Review Article

Atrial Arrhythmias in Obstructive Sleep Apnea: Underlying Mechanisms and Implications in the Clinical Setting

Table 1

Risk of atrial arrhythmias in obstructive sleep apnea.

Author, year DesignStudy populationDiagnostic method of patientsCardiac monitoringResults

Guilleminault et al., 1983 [46]UncontrolledSevere OSAPSG40024 h holter ECG Nocturnal paroxysms of AF in 3% of OSA patients
Sinus arrest and AV block in 10% and 7% of OSA patients

Gami et al., 2007 [47]Observational retrospectiveAdults underwent
a 1st PSG study.
No AF at baseline
PSG3542N/A. Medical
index diagnostic codes for AF
Obesity and OSA were independent risk factors for incident AF

Mooe et al., 1996 [49]Observational prospectivePatients underwent
CABG surgery
PSG121Prospective monitoring until dischargeAHI ≥ 5 was associated with significant higher risk of postsurgical AF

Ng et al., 2011 [50]Meta-analysis (observational studies)Patients
underwent PVI
PSG/Berlin
questionnaire
399524/48 h holter ECG
Event monitor/recorder
Telephone follow-up
ECG
OSA led to greater AF recurrence rates after PVI

Simantirakis et al., 2004 [40]Observational prospectiveModerate-severe
OSA
PSG23Implantable loop
recorder
Cardiac pauses >3 s and bradycardic
episodes <40 bpm in 47% of patients

Becker, 1998 [6]Observational prospectiveUnselected OSAPSG23924 h holter ECG2nd- and 3rd-degree AV block and/or sinus arrest in 7.5% of OSA patients

Hoffstein and Mateika, 1994 [56]Observational prospectivePatients underwent PSG studyPSG458Single lead ECG
during PSG
58% prevalence of arrhythmias in OSA patients

AF: atrial fibrillation; AHI: apnea/hypopnea index; AV block: atrioventricular block; CABG: coronary artery bypass graft; OSA: obstructive sleep apnea; PSG: polysomnography; PVI: pulmonary vein isolation.