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Stafford PL, Harmon EK, Patel P, Walker M, Lin GM, Park SJ, Chatterjee NA, Mehta NK, Mazimba S, Bilchick K, Kwon Y. The Influence of Obesity on the Association of Obstructive Sleep Apnea and Atrial Fibrillation. SLEEP MEDICINE RESEARCH 2021; 12:50-56. [PMID: 34497733 PMCID: PMC8423346 DOI: 10.17241/smr.2021.00857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The association between obstructive sleep apnea (OSA) and atrial fibrillation (AF) has been closely studied. However, obesity is a powerful confounder in the causal relationship between OSA and cardiovascular disease. The contribution of obesity in the relationship between OSA and AF remains unclear. METHODS We recruited 457 consecutive patients equally with and without AF who underwent clinically indicated diagnostic polysomnography at a single academic sleep center. Multivariable logistic regression adjusting for age, sex, hypertension, and heart failure was performed to study the independent association between OSA and AF stratified by obesity. RESULTS A total of 457 patients (male: 56.2%, mean age 63.1 ± 13.3 years) was included. OSA prevalence was similar between those with and without AF (52.6% vs. 47.4%, respectively; p = 0.24). In multivariable analysis, no association was found between AF and OSA regardless of obesity status. When severe OSA (vs. non-severe OSA) was modeled as a dependent variable, AF was associated with a higher likelihood of severe OSA in non-obese patients [odds ratio (OR): 2.29, 95% confidence interval (CI): 1.23-4.35, p = 0.01], but not in obese patients (OR: 0.95, 95% CI: 0.48-1.90, p = 0.89). CONCLUSION The association of OSA with AF was present only in the non-obese and was limited to severe OSA patients. In contrast, no association was found in obese patients. The association between OSA and AF is partly dependent on the body habitus.
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Affiliation(s)
| | - Evan K. Harmon
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Paras Patel
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - McCall Walker
- Department of Medicine, University of Texas- Southwestern, Dallas, TX, USA
| | - Gen-Min Lin
- Department of Preventative Medicine, Northwestern University, Chicago, IL, USA; Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan; Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Seung-Jung Park
- Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Nishaki K. Mehta
- Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kenneth Bilchick
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA
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Nelson JA, Gue YX, Christensen JM, Lip GYH, Ramakrishna H. Analysis of the ESC/EACTS 2020 Atrial Fibrillation Guidelines With Perioperative Implications. J Cardiothorac Vasc Anesth 2021; 36:2177-2195. [PMID: 34130901 DOI: 10.1053/j.jvca.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, with an individual lifetime risk of approximately 37% in the United States. Broadly defined as a supraventricular tachyarrhythmia with disorganized atrial activation, AF results in an increased risk of stroke, heart failure, valvular heart disease, and impaired quality of life, and confers a significant burden on the health of individuals and society. AF in the perioperative setting is common and a significant source of perioperative morbidity and mortality worldwide. The latest iteration of the European Society of Cardiology AF guidelines published in 2020 provide the clinician a valuable road map for the management of this arrythmia. This expert review will comprehensively analyze the 2020 European Society of Cardiology guidelines and provide perioperative management tools for the clinician.
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Affiliation(s)
- James A Nelson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ying X Gue
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jon M Christensen
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tanayapong P, Kuna ST. Sleep disordered breathing as a cause and consequence of stroke: A review of pathophysiological and clinical relationships. Sleep Med Rev 2021; 59:101499. [PMID: 34020180 DOI: 10.1016/j.smrv.2021.101499] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 12/22/2022]
Abstract
Stroke is the leading cause of death and disability globally. Sleep disordered breathing (SDB), a potentially modifiable risk factor of stroke, is highly prevalent in stroke survivors. Evidence supports a causal, bidirectional relationship between SDB and stroke. SDB may increase the risk of stroke occurrence and recurrence, and worsen stroke outcome. While SDB is associated with an increased incidence of hypertension and cardiac arrhythmias, both of which are traditional stroke risk factors, SDB is also an independent risk factor for stroke. A number of characteristics of SDB may increase stroke risk, including intermittent hypoxemia, sympathetic activation, changes in cerebral autoregulation, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction. On the other hand, stroke may also cause new SDB or aggravate preexisting SDB. Continuous positive airway pressure treatment of SDB may have a beneficial role in reducing stroke risk and improving neurological outcome after stroke. The treatment should be considered as early as possible, particularly when SDB is present post-stroke. The goal of this review is to highlight the strong link between SDB and stroke and to raise awareness for practitioners to consider the possibility of SDB being present in all stroke survivors.
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Affiliation(s)
- Pongsakorn Tanayapong
- Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; Neurology Center, Vibhavadi Hospital, Bangkok, Thailand.
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz VA, Medical Center, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Akinnusi M, El-Masri AR, Lawson Y, El-Solh AA. Association of overlap syndrome with incident atrial fibrillation. Intern Emerg Med 2021; 16:633-642. [PMID: 32803632 DOI: 10.1007/s11739-020-02469-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19-29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3-2.0], percentage of time spent with O2 saturation below 90% (CT90) (OR 3.72, 95% CI 1.18-11.71), and CPAP adherence (OR 0.32, 95% CI 0.13-0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03-2.37) and worse mortality rates (OR 1.92, 95% CI 1.04-3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.
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Affiliation(s)
- Morohunfolu Akinnusi
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Abdul Rahman El-Masri
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Ali Albert El-Solh
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
- Department of Medicine, Jacob's School of Medicine, Buffalo, NY, USA.
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Transforming electronic health record polysomnographic data into the Observational Medical Outcome Partnership's Common Data Model: a pilot feasibility study. Sci Rep 2021; 11:7013. [PMID: 33782494 PMCID: PMC8007756 DOI: 10.1038/s41598-021-86564-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Well-defined large-volume polysomnographic (PSG) data can identify subgroups and predict outcomes of obstructive sleep apnea (OSA). However, current PSG data are scattered across numerous sleep laboratories and have different formats in the electronic health record (EHR). Hence, this study aimed to convert EHR PSG into a standardized data format-the Observational Medical Outcome Partnership (OMOP) common data model (CDM). We extracted the PSG data of a university hospital for the period from 2004 to 2019. We designed and implemented an extract-transform-load (ETL) process to transform PSG data into the OMOP CDM format and verified the data quality through expert evaluation. We converted the data of 11,797 sleep studies into CDM and added 632,841 measurements and 9,535 observations to the existing CDM database. Among 86 PSG parameters, 20 were mapped to CDM standard vocabulary and 66 could not be mapped; thus, new custom standard concepts were created. We validated the conversion and usefulness of PSG data through patient-level prediction analyses for the CDM data. We believe that this study represents the first CDM conversion of PSG. In the future, CDM transformation will enable network research in sleep medicine and will contribute to presenting more relevant clinical evidence.
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Obstructive Sleep Apnoea and Cardiac Disease Among Aboriginal Patients in the Northern Territory of Australia. Heart Lung Circ 2021; 30:1184-1192. [PMID: 33741255 DOI: 10.1016/j.hlc.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 10/10/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is paucity of information on obstructive sleep apnoea (OSA) and cardiac diseases among Aboriginal Australian patients. This study evaluates the association of various cardiac disease profiles among Aboriginal patients undergoing a diagnostic polysomnography (PSG). METHOD In this 5-year retrospective study demographics, clinical characteristics, medical and cardiac -conditions were analysed. RESULTS There were total of 340 eligible patients included in the study. The median age was 47 (38-57) years, 51% were males and obesity was noted in 78%. In the overall study participants, cardiac diseases were present in 46%: coronary artery disease (CAD) in 27%, pulmonary hypertension (PH) 19% and atrial fibrillation (AF) 14%. Diabetes and hypertension were noted in 42 and 41% of patients. Overall, 73/340 (21.5%) had two, 69/340 (20.3%) three, 55/340 (16.2%) four, 40/340 (11.8%) five and 10/340 (2.9%) had six comorbidities. In the overall study participants, 297/340 (87%) had OSA (Apnoea-Hypopnoea Index [AHI]>5/hour). Co-occurrence of OSA and cardiac diseases was found in 140/297 (47%), CAD being the commonest (27%). Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Hospital admissions frequency showed a median 2 (IQR: 0-4) times readmission rates since the diagnosis of OSA overall compliance with CPAP therapy was observed in 63 (43%). CONCLUSION Our study demonstrated that a significant proportion of Aboriginal patients with OSA have co-existing cardiac diseases, with CAD being the commonest. Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Furthermore, hospital admission frequency increased among OSA patients with multiple comorbidities.
