Sleep Apnea & Afib

7/25/2019 Sleep Apnea & Afib

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SLEEP APNEA &

AFIB


2/19

What is Sleep Apnea?1

Disruptions in breathing which are coplete !i"e" apnea# orpartial !i"e" h$popneas# with a apnea%h$popnea ine' !A(I#!)isruptions*hr# o+ , - accopanie b$ a$tie sleepiness 1./

0 ain t$pes1

Obstructive (OSA)2 bloc3age o+ upper airwa$ ue pharn$gealcollapse

4entral 2 ecrease respirator$ brain ste output

i'e

Estiate that 5SA a6ects 718 illion Aericans. /9 ileage en. 89 ile age woen


3/19

S$ptos1.8

Lou. chronic snoring

Da$tie sleepiness

(eaaches

eor$. concentration i:culties

Fre;uent awa3ening to urinate

Dr$ or sore throat upon awa3ening


4/19

Who (as (igher s higher =aw sie proportionalit$

Palate

4ollar sie @1 inches en. @1 inches woen

Congue sie

Obesity 2 estiate -9 o+ obese population has 5SA 11

Hypothyroidisim

Acroegal$

Sleep Position

Male gender

Advanced age


5/19

Diagnostic Cools/

Polysomnography 2 cobintation o+ electroencephalograph$.electrooculograph$. electro$ograph$

Apnea an ($popnea episoes eterine b$ onitoring +or clearreuctions in airow*tial >oluen accopanie b$ ecrease 58 sawhich terinate with an arousal

Portable onitors

Pro>ie in+o on airow an o'$gen sat

(ighl$ Senstati>e. low specicit$

Not recoene +or patients with 4(F. cerebro>ascular or respiratoisease


6/19

Foral DiagnosisG

Aerican Acae$ o+ Sleep eicine

5SA ene as A(I , 1-!regarless o+ s$ptos# or , - e>ents*hrwith s$ptos

A(I % ) o+ apnea*h$popnea episoes*hr

Se>erit$ o+ 5SA

ilH A(I -%1/

oerateH 1-%0

Se>ereH @0

ESS 2uestionnaire e>aluating chances o+ oing uner certainsituations

Arousal ine' 2 +re;uenc$ o+ arousals*hr uring sleep as easure b$EEJ


7/19

4onse;uences8

(igh Bloo Pressure

(eart Attac3

Stro3eK @8 ' ris3 in en

5besit$

(eart Failure

Arr$thias

Da$tie sleepines

4ar accients


8/19

Pathoph$siolog$ o+ 5SA in relationto 4ariac a6ects11

uic3 re>iew o+ Sleep states

N


9/19

Pathoph$siolog$ o+ 5SA in relationto 4ariac a6ects11

4hronic A6ects o+ 5SA

Autonoic irregularities 2 BP. (< uring sleep an awa3e hrs

Inaation 2 ele>ate CNF. 4 reacti>e protein. IL. ILG

Enothelial $s+unction

etabolic isturbances

5'iati>e stress Procoagulati>e State


10/19

5SA group >s control re>eals 09 FA >s 19

Ho"stein et al (199#)$ Pre>alence o+ arr$thias higher inpeople with obstructi>e sleep apnea ! 5SA# an increases withgreater A(I

Gami A%S% et al%(&''#)ns pre>alance o+ AFIB in 5SA group

was /O9 >s 089 +or general population o+ patients in acariolog$ practice" ! p "/# O

Mehra et al% (&'')+oun pre>alence o+ AFIB /"G9 ! sleepisorere breathing# >s "O9 ! control# a+ter coparing 8saples +ro Sleep (eart (ealth Stu$ controlle +or age. se'.race. BI" 5< / !4I 1"0%1-"/#1


11/19

5bstructi>e Sleep Apnea !5SA# an


12/19

5bstructi>e Sleep Apnea !5SA#an


13/19

Stu$ 1H 4haracteristics

Create >s Tntreate 5SA group E;ual in all baseline characteristics

/ o+ /0 patients e'clue

1 ue to initial +ailure o+ cario>ersiRn

0 ue to lac3 o+ +*u ata

5ut o+ 0O patients +or +ollow%up

18 recei>e 4PAP treatent

8 untreate

8- non copliant

8 non copliant ! 1 +or using cPAP 8*wee3. 1 +or +re;uent reo>al

4ontrol baseline group ! Ab alone#

O patients


14/19

Stu$ 1 H s /8 9 treate 5SA group !p "10#

-09 recurrence rate in the control group !ab alone# !p "O

Inten to treat anal$sis woul ha>e prouce recurrence rates o

o+ 1/ o+ treate 5SA group

8 o+ 8- o+ untreate 5SA group UUUU- >s G9 !p "-#

1O9 o+ 5SA pts with AFIB recurrence treate appropiatel$ with4PAP >s -G9 5SA pts without recurrence


