。阻塞性睡眠呼吸暂停（OSA）在AF患者中很普遍。这一观察结果促使人们对理解OSA与AF之间的关系进行了大量研究。多项研究支持OSA在AF的发生和发展中起作用。这种关联独立于肥胖、体重指数和高血压。在OSA中可见自主神经张力不稳定和胸内压大幅波动。从机制上讲，这些通过降低心房有效不应期、促进肺静脉放电和心房扩张与OSA患者发生AF有关。OSA不仅促进AF的发生，还使AF的管理变得困难。在存在OSA的情况下，用于AF的药物治疗和电复律不太成功。OSA患者AF导管消融术后的早期复发率和总体复发率较高。已证明持续气道正压通气治疗OSA可改善AF的控制。然而，需要更多研究来确立OSA治疗与AF治疗成功之间更强的关系。对于AF患者，应提高对OSA的怀疑。需要制定指南，将OSA筛查作为AF管理的一部分。