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Impact of Obstructive Sleep Apnea on In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction. HEARTS 2021. [DOI: 10.3390/hearts2010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There are uncertainties about its impact on the in-hospital outcomes of patients who suffer acute coronary syndromes. We studied the largest publicly available all-payer inpatient healthcare database in the United States (National Inpatient Sample) to determine the effects of obstructive sleep apnea on the in-hospital outcomes of patients admitted with non-ST elevation myocardial infarction (NSTEMI). Methods: All adult patients (age ≥ 18) admitted primarily for NSTEMI between September 2010 and September 2015 were identified in the National Inpatient Sample. They were then categorized into those with OSA and those without OSA. The main outcome was in-hospital mortality. Propensity scoring and logistic regression models were created to determine the outcomes. Results: There were 1,984,432 patients with NSTEMI (weighted estimates), 123,551 (6.23%) of who had diagnosed OSA while 1,860,881 (93.77%) did not. In-hospital mortality was significantly lower in the OSA group [2.61% vs. 3.53%, adjusted odd ratio (aOR) 0.73 and confidence interval (CI) (0.66–0.81)]. Patients with OSA were also less likely to require coronary artery bypass surgery: 13.85% and 12.77% (p-value 0.0003). The patients with OSA had higher mean hospital costs compared to the patients who did not have OSA: $17,326 vs. $16,984, adjusted mean ratio (aMR) 1.02; CI (1.01–1.02). Conclusion: In-hospital mortality was lower in NSTEMI patients with diagnosed OSA compared to patients without diagnosed OSA. This appears to contrast with the widely recognized adverse effects of OSA on the cardiovascular system.
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Nakamura K, Nakamura H, Tohyama K, Takara C, Iseki C, Woodward M, Iseki K. Survival benefit of continuous positive airway pressure in Japanese patients with obstructive sleep apnea: a propensity-score matching analysis. J Clin Sleep Med 2021; 17:211-218. [PMID: 33006309 DOI: 10.5664/jcsm.8842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) improves quality of life in patients with obstructive sleep apneas. However, the long-term benefit in all-cause mortality and cardiovascular death are limited among Japanese. METHODS We conducted a retrospective study of patients treated in our sleep clinic in Okinawa, Japan. All patients with full-scale polysomnography from September 1990 to December 2010 were investigated in terms of outcomes such as death (dates and causes of death) between 2012 and 2013 by chart review, telephone calls, and letters of inquiry. Propensity-score matching was performed to balance baseline characteristic differences between a CPAP user group and a nonuser group. The primary outcomes were all-cause mortality and a composite of cardiovascular disease mortality, such as heart disease and stroke, between the two groups. RESULTS The CPAP user group, almost double in number, had more severe obstructive sleep apnea, more comorbidities, smoking, and alcohol consumption compared to the nonuser group but no significant difference in Epworth Sleepiness Scale. Propensity-score matching selected 1,274 of 4,519 patients as the CPAP user group and 1,274 of 2,128 as the CPAP nonuser group. Mean age of the patients was 52.3 (±13.5) years and 79% were men. After a median follow-up of 79 (interquartile interval, 24 to 128) months in the CPAP user group and 73.5 (interquartile interval, 26 to 111) in the non-CPAP group, death from all causes occurred in 53 (4.2%) patients in CPAP user group and in 94 (7.4%) patients in CPAP nonuser group. The leading cause of death was malignancy in each group. The hazard ratios for all-cause mortality and cardiovascular disease deaths were 0.56 (95% confidence interval (CI), 0.41-0.78) and 0.54 (95% CI, 0.28-1.03) between CPAP user group and CPAP nonuser group, respectively. CONCLUSIONS In obstructive sleep apnea patients, CPAP use was associated with lower all-cause mortality.
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Affiliation(s)
- Kei Nakamura
- Urasoe General Hospital, Okinawa, Japan.,Nakamura Clinic, Urasoe, Okinawa, Japan
| | | | | | | | | | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, United Kingdom.,The George Institute for Global Health, University of New South Wales, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5238] [Impact Index Per Article: 1746.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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高 莹, 温 永, 钱 小, 赵 力, 徐 虎, 徐 伟, 孔 晓, 车 贺, 王 亚, 刘 霖. [Cardiac functional alterations and its risk factors in elderly patients with obstructive sleep apnea syndrome free of cardiovascular disease]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1587-1592. [PMID: 33243740 PMCID: PMC7704368 DOI: 10.12122/j.issn.1673-4254.2020.11.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications. METHODS Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI < 15) and moderate to severe OSA group (AHI ≥ 15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups. RESULTS Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 vs 0.17±0.04, P=0.032) and serum creatinine level (70.94± 27.88 vs 54.49±34.22 μmol/L, P=0.022). The left ventricular ejection fraction, interventricular septal thickness, left ventricular posterior wall thickness, left atrial diameter and left ventricular end-diastolic diameter were all similar between the two groups. With a similar early diastolic mitral flow velocity (E) between the two groups, the patients with moderate to severe OSA had a significantly higher late diastolic mitral flow velocity (A) (70.35±6.87 vs 64.09±8.31, P=0.0001) and a significantly lower E/A ratio (0.98±0.06 vs 1.08±0.05, P=0.0001) than the patients with mild OSA. Multiple linear regression showed that the E/A ratio was negatively correlated with AHI (β =- 0.645, P=0.0001). CONCLUSIONS Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.
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Affiliation(s)
- 莹卉 高
- 北京大学国际医院睡眠中心,北京 102206PKU-UPenn Sleep Center, Peking University International Hospital, Beijing 102206, China
| | - 永飞 温
- 北京大学国际医院睡眠中心,北京 102206PKU-UPenn Sleep Center, Peking University International Hospital, Beijing 102206, China
| | - 小顺 钱
- 解放军总医院第二医学中心呼吸与危重症医学科,北京 100853Department of Pulmonary and Critical Care Medicine, General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 力博 赵
- 解放军总医院第二医学中心心血管内科,北京 100853Department of Geriatric Cardiology, Second Medical Center of General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 虎 徐
- 解放军总医院第二医学中心心血管内科,北京 100853Department of Geriatric Cardiology, Second Medical Center of General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 伟豪 徐
- 解放军总医院第二医学中心心血管内科,北京 100853Department of Geriatric Cardiology, Second Medical Center of General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 晓萱 孔
- 解放军总医院第二医学中心心血管内科,北京 100853Department of Geriatric Cardiology, Second Medical Center of General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 贺宾 车
- 解放军总医院大数据中心,北京 100853Big Data Center, General Hospital of PLA, Beijing 100853, China
| | - 亚斌 王
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
| | - 霖 刘
- 解放军总医院第二医学中心呼吸与危重症医学科,北京 100853Department of Pulmonary and Critical Care Medicine, General Hospital of PLA, Beijing 100853, China
- 解放军总医院国家老年疾病临床医学研究中心,北京 100853National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, China
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Kim D, Yang PS, Lip GY, Joung B. Atrial Fibrillation Increases the Risk of Early-Onset Dementia in the General Population: Data from a Population-Based Cohort. J Clin Med 2020; 9:jcm9113665. [PMID: 33202611 PMCID: PMC7697737 DOI: 10.3390/jcm9113665] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is considered a risk factor for dementia, especially in the elderly. However, the association between the two diseases is not well identified in different age subgroups. The association of incident AF with the development of dementia was assessed from 1 January 2005, to 31 December 2013, in 428,262 participants from a longitudinal cohort (the Korea National Health Insurance Service-Health Screening cohort). In total, 10,983 participants were diagnosed with incident AF during the follow-up period. The incidence of dementia was 11.3 and 3.0 per 1000 person-years in the incident-AF and without-AF groups, respectively. After adjustment for clinical variables, the risk of dementia was significantly elevated by incident AF, with a hazard ratio (HR) of 1.98 (95% confidence interval [CI]: 1.80-2.17, p < 0.001), even after censoring for stroke (HR: 1.74, 95% CI: 1.55-1.94, p < 0.001). The HRs of incident AF for dementia onset before the age of 65 (early-onset dementia) and for onset after the age of 65 (late-onset dementia) were 2.91 (95% CI: 1.93-4.41) and 1.67 (95% CI: 1.49-1.87), respectively. Younger participants with AF were more prone to dementia development than older participants with AF (p for trend < 0.001). AF was associated with an increased risk of both early- and late-onset dementia, independent of clinical stroke.