15/19

Creatents

ontinuos Positive Air*ay Pressure (PAP) +evice

A4P strong ience !G#

A4P re>iew 810 2 4PAP ipro>es sleep easures !A(I. ESS. Arousal Ine'# in patients witoerate V s$ptos !A(I , 1-# but no high grae e>ience ! i"e" ational stuies show reuction in ortalit$ !G#

% Benets

Ieiate re>ersal o+ apnea an h$popnea episoes ! /#

Decrease sonolence an ipro>e oL Decrease snoring to relie+ o+ others

Decrease a$tie sleepiness

Issues

4opliance is -%G9 % obtrusi>e. nasal congestion


16/19

4PAP !cont# 2 A(I. ESS. AIeasures Fi'e >s Auto a=uste 2 e;uall$ e:cacious

Bile>el 4PAP >s Fi'e 4PAP 2 insu:cient e>ience. longer use in B

Fle'ibile 4PAP >s Fi'e 4PAP 2 insu:cient e>ience. no i6erence

Nasal >s 5ral 2 insu:cient e>ience. no i6erence in stuies

4PAP w* or w*o huiication 2 insu:cient e>ience

4%Fle' >s 'e 4PAP 2 e;ual +or ESS. insu:cient e>ience +or otheeasures


17/19

5ther Strategies ! /#

Weight Loss !A4P strong recoenation. low ;ualit$ e>ience# eical 2 one stu$ showe 8 9 reuction in A(I with 19 weight loss

Surgical 2 reuction o+ A(I +ro O to 11 in one stu$

No stuies coparing the

Lateral Sleeping Position

A>oiance o+ Et%5( an seati>es

anibular & Congue A>anceent De>ices !AD# !G#

4an reuce A(I & a$tie sleepiness ! G#. 4PAP ore e6ecti>e in these Xreas !G# No e>ience +or long ter clinical easures

No e>ience to suggest who benets with AD >s 4PAP

Surger$

Liite e>ience. a$ be less e6ecti>e than oral appliances

Pharacotherap$

Insu:cient e>ience 2 inconsistent ata +ro i6erent agents V 4PAP >s 4PAP alone ! G#


18/19

*health*health%topics*topics*sleepapnea*signs"htl 8" Sleep Apnea" (ealth Copics" National (eart. Lung. & Blooe Institute" Accesse G*01*1/"

httpH**www"nhlbi"nih"go>*health*health%topics*topics*sleepapnea*

0" 5bstructi>e Sleep Apnea" Tni>ersit$ o+ ar$lan eical 4enter"httpH**u"eu*health*eical*enc$*articles*obstructi>e%sleep%apnea

/" Fleons W" W" 5bstructi>e Sleep Apnea" New Englian Yournal o+ eicine 88" 0/H /OG%-/httpH**www"ne="org*oi*+ull*1"1-*NEYcp18G/O

-" Finle$ LY" Autoobile accients in>ol>ing patients with obstructi>e sleep apnea" 1OGG" AugK10G!8# 00%/ !Abstract#httpH**www"ncbi"nl"nih"go>*pube*01O-G08

"Arias "A" Fibrilacion auricular $ apnea obstructi>a el suenoH algo as ;ue una coinciencia" Atrias "A. Baranchuc3 A"ista Espanola e 4ariologia" 810K !#H -8O%-01

" Qanagala e sleep apnea an the recurrence o+ atrial brillation" 4irculation" 80K 1H 8-GO%O/ G" asee A" et al" anageent o+ 5bstructi>e Sleep Apnea in Aults" A 4linical Practice Juieline +ro the Aerican

4ollege o+ Ph$sicians" Annals o+ Internal eicine 810K 1-OH /1%/G0

O" Jai AS et al" 5bstructi>e sleep apnea. obesit$. an the ris3 o+ incient atrial brillation" Y" Aerican 4ollege o+ 4ariolo8K /OH --%1

1" ehra


19/19

Sleep Apnea & Afib

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