He Hejie, Lim Ven Gee, Weight Nicholas, Lachlan Thomas, Osman Faizel
Institute for Cardiometabolic Medicine (ICMM), University Hospital Coventry, CV2 2DX Coventry, UK.
Warwick Medical School, University of Warwick, CV4 7HL Coventry, UK.
Rev Cardiovasc Med. 2025 Jul 11;26(7):31308. doi: 10.31083/RCM31308. eCollection 2025 Jul.
Obstructive sleep apnoea (OSA) is highly prevalent in Western populations, causing breathing cessation during sleep due to airway collapse. OSA is strongly associated with cardiovascular disease and arrhythmia, with several mechanisms likely to increase arrhythmia incidence. Continuous positive airway pressure (CPAP) is the mainstay of treatment, and whilst CPAP effectively treats OSA, specific arrhythmias and major adverse cardiovascular events may remain unchanged. Furthermore, arrhythmias are likely significantly underdiagnosed in this population. Meanwhile, implantable loop recorders (ILRs) are the gold-standard detection method for arrhythmias.
This review aimed to systematically evaluate observational studies using ILRs to identify the incidence of arrhythmia in treated OSA patients. We searched the Medline/Excerpta Medica Database (EMBASE) databases, identifying observational studies involving any OSA patients with no history of arrhythmia and who had ILRs inserted. Two reviewers assessed the quality of the studies and potential bias using the Observational Study Quality Evaluation (OSQE) tool.
Three studies met the criteria with 77 participants; however, the study outcomes were incomparable and could not be pooled. CPAP significantly reduced bradyarrhythmia/pauses. There was a high incidence of atrial fibrillation (AF), up to 31%, although the sample size and overall characteristics were insufficient and could not be generalized. AF and other tachyarrhythmias were likely underdiagnosed in OSA patients. CPAP did reduce bradyarrhythmia/pauses but is potentially insufficient to reduce AF or other tachyarrhythmias. Only one ongoing study was found to evaluate the incidence of arrhythmias in OSA.
We highlight the need for arrhythmia screening in OSA patients and for further studies to clarify the true incidence of arrhythmias in OSA patients. These additional studies may influence the guidelines for arrhythmia screening and identify mechanisms and therapeutic targets in OSA.
阻塞性睡眠呼吸暂停（OSA）在西方人群中非常普遍，由于气道塌陷导致睡眠期间呼吸停止。OSA与心血管疾病和心律失常密切相关，有多种机制可能增加心律失常的发生率。持续气道正压通气（CPAP）是主要的治疗方法，虽然CPAP能有效治疗OSA，但特定的心律失常和主要不良心血管事件可能仍无变化。此外，该人群中心律失常可能存在显著的漏诊情况。同时，植入式循环记录仪（ILR）是心律失常的金标准检测方法。
本综述旨在系统评价使用ILR来确定接受治疗的OSA患者心律失常发生率的观察性研究。我们检索了医学文献数据库/医学文摘数据库（EMBASE），识别涉及任何无心律失常病史且植入了ILR的OSA患者的观察性研究。两名评价者使用观察性研究质量评估（OSQE）工具评估研究质量和潜在偏倚。
三项研究符合标准，共77名参与者；然而，研究结果无法比较，不能进行汇总分析。CPAP显著降低了缓慢性心律失常/停顿。心房颤动（AF）的发生率很高，高达31%，尽管样本量和总体特征不足，无法进行推广。AF和其他快速性心律失常在OSA患者中可能存在漏诊。CPAP确实降低了缓慢性心律失常/停顿，但可能不足以降低AF或其他快速性心律失常。仅发现一项正在进行的研究评估OSA中心律失常的发生率。
我们强调OSA患者需要进行心律失常筛查，并需要进一步研究以明确OSA患者心律失常的真实发生率。这些额外的研究可能会影响心律失常筛查指南，并确定OSA的机制和治疗靶点。