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Affiliation(s)
- Dongmin Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dankook University, Cheonan-si, Chungnam 31116, Korea;
- Department of Medicine, The Graduate School, Yonsei University, Seoul 03722, Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Centre, CHA University, Seongnam 13496, Korea;
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK
- Correspondence: ; Tel.: +82-2-2228-846
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
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Association between obstructive sleep apnoea syndrome and the risk of cardiovascular diseases: an updated systematic review and dose–response meta-analysis. Sleep Med 2020; 71:39-46. [DOI: 10.1016/j.sleep.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 01/11/2023]
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Bhat A, Khanna S, Chen HHL, Gan GCH, MacIntyre CR, Tan TC. Drivers of hospitalization in atrial fibrillation: A contemporary review. Heart Rhythm 2020; 17:1991-1999. [PMID: 32565194 DOI: 10.1016/j.hrthm.2020.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation (AF)-related hospitalization has risen over the last 2 decades and is the most influential determinant of total disease-related expenditure. In this review article, we describe several identified drivers of hospitalization from several registries and large-scale clinical trials, including key cardiovascular and non-traditional risk factors. We also discuss available assessment tools for discerning overall risk of hospitalization, including AF symptom scores, thrombosis and bleeding disposition, and non-invasive cardiac structural assessment. Finally, we highlight the different treatment paradigms that have been proven to reduce AF burden, progression, and hospitalization in the literature.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, Noseworthy PA, Pack QR, Sanders P, Trulock KM. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e750-e772. [DOI: 10.1161/cir.0000000000000748] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
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Xu H, Wang J, Yuan J, Hu F, Yang W, Guo C, Luo X, Liu R, Cui J, Gao X, Chun Y, Qiao S. Implication of Apnea-Hypopnea Index, a Measure of Obstructive Sleep Apnea Severity, for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2020; 9:e015013. [PMID: 32297565 PMCID: PMC7428529 DOI: 10.1161/jaha.119.015013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Obstructive sleep apnea (OSA) is common and independently associated with atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). This study aimed to investigate the relationship between apnea‐hypopnea index (AHI), a measure of OSA severity, and prevalence of AF in a large series of patients with HCM. Methods and Results A total of 555 patients with HCM who underwent sleep evaluations were retrospectively included. Data from polysomnography studies, echocardiography, and baseline clinical characteristics were collected. OSA was present in 327 patients (58.9%). Patients with OSA or higher AHI quartiles were older, more often male, had a higher body mass index, and more clinical comorbidities. The prevalence of AF increased in patients with OSA (23.9% versus 13.6%, P=0.003) or across AHI quartiles (9.4%, 17.3%, 26.6%, and 25.2%, respectively; P for trend <0.001). After adjustment for age, sex, body mass index, New York Heart Association class, left atrial diameter, hypertension, oxygen desaturation index, and obstructive HCM, highest AHI quartile (odds ratio, 4.42; 95% CI, 1.35–14.52 [P=0.014]) or moderate to severe OSA (odds ratio, 3.03; 95% CI, 1.28–7.20 [P=0.012]) but not presence of OSA (odds ratio, 1.58; 95% CI, 0.84–2.97 [P=0.153]) were significantly associated with AF. Higher AHI levels were also factors associated with persistent or permanent AF (highest AHI quartile with odds ratio, 10.96; 95% CI, 1.07–111.85). Conclusions Severity of AHI level is independently associated with AF in patients with HCM. Clinical trials are required to determine the benefits of OSA treatment on AF in patients with HCM.
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Affiliation(s)
- Haobo Xu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Juan Wang
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Jiansong Yuan
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Fenghuan Hu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Weixian Yang
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Chao Guo
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Xiaoliang Luo
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Rong Liu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Jingang Cui
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Xiaojin Gao
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Yushi Chun
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Shubin Qiao
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
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McArdle N, Ward SV, Bucks RS, Maddison K, Smith A, Huang RC, Pennell CE, Hillman DR, Eastwood PR. The prevalence of common sleep disorders in young adults: a descriptive population-based study. Sleep 2020; 43:5819386. [PMID: 32280974 DOI: 10.1093/sleep/zsaa072] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/25/2020] [Indexed: 01/12/2023] Open
Abstract
Abstract
Sleep disorders in adults are associated with adverse health effects including reduced quality of life and increased mortality. However, there is little information on sleep disorders in young adults. A cross-sectional observational study was undertaken in 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012–2014) to describe the prevalence of common sleep disorders. In-laboratory polysomnography (PSG) and validated survey methods were used, including the Epworth Sleepiness Scale, Pittsburgh Sleep Symptom Questionnaire-Insomnia, and International Restless Legs Syndrome Study Group criteria. A total of 1,146 participants completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analyzable PSG data. Participants had a mean age of 22.2 years and female to male ratio of 1.1 to 1. The respective sleep disorder prevalences in females and males were: obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI]: ≥5 events/hour) 14.9% (95% CI: 11.8–18.5) and 26.9% (95% CI: 22.9–31.2); chronic insomnia, 19.3% (95% CI: 16.7–23.9) and 10.6% (95% CI: 8.3–13.9); restless legs syndrome, 3.8% (95% CI: 2.4–5.6) and 1.9% (95% CI: 0.9–3.4); and abnormal periodic leg movements during sleep (>5 movements/hour), 8.6% (95% CI: 6.3–11.5) and 9.6% (95% CI: 7.1–12.7). There were statistically significant differences in prevalence between sexes for OSA and insomnia, which persisted after adjustment for body mass index and education. In those with complete data on all sleep-related assessments (n = 836), at least one sleep disorder was present in 41.0% of females and 42.3% of males. Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.
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Affiliation(s)
- Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Nedlands, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sarah V Ward
- Centre for Genetic Origins of Health and Disease, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Nedlands, Australia
| | - Kathleen Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Nedlands, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Rae-Chi Huang
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, Faculty of Medicine and Health, University of Newcastle, Callaghan, New South Wales, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Nedlands, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Nedlands, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
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Klum M, Urban M, Tigges T, Pielmus AG, Feldheiser A, Schmitt T, Orglmeister R. Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVETand Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2033. [PMID: 32260436 PMCID: PMC7180963 DOI: 10.3390/s20072033] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 01/09/2023]
Abstract
Cardiovascular diseases are the main cause of death worldwide, with sleep disordered breathing being a further aggravating factor. Respiratory illnesses are the third leading cause of death amongst the noncommunicable diseases. The current COVID-19 pandemic, however, also highlights the impact of communicable respiratory syndromes. In the clinical routine, prolonged postanesthetic respiratory instability worsens the patient outcome. Even though early and continuous, long-term cardiorespiratory monitoring has been proposed or even proven to be beneficial in several situations, implementations thereof are sparse. We employed our recently presented, multimodal patch stethoscope to estimate Einthoven electrocardiogram (ECG) Lead I and II from a single 55 mm ECG lead. Using the stethoscope and ECG subsystems, the pre-ejection period (PEP) and left ventricular ejection time (LVET) were estimated. ECG-derived respiration techniques were used in conjunction with a novel, phonocardiogram-derived respiration approach to extract respiratory parameters. Medical-grade references were the SOMNOmedics SOMNO HDTM and Osypka ICON-CoreTM. In a study including 10 healthy subjects, we analyzed the performances in the supine, lateral, and prone position. Einthoven I and II estimations yielded correlations exceeding 0.97. LVET and PEP estimation errors were 10% and 21%, respectively. Respiratory rates were estimated with mean absolute errors below 1.2 bpm, and the respiratory signal yielded a correlation of 0.66. We conclude that the estimation of ECG, PEP, LVET, and respiratory parameters is feasible using a wearable, multimodal acquisition device and encourage further research in multimodal signal fusion for respiratory signal estimation.
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Affiliation(s)
- Michael Klum
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
| | - Mike Urban
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
| | - Timo Tigges
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
| | - Alexandru-Gabriel Pielmus
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
| | - Aarne Feldheiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Evang. Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Henricistr. 92, 45136 Essen, Germany;
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany and Charité Campus Mitte, 10117 Berlin, Germany
| | - Theresa Schmitt
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
| | - Reinhold Orglmeister
- Department of Electronics and Medical Signal Processing, Technische Universität Berlin, Einsteinufer 17, 10587 Berlin, Germany; (M.U.); (T.T.); (A.-G.P.); (T.S.); (R.O.)
