Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring

Publication date: Available online 18 October 2019Source: IJC Heart &VasculatureAuthor(s): Dominik Linz, Mathias Baumert, Lien Desteghe, Kadhim Kadhim, Kevin Vernooy, Jonathan M. Kalman, Dobromir Dobrev, Michael Arzt, Manu Sastry, Harry J.G.M. Crijns, Ulrich Schotten, Martin R. Cowie, R. Doug McEvoy, Hein Heidbuchel, Jeroen Hendriks, Prashanthan Sanders, Dennis H. LauAbstractIn patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF.In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for...
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research

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ConclusionsIn AF patients, there is underuse of GDT for non-AF comorbidities. The association between GDT use and outcomes was strongest in heart failure and obstructive sleep apnea patients where use of GDT was associated with lower mortality and less AF progression.
Source: American Heart Journal - Category: Cardiology Source Type: research
A 72-year-old, 94-kg, 173-cm man with hypertension, diabetes mellitus, obstructive sleep apnea, and a family history of coronary artery disease presented to the authors ’ preoperative evaluation clinic before an elective carpal tunnel release. An electrocardiogram obtained in the clinic showed previously undocumented atrial flutter. The hand surgery was postponed; the patient was referred to the electrophysiology service for further evaluation. He subsequently un derwent a radiofrequency ablation, but then developed recurrent paroxysmal atrial fibrillation after the procedure.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Heart failure with preserved ejection fraction (HFpEF) is an increasingly studied entity accounting for 50% of all diagnosed heart failure and that has claimed its own dignity being markedly different from heart failure with reduced EF in terms of etiology and natural history (Graziani et al., 2018). Recently, a growing body of evidence points the finger toward microvascular dysfunction as the major determinant of the pathological cascade that justifies clinical manifestations (Crea et al., 2017). The high burden of comorbidities such as metabolic syndrome, hypertension, atrial fibrillation, chronic kidney disease, obstruc...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
I am coming to understand that various types of"wearable health ecosystems" (i.e., wearable business models) are evolving. This is an important step in the creation of consumer-facing, healthcare/wellness systems. The latest example is that of Fitbit partnering with pharmaceutical companies (see:Fitbit collaborating with pharma giants Bristol-Myers Squibb and Pfizer). Below is an excerpt from this article:Fitbit and pharmaceutical giants Bristol-Myers Squibb and Pfizer have inked a multiyear partnership to accelerate the detection and diagnosis of atrial fibrillation to reduce the risk of life-threatening ev...
Source: Lab Soft News - Category: Laboratory Medicine Authors: Tags: Diagnostics Health Wearable Healthcare Information Technology Healthcare Innovations Public Health Telemedicine Test Kits and Home Testing Source Type: blogs
“We’re not as healthy as we should be.” That’s what Fitbit CEO and co-founder James Park said at Thursday’s TIME 100 Health Summit, where MSNBC anchor Stephanie Ruhle interviewed him about the company’s future in the health care space, the impact of wearables and just how active Fitbit’s 30 million active users really are. Ruhle talked with Park about Fitbit’s position as one of the first major wearables company to have gone public, one that led the charge in terms of mass market adoption but has lost ground to competitors offering more advanced wearable devices, as well as ...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized fitness HealthSummit19 technology Source Type: news
This study sought to evaluate the effectiveness of PAP therapy for SDB on AF recurrence.Methods:This was a single-center, retrospective study conducted at a tertiary referral center. All adult patients who had SDB on polysomnography and underwent AF intervention (ablation or cardioversion) following polysomnography from January 1992-December 2014 were analyzed. Primary outcome was time to first-documented recurrence of AF after AF intervention by Kaplan–Meier estimates.Results:Among 30,188 patients with obstructive and central SDB, 429 had this diagnosis before AF intervention; 269 were“PAP-adherent users,&rdqu...
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Authors: Bashir MU, Bhagra A, Kapa S, McLeod CJ Abstract Atrial fibrillation is the most common symptomatic arrhythmia that is associated with stroke. Contemporary management of the disease is focused on anticoagulation to prevent stroke, coupled with catheter ablation to limit symptoms and prevent deleterious cardiac remodeling. Emerging data highlights the importance of lifestyle modification by managing sleep apnea, increasing physical activity, and weight loss. There is significant data that supports a link between the autonomic nervous system, arrhythmia development, and atrial fibrillation therapy. It is like...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
iRhythm and Verily announced a partnership last month to “co-develop solutions intended to provide early warning, diagnosis and management for patients, particularly for those with silent or undiagnosed AF.” We spoke with iRhythm CEO Kevi...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiology Diagnostics Exclusive irhythm verily Source Type: blogs
Purpose of review This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences. Recent findings Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and...
Source: Current Opinion in Pulmonary Medicine - Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Brian D. Kent Source Type: research
Conclusions: Obstructive sleep apnea diagnosis in atrial fibrillation patients was strongly associated with reduced risk of incident cardiovascular disease. We discuss misclassification, selection bias, and residual confounding as potential explanations.
Source: Epidemiology - Category: Epidemiology Tags: Sleep Source Type: research
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