Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
J Clin Sleep Med. 2022 May 1;18(5):1279-1286. doi: 10.5664/jcsm.9840.
Obstructive sleep apnea (OSA) is commonly seen in patients with atrial fibrillation (AF), but it is unclear to what extent this relationship is one of causation or association. We examined a cohort of patients with paroxysmal AF to determine whether the presence of OSA (apnea-hypopnea index ≥ 15 events/h) affects the time of onset of symptomatic AF episodes.
Patients with a recent emergency department visit for a symptomatic episode of paroxysmal AF were recruited from an AF clinic. The time of onset of the AF attack was classified as occurring in "sleeping hours" or "waking hours" based on direct history from the patient and emergency department visit documentation.
Of 152 patients with paroxysmal AF, 67 underwent polysomnography; 1 (1.5%) had central sleep apnea, 46 (68.7%) had mild or no OSA, and 20 (29.8%) had OSA. In the OSA group, 14/20 (70.0%) had their symptomatic AF attack during sleeping hours compared to 12/46 (26.1%) in the mild or no OSA group ( = .001). Compared with those who had a paroxysmal AF attack during waking hours, and adjusting for confounders, those who had a paroxysmal AF attack during sleeping hours had almost 6 times the odds of having OSA (odds ratio, 5.53; = .007).
Compared to patients with paroxysmal AF with mild or no OSA, those with OSA were far more likely to have a symptomatic AF attack during sleeping hours, supporting a causal role for OSA in the pathogenesis of AF in this population. These findings strongly suggest that patients who have nocturnal AF attacks should be evaluated for OSA.
Lin C-H, Timofeeva M, O'Brien T, Lyons OD. Obstructive sleep apnea and nocturnal attacks of paroxysmal atrial fibrillation. 2022;18(5):1279-1286.
阻塞性睡眠呼吸暂停（OSA）在心房颤动（AF）患者中很常见，但尚不清楚这种关系在多大程度上是因果关系还是关联关系。我们检查了一组阵发性 AF 患者，以确定 OSA（呼吸暂停-低通气指数≥15 次/小时）的存在是否会影响有症状的 AF 发作的发作时间。
从 AF 诊所招募了因阵发性 AF 症状性发作而最近在急诊科就诊的患者。根据患者的直接病史和急诊科就诊记录，将 AF 发作的发作时间分类为“睡眠时间”或“清醒时间”。
在 152 例阵发性 AF 患者中，67 例行多导睡眠图检查；1 例（1.5%）为中枢性睡眠呼吸暂停，46 例（68.7%）为轻度或无 OSA，20 例（29.8%）为 OSA。在 OSA 组中，20 例中有 14 例（70.0%）的症状性 AF 发作发生在睡眠时间，而在轻度或无 OSA 组中，46 例中有 12 例（26.1%）（ =.001）。与那些在清醒时间发生阵发性 AF 发作的患者相比，并调整混杂因素后，在睡眠时间发生阵发性 AF 发作的患者发生 OSA 的可能性几乎是后者的 6 倍（比值比，5.53； =.007）。
与轻度或无 OSA 的阵发性 AF 患者相比，患有 OSA 的患者更有可能在睡眠时间发生有症状的 AF 发作，这支持 OSA 在该人群中 AF 发病机制中的因果作用。这些发现强烈表明，应评估夜间发生 AF 发作的患者是否存在 OSA。
Lin C-H、Timofeeva M、O'Brien T、Lyons OD。阻塞性睡眠呼吸暂停与阵发性心房颤动的夜间发作。 2022；18（5）：1279-1286。