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Al-Halawani M, Kyung C, Liang F, Kaplan I, Moon J, Clerger G, Sabin B, Barnes A, Al-Ajam M. Treatment of obstructive sleep apnea with CPAP improves chronic inflammation measured by neutrophil-to-lymphocyte ratio. J Clin Sleep Med 2020; 16:251-257. [PMID: 31992409 DOI: 10.5664/jcsm.8176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with chronic inflammation likely triggered by nocturnal, intermittent hypoxemia and increased adrenergic tone. The neutrophil-to-lymphocyte ratio (NLR) was recently described as a measure of subclinical systemic inflammation. Studies on the effect of continuous positive airway pressure (CPAP) therapy in OSA on subclinical inflammation measured by NLR are lacking. We hypothesize that NLR levels would improve as chronic inflammation diminishes in patients with OSA treated with CPAP. METHODS We retrospectively reviewed patients in whom OSA was diagnosed and who were treated with CPAP therapy. Complete blood count (CBC) were obtained pretreatment and posttreatment for calculation of NLR, which was calculated by dividing the number of neutrophils by the number of lymphocytes. Patients with conditions known to affect NLR such as chronic infections, inflammatory diseases, active cardiovascular disease, and malignancies were excluded from the study. CPAP adherence downloads were obtained for all patients. RESULTS Out of 184 patients in whom OSA was diagnosed and who were treated with CPAP, 109 met our study criteria, including baseline polysomnogram, baseline and posttreatment CBC, and available adherence download. We compared the NLR before and after treatment with CPAP. There was a significant difference in NLR before and after treatment with CPAP (P < .0001). There was also a significant difference in apnea-hypopnea index before and after treatment (P < .0001). We also assessed the relationship between CPAP adherence (percentage of days used for > 4 hours) and the change in NLR. NLR decreased significantly in both the adherent (CPAP use ≥ 70% of days; P = .014) and nonadherent groups (CPAP use < 70% of days; P = .0003). Finally, we noticed a significant direct correlation between CPAP adherence beyond 70% and the change in NLR (ΔNLR) (P = .046) in patients who had ≥ 70% adherence with CPAP, which was not observed in patients with < 70% adherence. CONCLUSIONS The NLR may be a useful marker for monitoring improvement, as CPAP had a desirable effect on the chronic inflammation induced by OSA when measured by NLR in this study. Our results specifically suggest that the NLR values decrease significantly in patients using CPAP regardless of adherence, but with a more direct relationship in those who use it beyond 70% of days, at least 4 hours a day.
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Affiliation(s)
- Moh'd Al-Halawani
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Christian Kyung
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Fei Liang
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Ian Kaplan
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jane Moon
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Guerrier Clerger
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Bruce Sabin
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Andrea Barnes
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Mohammad Al-Ajam
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
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Uncovering Synergistic Mechanism of Chinese Herbal Medicine in the Treatment of Atrial Fibrillation with Obstructive Sleep Apnea Hypopnea Syndrome by Network Pharmacology. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:8691608. [PMID: 31949472 PMCID: PMC6948354 DOI: 10.1155/2019/8691608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022]
Abstract
Paroxysmal atrial fibrillation (AF) combined with obstructive sleep apnea hypopnea syndrome (OSAHS) is very common in clinical practice. Traditional Chinese medicine (TCM) rule of regulating the liver based on psycho-cardiology shows satisfactory effectiveness in the treatment of paroxysmal AF combined with OSAHS. However, its underlying pharmacological mechanism has not yet been elucidated. This study applied network pharmacology to identify 94 active components in the six TCM liver-regulating herbs and 182 corresponding targets from several databases and comprehensive literature studies, as well as retrieved AF combined with OSAHS-related targets. Cytoscape software was adopted to construct the component-component target network and component-putative target-AF combined with OSAHS target network. Then, we obtained 38 putative therapeutic targets against AF combined with OSAHS. After the production of a putative therapeutic target interaction network, topological analysis was adopted to determine the core targets of TCM liver-regulating herbs in the treatment of paroxysmal AF combined with OSAHS. For all putative therapeutic targets, biological process analysis and pathway enrichment analysis were utilized to investigate the possible mechanism of TCM liver-regulating herbs in the treatment of paroxysmal AF combined with OSAHS. Mechanistically, it included positive regulation of nitric oxide biosynthetic process, aging, response to hypoxia, TNF signaling pathway, HIF-1 signaling pathway, PI3K-Akt signaling pathway, neuroactive ligand-receptor interaction, and calcium signaling pathway. Especially, six core targets of TCM liver-regulating herbs, namely, TNF, STAT3, AKT1, IL-6, TP53, and INS, were significant in the regulation of the above biological processes and pathways. This study demonstrates the multicomponent, multitarget, and multipathway feature of TCM liver-regulating herbs, provides an extensional foundation for further research, and facilitates the reasonable application of TCM liver-regulating herbs in treating paroxysmal AF combined with OSAHS.
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71
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Chadda KR, Fazmin IT, Ahmad S, Valli H, Edling CE, Huang CLH, Jeevaratnam K. Arrhythmogenic mechanisms of obstructive sleep apnea in heart failure patients. Sleep 2019; 41:5054592. [PMID: 30016501 DOI: 10.1093/sleep/zsy136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/13/2018] [Indexed: 01/01/2023] Open
Abstract
Heart failure (HF) affects 23 million people worldwide and results in 300000 annual deaths. It is associated with many comorbidities, such as obstructive sleep apnea (OSA), and risk factors for both conditions overlap. Eleven percent of HF patients have OSA and 7.7% of OSA patients have left ventricular ejection fraction <50% with arrhythmias being a significant comorbidity in HF and OSA patients. Forty percent of HF patients develop atrial fibrillation (AF) and 30%-50% of deaths from cardiac causes in HF patients are from sudden cardiac death. OSA is prevalent in 32%-49% of patients with AF and there is a dose-dependent relationship between OSA severity and resistance to anti-arrhythmic therapies. HF and OSA lead to various downstream arrhythmogenic mechanisms, including metabolic derangement, remodeling, inflammation, and autonomic imbalance. (1) Metabolic derangement and production of reactive oxidative species increase late Na+ currents, decrease outward K+ currents and downregulate connexin-43 and cell-cell coupling. (2) remodeling also features downregulated K+ currents in addition to decreased Na+/K+ ATPase currents, altered Ca2+ homeostasis, and increased density of If current. (3) Chronic inflammation leads to downregulation of both Nav1.5 channels and K+ channels, altered Ca2+ homeostasis and reduced cellular coupling from alterations of connexin expression. (4) Autonomic imbalance causes arrhythmias by evoking triggered activity through increased Ca2+ transients and reduction of excitation wavefront wavelength. Thus, consideration of these multiple pathophysiological pathways (1-4) will enable the development of novel therapeutic strategies that can be targeted against arrhythmias in the context of complex disease, such as the comorbidities of HF and OSA.
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Affiliation(s)
- Karan R Chadda
- Faculty of Health and Medical Science, University of Surrey, Guildford, United Kingdom.,Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom
| | - Ibrahim T Fazmin
- Faculty of Health and Medical Science, University of Surrey, Guildford, United Kingdom.,Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom
| | - Haseeb Valli
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom
| | - Charlotte E Edling
- Faculty of Health and Medical Science, University of Surrey, Guildford, United Kingdom
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom.,Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Science, University of Surrey, Guildford, United Kingdom.,Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, United Kingdom
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De Cruz S, Selvaggio A, Aysola R, Bindra S, Padilla A, Zeidler M. A 67-Year-Old Man With Palpitations During Sleep. Chest 2019; 154:e97-e100. [PMID: 30290955 DOI: 10.1016/j.chest.2018.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/20/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022] Open
Abstract
CASE PRESENTATION A 67-year-old man with a history of atrial fibrillation (AF) presented to his physician with symptoms of episodic, nighttime palpitations and excessive daytime sleepiness. Four years prior he underwent radiofrequency ablation after a confirmed diagnosis of AF with subsequent resolution of his palpitations. His palpitations returned approximately 1 year following the ablation. These events would occur only at night and awake him from sleep. Holter monitoring showed baseline sinus rhythm with multiple episodes of AF with rates of 75 to 169 beats/min. These events were all nocturnal and correlated with the symptom diary; episodes ranged from 45 min to 2 h. An echocardiogram showed normal left ventricular size and ejection fraction with a mildly enlarged right atrium (4.38 cm) and no evidence of pulmonary hypertension.
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Affiliation(s)
- Sharon De Cruz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA.
| | - Anna Selvaggio
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Health System, Los Angeles, CA
| | - Ravi Aysola
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA
| | - Sanjay Bindra
- Division of Cardiology, University of California at Los Angeles School of Medicine, Los Angeles, CA
| | - Alex Padilla
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA
| | - Michelle Zeidler
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA
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Strutz PK, Kronzer V, Tzeng W, Arrington B, McKinnon SL, Ben Abdallah A, Haroutounian S, Avidan MS. The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort. Anaesthesia 2019; 74:1542-1550. [PMID: 31531850 DOI: 10.1111/anae.14855] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/03/2023]
Abstract
Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the 'STOP-BANG' screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2-23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22-2.57; p = 0.003). After adjustment for pre-specified variables, the association was not statistically significant with odds ratio 1.34 (0.80-2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0-100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (β-coefficient 2.82; 95%CI, -2.34-7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.
