Eysenck William, Sulke Neil, Freemantle Nick, Patel Nikhil R, Furniss Steve S, Veasey Rick A
Cardiology Research Department, Eastbourne General Hospital, Eastbourne, United Kingdom.
Institute of Clinical Trials and Methodology, University College London, London, United Kingdom.
Clin Respir J. 2019 May;13(5):280-288. doi: 10.1111/crj.13008. Epub 2019 Apr 1.
Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are associated. This study investigated the impact of AF intervention on 6-month home sleep testing data.
Sixty-seven patients (aged 66 to 86, 53% male) with persistent AF were randomized (1:1:1) to direct current cardioversion (DCCV) (22 patients), permanent pacemaker (PPM) + atrioventricular node ablation (AVNA) + DCCV (22 patients) or AF ablation (23 patients). Baseline and 6-month multichannel home sleep tests with the Watch-PAT200 (Itamar Medical Lts., Caesarea, Israel) were recorded. Implantable cardiac monitors (ICMs) (Medtronic Reveal XT, Minneapolis, Minnesota) in the DCCV and AF ablation groups, and PPM Holters in the 'pace and ablate' group were utilized to assess cardiac rhythm beat-to-beat throughout the study period.
The prevalence of moderate-to-severe SDB [apnoea-hypopnoea index (AHI) ≥ 15/h] was 60%. At 6 months there was no change in AHI, Epworth sleepiness scale, sleep time, % REM sleep, respiratory desaturation index or central apnoeic events. Twenty-five patients (15 AF ablation, 9 DCCV and 1 following DCCV post-AVNA) maintained SR at 6 months confirmed on ICMs in these patients. AHI fell from 29.8 ± 26.6/h to 22.2 ± 20.4/h; P = 0.049.
SDB is highly prevalent in patients with persistent AF. Restoration of sinus rhythm, and the associated long-term recovery of haemodynamics, is associated with a significant reduction in AHI. This implicates reversal of fluid shift from the lower limbs to the neck region, a key mechanism in the pathogenesis of SDB.
睡眠呼吸紊乱（SDB）与心房颤动（AF）相关。本研究调查了房颤干预对6个月家庭睡眠测试数据的影响。
67例持续性房颤患者（年龄66至86岁，53%为男性）被随机分为（1:1:1）直流电复律（DCCV）组（22例患者）、永久起搏器（PPM）+房室结消融（AVNA）+DCCV组（22例患者）或房颤消融组（23例患者）。使用Watch-PAT200（以色列凯撒利亚的Itamar Medical Lts.公司）记录基线和6个月的多导家庭睡眠测试。在整个研究期间，DCCV组和房颤消融组使用植入式心脏监测器（ICM）（美敦力Reveal XT，明尼苏达州明尼阿波利斯），“起搏和消融”组使用PPM动态心电图监测仪来评估逐搏心律。
中重度SDB的患病率[呼吸暂停低通气指数（AHI）≥15次/小时]为６０％。6个月时，AHI、爱泼沃斯嗜睡量表、睡眠时间、快速眼动睡眠百分比、呼吸去饱和指数或中枢性呼吸暂停事件均无变化。25例患者（15例房颤消融、9例DCCV和1例DCCV后AVNA）在6个月时通过ICM证实维持窦性心律。AHI从29.8±26.6次/小时降至22.2±20.4次/小时；P = 0.049。
SDB在持续性房颤患者中高度流行。窦性心律的恢复以及相关的长期血流动力学恢复与AHI的显著降低相关。这意味着下肢至颈部区域的液体转移逆转，这是SDB发病机制中的关键机制。