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Affiliation(s)
- P K Strutz
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA.,University of Illinois at Chicago College of Medicine Chicago, Illinois, USA
| | - V Kronzer
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Tzeng
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | | | - S L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | - A Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | - S Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA.,Washington University Pain Center, St. Louis, MO, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
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Gahungu N, Judkins C, Gabbay E, Playford D. Advances in screening for undiagnosed atrial fibrillation for stroke prevention and implications for patients with obstructive sleep apnoea: a literature review and research agenda. Sleep Med 2019; 57:107-114. [DOI: 10.1016/j.sleep.2019.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/30/2018] [Accepted: 01/30/2019] [Indexed: 02/03/2023]
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75
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Gwag HB, Park Y, Lee SS, Kim JS, Park KM, On YK, Lee DI, Shin DG, Choi EK, Kang GH, Park HS, Park HW, Shim JM, Uhm JS, Kim J, Kim JH, Kang KW, Park SW, Oh YS, Cho Y, Lee YS, Park SJ. Rationale, design, and endpoints of the ‘DEvice-Detected CArdiac Tachyarrhythmic Events and Sleep-disordered Breathing (DEDiCATES)’ study: Prospective multicenter observational study of device-detected tachyarrhythmia and sleep-disordered breathing. Int J Cardiol 2019; 280:69-73. [DOI: 10.1016/j.ijcard.2019.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/31/2023]
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76
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Singh M, Hanis CL, Redline S, Ballantyne CM, Hamzeh I, Aguilar D. Sleep apnea and galectin-3: possible sex-specific relationship. Sleep Breath 2019; 23:1107-1114. [PMID: 30721387 DOI: 10.1007/s11325-019-01788-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/10/2019] [Accepted: 01/23/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Sleep apnea is associated with increased risk of cardiovascular disease. Elevated plasma galectin-3 levels, a biomarker associated with myocardial fibrosis, are also associated with adverse cardiovascular events, including heart failure. Our objective was to determine the relationship between severity of sleep apnea and plasma levels of galectin-3 and to determine whether this relationship was modified by sex. METHODS We performed a cross-sectional study of 471 Mexican Americans from Starr County, TX who underwent an overnight, in-home sleep evaluation, and plasma measurement of galectin-3. Severity of sleep apnea was based on apnea hypopnea index (AHI). Multivariable linear regression modeling was used to determine the association between categories of sleep apnea and galectin-3. We also tested for interactions by sex. RESULTS The mean age was 53 years, and 74% of the cohort was female. The prevalence of moderate to severe sleep apnea (AHI > 15 apnea-hypopnea events per hour) was 36.7%. Moderate to severe sleep apnea was associated with increased levels of galectin-3 in the entire population, but we identified a statistically significant interaction between galectin-3 levels and category of sleep apnea by sex (p for interaction = 0.02). Plasma galectin levels were significantly higher in women with moderate or severe sleep apnea than women with no/mild sleep apnea (multivariable adjusted p < 0.001), but not in men (p = 0.5). CONCLUSIONS Sleep apnea is associated elevated galectin-3 levels in women but not men. Our findings highlight a possible sex-specific relationship between sleep apnea and galectin-3, a biomarker of potential myocardial fibrosis that has been associated with increased cardiovascular risk.
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Affiliation(s)
- Mohita Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Craig L Hanis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Suite E431, Houston, TX, 77030, USA
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christie M Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ihab Hamzeh
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David Aguilar
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Suite E431, Houston, TX, 77030, USA.
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77
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Najjar N, Staiano P, Louis M. Obstructive Sleep Apnea and Cardiovascular Disease in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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78
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Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome. Ir J Med Sci 2019; 188:783-790. [DOI: 10.1007/s11845-018-01959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
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79
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Traaen GM, Aakerøy L, Hunt TE, Øverland B, Lyseggen E, Aukrust P, Ueland T, Helle-Valle T, Steinshamn S, Edvardsen T, Khiabani Zaré H, Aakhus S, Akre H, Anfinsen OG, Loennechen JP, Gullestad L. Treatment of sleep apnea in patients with paroxysmal atrial fibrillation: design and rationale of a randomized controlled trial. SCAND CARDIOVASC J 2019; 52:372-377. [PMID: 30638392 DOI: 10.1080/14017431.2019.1567933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE Atrial fibrillation is associated with increased mortality as well as morbidity. There is strong evidence for an association between atrial fibrillation and sleep apnea. It is not known whether treatment of sleep apnea with continuous positive airway pressure (CPAP) will reduce the burden of atrial fibrillation. OBJECTIVE The Treatment of Sleep Apnea in Patients with Paroxysmal Atrial Fibrillation study will investigate the effects of CPAP in patients with paroxysmal atrial fibrillation and sleep apnea. DESIGN The trial has a dual center, randomized, controlled, open-label, parallel design. METHODS Two centers will enroll a total of 100 patients with both paroxysmal atrial fibrillation and sleep apnea (apnea-hypopnea index [AHI] ≥ 15 events/h) who are scheduled for catheter ablation. Patients will be randomized in a 1:1 ratio to CPAP or control group (50 patients in each arm). The effects of CPAP treatment on atrial fibrillation will be determined using an implanted loop recorder (Reveal LINQ™, Medtronic) that detects all arrhythmia episodes. The primary endpoint is a reduction of the total burden of atrial fibrillation in the intervention group, after 5 months' follow-up (preablation). Reduction in the arrhythmia recurrence rate after ablation is the main secondary endpoint. All patients will be followed up for 12 months after ablation. CONCLUSION This study is the first randomized controlled trial that will provide data on the effects of CPAP therapy in patients with paroxysmal atrial fibrillation and sleep apnea. The results are expected to improve our understanding of the interaction between paroxysmal atrial fibrillation and sleep apnea. ClinicalTrials.gov Identifier. NCT02727192.
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Affiliation(s)
- Gunn Marit Traaen
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,c KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research , Oslo University Hospital , Oslo , Norway
| | - Lars Aakerøy
- d Department of Thoracic Medicine , St. Olavs University Hospital , Trondheim , Norway.,e K.G Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science , Norwegian University of Science and Technology , Trondheim , Norway
| | - Tove-Elizabeth Hunt
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,f Department of Cardiology and Center for Cardiological Innovation , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Britt Øverland
- g Department of Otorhinolaryngology, Head & Neck Surgery , Sleep Unit, Lovisenberg Diakonale Hospital , Oslo , Norway
| | - Erik Lyseggen
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Pål Aukrust
- b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,h Research Institute of Internal Medicine , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Thor Ueland
- h Research Institute of Internal Medicine , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Thomas Helle-Valle
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Sigurd Steinshamn
- d Department of Thoracic Medicine , St. Olavs University Hospital , Trondheim , Norway.,e K.G Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science , Norwegian University of Science and Technology , Trondheim , Norway
| | - Thor Edvardsen
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,f Department of Cardiology and Center for Cardiological Innovation , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Hasse Khiabani Zaré
- i Department of Pharmacology, Clinical Trial Unit , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Svend Aakhus
- j Department, of Circulation and Imaging, Faculty of Medicine and Health Science, NTNU , Norwegian University of Science and Technology , Trondheim , Norway.,k Department of Cardiology , St.Olavs University Hospital , Trondheim , Norway
| | - Harriet Akre
- b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,l Department of Otorhinolaryngology, Head & Neck Surgery , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Ole-Gunnar Anfinsen
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,f Department of Cardiology and Center for Cardiological Innovation , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Jan Pål Loennechen
- e K.G Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science , Norwegian University of Science and Technology , Trondheim , Norway.,k Department of Cardiology , St.Olavs University Hospital , Trondheim , Norway
| | - Lars Gullestad
- a Department of Cardiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,c KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research , Oslo University Hospital , Oslo , Norway
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80
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Pichler L, Weinstein SM, Cozowicz C, Poeran J, Liu J, Poultsides LA, Saleh JN, Memtsoudis SG. Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis. Reg Anesth Pain Med 2019; 44:303-308. [DOI: 10.1136/rapm-2018-000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/04/2018] [Indexed: 01/13/2023]
Abstract
Background and objectivesObstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia.MethodsAfter Institutional Review Board approval, 41 766 cases of primary total hip and knee arthroplasties (THAs/TKAs) from 2005 to 2014 were extracted from institutional data of the Hospital for Special Surgery (approximately 5000 THAs and 5000 TKAs annually, of which around 90% under neuraxial anesthesia).The main effect was OSA (identified by the International Classification of Diseases, ninth revision codes); outcomes of interest were cardiac, pulmonary, gastrointestinal, renal/genitourinary, thromboembolic complications, delirium, and prolonged length of stay (LOS). Multivariable logistic regression models provided ORs, corresponding 95% CIs, and p values.ResultsOverall, OSA was seen in 6.3% (n=1332) of patients with THA and 9.1% (n=1896) of patients with TKA. After adjustment for relevant covariates, OSA was significantly associated with 87% (OR 1.87, 95% CI 1.51 to 2.30), 52% (OR 1.52, 95% CI 1.13 to 2.04), and 44% (OR 1.44,95% CI 1.31 to 1.57) increased odds for pulmonary gastrointestinal complications, and prolonged LOS, respectively. The odds for other outcomes remained unaltered by OSA diagnosis.ConclusionWe showed that, even in a setting with almost universal regional anesthesia use, OSA was associated with increased odds for prolonged LOS, and pulmonary and gastrointestinal complications. This puts forward the question of how effective regional anesthesia is in mitigating postoperative complications in patients with OSA.
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81
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Al-Abed MA, Al-Bashir AK, Saraereh OA, Al-Refaie FA, Qaqi RA, Al-Marahlah SM, Saleh YE. Computer simulated assessment of radio frequency electromagnetic waves for the detection of obstructive sleep apnea. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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82
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The impact of alcohol on breathing parameters during sleep: A systematic review and meta-analysis. Sleep Med Rev 2018; 42:59-67. [DOI: 10.1016/j.smrv.2018.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/30/2018] [Accepted: 05/31/2018] [Indexed: 02/02/2023]
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83
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Yeung C, Drew D, Hammond S, Hopman WM, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Extended Cardiac Monitoring in Patients With Severe Sleep Apnea and No History of Atrial Fibrillation (The Reveal XT-SA Study). Am J Cardiol 2018; 122:1885-1889. [PMID: 30274768 DOI: 10.1016/j.amjcard.2018.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is a risk factor for ischemic stroke and reported to be associated with severe obstructive sleep apnea (OSA). The aim of this study was to determine the occurrence of newly detected AF in patients with severe OSA and no previous history of AF. Prospective observational study included patients with severe OSA (Apnea-Hypopnea Index [AHI] ≥ 30) and no history of AF. Primary outcome was detection of AF lasting ≥10 seconds. Patients were subjected to 2 24-hour Holter monitors, and if no AF was detected, implanted with a Medtronic Reveal XT implantable loop recorder. Follow-up was done every 6 months for a total of 3years. Implantable loop recorder was explanted if the primary outcome was detected (AF) or the battery was exhausted. Of the 31 patients enrolled, 6 withdrew participation in the study before implantation. Mean age was 57 ± 10years, mean body mass index was 35 ± 6; 52% male patients. Hypertension 56% and coronary artery disease 24%. Mean AHI was 55 ± 18. AF was detected in 5 patients (20%). AF mean duration was 4.8hours (range 20 seconds to 15.3 hours). Mean time to diagnosis was 11 ± 7 months. Male gender was predictive for AF detection (p = 0.04). Continuous positive airway pressure therapy was used by 96% of patients with 68% total adherence. Mean follow-up was 27 months. In conclusion, extended cardiac monitoring of patients with severe OSA may facilitate the identification of newly detected AF.
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Affiliation(s)
- Cynthia Yeung
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Doran Drew
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sharlene Hammond
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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84
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Kendzerska T, Gershon AS, Atzema C, Dorian P, Mangat I, Hawker G, Leung RS. Sleep Apnea Increases the Risk of New Hospitalized Atrial Fibrillation. Chest 2018; 154:1330-1339. [DOI: 10.1016/j.chest.2018.08.1075] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/28/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022] Open
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85
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Sepehri Shamloo A, Arya A, Dagres N, Hindricks G. Sleep Disorders and Atrial Fibrillation: Current Situation and Future Directions. Galen Med J 2018; 7:e1416. [PMID: 34466452 PMCID: PMC8343595 DOI: 10.22086/gmj.v0i0.1416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022] Open
Abstract
Atrial fibrillation (AF) is a growing health problem worldwide. In recent years, there has been a rising interest in the relationship between sleep disorders and AF. Several studies have reported higher prevalence and incidence rates of AF in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). However, some believe that OSAHS is not a risk factor for AF; but AF, by itself, is regarded as one of the possible triggers for OSAHS. In this study, the related literature investigating the association between OSAHS and AF was reviewed, and then the possible mechanisms of this interplay were discussed. To conclude, recommendations for further research in this field were presented to researchers and some points were highlighted for physicians.
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Affiliation(s)
- Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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86
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Konecny T, Brady PA, Park JY, Reddy PK, Ruzek L, Mach L, Caples SM, Somers VK. Usefulness of Heart Rate Control in Atrial Fibrillation Patients With Obstructive Sleep Apnea. Am J Cardiol 2018; 122:1482-1488. [PMID: 30244846 DOI: 10.1016/j.amjcard.2018.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023]
Abstract
In patients without atrial fibrillation and flutter (AF), obstructive sleep apnea (OSA) is associated with cyclic and often marked changes in heart rate (HR). We aimed to assess whether presence of OSA impacts optimal HR control in patients in AF. We retrospectively correlated diurnal HR patterns (recorded by 24-hour Holter monitoring) in patients with AF who independently also underwent diagnostic polysomnography. Exclusion criteria were paced rhythm or inadequate recordings from polysomnography and Holter monitoring. The relationship between the presence and severity of OSA and the mean, minimum, maximum HR, as well as pauses (>2 seconds) and their diurnal variation were studied. Of the 494 studied patients (age 69 ± 10 years; 26% women) mild-moderate OSA (apnea hypoxia index ≥5 and <20) was present in 171 (34%) and severe OSA (apnea hypoxia index ≥20) in 254 (51%). Mean 24-hour HR in patients with severe OSA and mild-moderate OSA was similar to those without OSA (78 vs 80 vs 79 beats per minute; p = 0.39), and there was no significant difference observed in minimum and maximum HR of these groups. However, the frequency of short pauses was greater in OSA patients (p = 0.009), with a prominent nocturnal distribution. In conclusion, OSA was not associated with increased HR in patients with AF suggesting that adequate HR control was similarly achievable in patients with and without OSA. The increased frequency of nocturnal pauses in OSA patients may function as a clinical hallmark, and the timing of pauses (during sleep vs wakefulness) should be noted before making therapeutic decisions regarding HR control.
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87
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- University of Birmingham, Birmingham, UK.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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88
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Li Y, Pastori D, Guo Y, Wang Y, Lip GYH. Risk factors for new-onset atrial fibrillation: A focus on Asian populations. Int J Cardiol 2018; 261:92-98. [PMID: 29657061 DOI: 10.1016/j.ijcard.2018.02.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
The incidence of new-onset atrial fibrillation (NOAF) is increasing both in the Asian populations and Western countries. Several demographic and clinical risk factors were independently associated with NOAF, including ageing, male sex, obesity, obstructive sleep apnea syndrome, hypertension, coronary artery disease, renal dysfunction and heart failure. However, some differences in the incidence of NOAF, the prevalence of some risk factors and lifestyle or environmental conditions may exist between Asian and Western countries. Early recognition and holistic management of risk factors in an integrated manner may help reduce the burden of NOAF and its complications. While some risk scores have been developed to predict the risk of NOAF, thus far none are currently recommended or adequately validated to be used as a screening tool especially in the Asian population. The present semi-systematic review article aims to provide a comprehensive overview on the risk factors associated to NOAF, focusing on those explored in the Asian populations.
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Affiliation(s)
- Yanguang Li
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Chinese PLA General Hospital, Chinese PLA Medical School, Department of Cardiology, Beijing, China
| | - Daniele Pastori
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Yutao Guo
- Chinese PLA General Hospital, Chinese PLA Medical School, Department of Cardiology, Beijing, China
| | - Yutang Wang
- Chinese PLA General Hospital, Chinese PLA Medical, Department of Geriatric Cardiology, Beijing, China
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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90
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Ghazal F, Theobald H, Rosenqvist M, Al-Khalili F. Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study. PLoS One 2018; 13:e0198069. [PMID: 29795689 PMCID: PMC5993113 DOI: 10.1371/journal.pone.0198069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/14/2018] [Indexed: 12/03/2022] Open
Abstract
Background Atrial fibrillation (AF) is a major risk factor for ischemic stroke unless treated with an anticoagulant. Detecting AF can be difficult because AF is often paroxysmal and asymptomatic. The aims of this study were to develop a screening model to detect AF in a primary healthcare setting and to initiate oral anticoagulant therapy in high-risk patients to prevent stroke. Methods This was a cross-sectional study. All 70- to 74-year-old individuals registered at a single primary healthcare center in Stockholm were invited to participate in AF screening upon visiting the center during a ten-month period. Those who did not have contact with the center during this period were invited to participate by letter. Thirty-second intermittent ECG recordings were made twice a day using a handheld Zenicor device over a 2-week period in participants without AF. Oral anticoagulant therapy was offered to patients with newly detected AF. Findings Of the 415 eligible individuals, a total of 324 (78.1%) patients participated in the study. The mean age of the participants was 72 years, 52.2% were female, and the median CHA2DS2-VASc score of the participants was 3. In the target population, 34 (8.2%) individuals had previously diagnosed AF. Among participants without previously known AF, 16 (5.5%) cases of AF were detected. The final AF prevalence in the target population was 12%. Oral anticoagulant therapy was successfully initiated in 88% of these patients with newly detected AF. Conclusions The AF screening project exhibited a high participation rate and resulted in a high rate of newly discovered AF; of these newly diagnosed patients, 88% could be treated with an oral anticoagulant.
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Affiliation(s)
- Faris Ghazal
- Karolinska Institute, Department of Clinical Sciences, Cardiology Unit, Danderyd Hospital, Stockholm, Sweden
| | - Holger Theobald
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Mårten Rosenqvist
- Karolinska Institute, Department of Clinical Sciences, Cardiology Unit, Danderyd Hospital, Stockholm, Sweden
| | - Faris Al-Khalili
- Karolinska Institute, Department of Clinical Sciences, Cardiology Unit, Danderyd Hospital, Stockholm, Sweden
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91
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McEvoy RD, Kohler M. Con: continuous positive airway pressure and cardiovascular prevention. Eur Respir J 2018; 51:51/5/1702721. [PMID: 29748242 DOI: 10.1183/13993003.02721-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/19/2018] [Indexed: 01/27/2023]
Affiliation(s)
- R Doug McEvoy
- Sleep Health Service, SALHN, Respiratory and Sleep Services, Adelaide, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, Australia
| | - Malcolm Kohler
- Dept of Pulmonology, University Hospital of Zurich, Zurich, Switzerland.,Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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92
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Mou J, Pflugeisen BM, Crick BA, Amoroso PJ, Harmon KT, Tarnoczy SF, Shirley Ho S, Mebust KA. The discriminative power of STOP-Bang as a screening tool for suspected obstructive sleep apnea in clinically referred patients: considering gender differences. Sleep Breath 2018; 23:65-75. [PMID: 29691799 DOI: 10.1007/s11325-018-1658-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/07/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is the most commonly seen clinical sleep disorder. STOP-Bang, a widely used screening tool, yields a composite score based on eight dichotomized items including male gender. This study was designed to validate STOP-Bang among clinically referred patients and tested alternative scoring designs on tool performance, with a focus on gender differences in OSA. METHOD STOP-Bang was administered to 403 female and 532 male subjects, followed by comprehensive sleep evaluation that included measurement of apnea-hypopnea indexes. Gender differences in STOP-Bang scores, OSA diagnosis, and severities were explored, and gender-specific alternative score cutoffs evaluated. Optimal operating points (OOP) were tested for female body mass index (BMI) and male neck circumference to inform STOP-Bang threshold refinement. Receiver operating characteristic curves were used to compare conventional and modified STOP-Bang. RESULTS STOP-Bang performance by gender showed extremely low specificity in males at the recommended cutoff of ≥3. Better utility was presented at a cutoff of 4 or 5 among clinically referred patients irrespective of gender differences. Screening performance was improved by modifying BMI and/or neck circumference thresholds using gender-triaged OOP estimation. Three gender-based model revisions outperformed conventional STOP-Bang. CONCLUSION Our study suggests that gender-specific consideration needs to be incorporated into the application of STOP-Bang in a clinically referred patient population with a higher risk of OSA. Alternative scoring systems may improve predictive performance of STOP-Bang.
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Affiliation(s)
- Jin Mou
- MultiCare Institute for Research & Innovation, MultiCare Health System, Ste 402, 314 MLK Jr. Way, Tacoma, WA, 98405, USA.
| | - Bethann M Pflugeisen
- MultiCare Institute for Research & Innovation, MultiCare Health System, Ste 402, 314 MLK Jr. Way, Tacoma, WA, 98405, USA
| | - Brian A Crick
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, 98405, USA
| | - Paul J Amoroso
- MultiCare Institute for Research & Innovation, MultiCare Health System, Ste 402, 314 MLK Jr. Way, Tacoma, WA, 98405, USA
| | - Kirk T Harmon
- MultiCare Centers of Occupational Medicine, Fife, WA, 98424, USA
| | - Stephen F Tarnoczy
- MultiCare Sleep Medicine Center, MultiCare Neuroscience Center of Washington, Tacoma, WA, 98405, USA
| | - S Shirley Ho
- MultiCare Sleep Medicine Center, MultiCare Neuroscience Center of Washington, Tacoma, WA, 98405, USA
| | - Kimberly A Mebust
- MultiCare Sleep Medicine Center, MultiCare Neuroscience Center of Washington, Tacoma, WA, 98405, USA
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93
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Ando SI. Influence of hypoxia induced by sleep disordered breathing in case of hypertension and atrial fibrillation. J Cardiol 2018; 72:10-18. [PMID: 29627145 DOI: 10.1016/j.jjcc.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022]
Abstract
Sleep disordered breathing (SDB) has been recognized as one of the important causes or factors of worsening for various cerebro- and cardiovascular diseases. On the other hand, a recent large randomized study and meta-analysis about the effect of continuous positive airway pressure (CPAP) indicated no or only minor effects to improve the outcome of SDB patients. Accumulating evidence has indicated that the key factor of the link between SDB and cardiovascular diseases might be hypoxia caused during repetitive long apneic episodes. Hypertension and atrial fibrillation (AF) are two important cardiovascular diseases that relate to SDB and the therapeutic consequences by CPAP treatment have been studied. As for the mechanism that elevates blood pressure during night, stimulation of chemoreceptors by hypoxia and the resultant increase in sympathetic nervous activity is the first step and repetitive hypoxic stimulation changes the characteristics of chemoreceptors and baroreceptors resulting in daytime hypertension. Pathological changes in the atrial muscle in SDB patients might be a result of repetitive hypoxia and atrial expansion. As for triggering AF, several animal studies revealed that the changes in autonomic nervous system caused by hypoxia and negative intra-thoracic pressure might be crucial. However, a recent observational study could not show the relation between SDB and AF. The difference between the previous studies and this negative study seems to exist in the difference of the severity of SDB or the degree of hypoxia. Such a difference might be also one of the reasons why a recent randomized trial to prove the effect of CPAP in cardio- or cerebrovascular patients failed to improve the patient prognosis. Hence, in this review, the relationship between hypoxia and onset or continuation of hypertension and AF will be reconsidered to understand the fundamental and robust relationship between SDB and these cardiovascular diseases.
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Affiliation(s)
- Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan.
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94
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Strutz P, Tzeng W, Arrington B, Kronzer V, McKinnon S, Ben Abdallah A, Haroutounian S, Avidan MS. Obstructive sleep apnea as an independent predictor of postoperative delirium and pain: protocol for an observational study of a surgical cohort. F1000Res 2018; 7:328. [PMID: 30026927 PMCID: PMC6039916 DOI: 10.12688/f1000research.14061.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: Postoperative delirium and pain are common complications in adults, and are difficult both to prevent and treat. Obstructive sleep apnea (OSA) is prevalent in surgical patients, and has been suggested to be a risk factor for postoperative delirium and pain. OSA also might impact pain perception, and alter pain medication requirements. This protocol describes an observational study, with the primary aim of testing whether OSA is an independent predictor of postoperative complications, focusing on (i) postoperative incident delirium and (ii) acute postoperative pain severity. We secondarily hypothesize that compliance with prescribed treatment for OSA (typically continuous positive airway pressure or CPAP) might decrease the risk of delirium and the severity of pain. Methods and analysis: We will include data from patients who have been enrolled into three prospective studies: ENGAGES, PODCAST, and SATISFY-SOS. All participants underwent general anesthesia for a non-neurosurgical inpatient operation, and had a postoperative hospital stay of at least one day at Barnes Jewish Hospital in St. Louis, Missouri, from February 2013 to May 2018. Patients included in this study have been assessed for postoperative delirium and pain severity as part of the parent studies. In the current study, determination of delirium diagnosis will be based on the Confusion Assessment Method, and the Visual Analogue Pain Scale will be used for pain severity. Data on OSA diagnosis, OSA risk and compliance with treatment will be obtained from the preoperative assessment record. Other variables that are candidate risk factors for delirium and pain will also be extracted from this record. We will use logistic regression to test whether OSA independently predicts postoperative delirium and linear regression to assess OSAs relationship to acute pain severity. We will conduct secondary analyses with subgroups to explore whether these relationships are modified by compliance with OSA treatment.
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Affiliation(s)
- Patricia Strutz
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - William Tzeng
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Brianna Arrington
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Vanessa Kronzer
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Sherry McKinnon
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
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95
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Youssef I, Kamran H, Yacoub M, Patel N, Goulbourne C, Kumar S, Kane J, Hoffner H, Salifu M, McFarlane SI. Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis. ACTA ACUST UNITED AC 2018; 7. [PMID: 29657903 PMCID: PMC5898401 DOI: 10.4172/2167-0277.1000282] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives To conducted a meta-analysis assessing the relationship between Obstructive Sleep Apnea (OSA) and the risk of Atrial Fibrillation (AF) Methods We searched PUBMED, Medline, and Cochrane Library using the keywords “atrial fibrillation”, “obstructive sleep apnea” and “sleep disordered breathing (SDB)”. All subjects included had established diagnosis of OSA/SDB. We then compared the occurrence of AF versus no AF. Analysis done with Comprehensive Meta-Analysis package V3 (Biostat, USA). Results A total of 579 results were generated. Duplicates were removed and 372 records were excluded based on irrelevant abstracts, titles, study design not consistent with the stated outcome, or full-text unavailable. Twelve studies meeting the inclusion criteria were reviewed in full-text; 2 of these articles were eventually removed due to unconfirmed OSA diagnostic modality, and one was also removed based on a control group inconsistent with the other studies. Therefore, a total of 9 studies were included (n=19,837). Sample sizes ranged from n=160 patients to n=6841 patients. The risk of AF was found to be higher among OSA/SDB versus control group (OR; 2.120, C.I: 1.845–2.436, Z; 10.598 p: <0.001). The heterogeneity observed for the pooled analysis was Q-value; 22.487 df (Q); 8 P-value; 0.004, I-squared; 64.424 Tau2; 0.098, suggesting appropriate study selection and moderate heterogeneity. Conclusion OSA/SDB is strongly associated with AFib confirming the notion that OSA/SDB populations are high risk for development of AF. Prospective studies are needed to ascertain the effect of the treatment of OSA/SDB for the prevention of AF, a growing health burden with serious consequences.
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Affiliation(s)
- Irini Youssef
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Haroon Kamran
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Mena Yacoub
- Department of Cardiology, Northside Hospital, St. Petersburg FL, USA
| | - Nirav Patel
- Department of Cardiology, Hartford Hospital, Hartford, CT
| | - Clive Goulbourne
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Shweta Kumar
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Jesse Kane
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Haley Hoffner
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Moro Salifu
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Samy I McFarlane
- Department of Medicine, Divisions of Endocrinology, Cardiology and Renal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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96
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Koo DL, Nam H, Thomas RJ, Yun CH. Sleep Disturbances as a Risk Factor for Stroke. J Stroke 2018; 20:12-32. [PMID: 29402071 PMCID: PMC5836576 DOI: 10.5853/jos.2017.02887] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/07/2018] [Accepted: 01/15/2018] [Indexed: 12/30/2022] Open
Abstract
Sleep, a vital process of human being, is carefully orchestrated by the brain and consists of cyclic transitions between rapid eye movement (REM) and non-REM (NREM) sleep. Autonomic tranquility during NREM sleep is characterized by vagal dominance and stable breathing, providing an opportunity for the cardiovascular-neural axis to restore homeostasis, in response to use, distress or fatigue inflicted during wakefulness. Abrupt irregular swings in sympathovagal balance during REM sleep act as phasic loads on the resting cardiovascular system. Any causes of sleep curtailment or fragmentation such as sleep restriction, sleep apnea, insomnia, periodic limb movements during sleep, and shift work, not only impair cardiovascular restoration but also impose a stress on the cardiovascular system. Sleep disturbances have been reported to play a role in the development of stroke and other cardiovascular disorders. This review aims to provide updated information on the role of abnormal sleep in the development of stroke, to discuss the implications of recent research findings, and to help both stroke clinicians and researchers understand the importance of identification and management of sleep pathology for stroke prevention and care.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Robert J Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Chang-Ho Yun
- Department of Neurology, Bundang Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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97
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Zhao E, Chen S, Du Y, Zhang Y. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5215868. [PMID: 29581977 PMCID: PMC5822830 DOI: 10.1155/2018/5215868] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/04/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Numerous reports have been done to seek the relationship between sleep apnea hypopnea syndrome (SAHS) and the risk of atrial fibrillation (AF). However, definite conclusion has not yet been fully established. We examined whether SAHS increases AF incidence in common population and summarized all existing studies in a meta-analysis. We summarized the current studies by searching related database for potential papers of the association between SAHS and the risk of AF. Studies that reported original data or relative risks (RRs) with 95% confidence intervals (CIs) for the associations were included. Sensitivity analyses were performed by omitting each study iteratively and publication bias was detected by Begg's tests. Eight eligible studies met the inclusion criteria. Fixed effects meta-analysis showed that SAHS increased AF risk in the common population (RR = 1.70, 95% CI: 1.53-1.89, P = 0.002, I2 = 69.2%). There was a significant association between mild SAHS and the risk of AF (RR = 1.52, 95% CI: 1.28-1.79, P = 0.01, I2 = 78.4%), moderate SAHS (RR = 1.88, 95% CI: 1.55-2.27, P = 0.017, I2 = 75.6%), and severe SAHS (RR = 2.16, 95% CI: 1.78-2.62, P < 0.001, I2 = 91.0%). The results suggest that sleep apnea hypopnea syndrome could increase the risk of AF, and the higher the severity of SAHS, the higher risk of atrial fibrillation.
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Affiliation(s)
- Enfa Zhao
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shimin Chen
- Department of Gastroenterology, The First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yajuan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yushun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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98
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Ratneswaran C, Sagoo MK, Steier J. Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review. J Thorac Dis 2018; 10:S1-S23. [PMID: 29445524 PMCID: PMC5803052 DOI: 10.21037/jtd.2017.10.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Manpreet K Sagoo
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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99
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Brandes A, Smit MD, Nguyen BO, Rienstra M, Van Gelder IC. Risk Factor Management in Atrial Fibrillation. Arrhythm Electrophysiol Rev 2018; 7:118-127. [PMID: 29967684 DOI: 10.15420/aer.2018.18.2] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased morbidity and mortality. There is growing evidence that numerous cardiovascular diseases and risk factors are associated with incident AF and that lone AF is rare. Beyond oral anticoagulant therapy, rate and rhythm control, therapy targeting risk factors and underlying conditions is an emerging AF management strategy that warrants better implementation in clinical practice. This review describes current evidence regarding the association between known modifiable risk factors and underlying conditions and the development and progression of AF. It discusses evidence for the early management of underlying conditions to improve AF outcomes. It also provides perspective on the implementation of tailored AF management in daily clinical practice.
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Affiliation(s)
- Axel Brandes
- Department of Cardiology, Cardiology Research Unit, Odense University Hospital, University of Southern Denmark Odense, Denmark
| | - Marcelle D Smit
- Thoraxcentre, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Bao Oanh Nguyen
- Thoraxcentre, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Michiel Rienstra
- Thoraxcentre, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, Cardiology Research Unit, Odense University Hospital, University of Southern Denmark Odense, Denmark.,Thoraxcentre, University of Groningen, University Medical Centre Groningen, The Netherlands
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100
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Mehra R. Sleep Apnea and Nocturnal Cardiac Arrhythmia: Understanding Differences Across Ethnicity. J Clin Sleep Med 2017; 13:1229-1231. [PMID: 29065964 DOI: 10.5664/jcsm.6784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Reena Mehra
- Center for Sleep Disorders, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; Heart and Vascular Institute, Cleveland, Ohio; Department of Molecular Cardiology, Lerner Research Institute, Cleveland, Ohio
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