Obstructive sleep apnea as a potentially reversible cause of nighttime bradyarrhythmias. Clinical case

Abstract

Obstructive sleep apnea syndrome is a common condition, especially among obese patients. Patients with obstructive sleep apnea syndrome have an increased risk of developing arterial hypertension and cardiovascular events, as well as cardiac arrhythmias, which include reflexively occurring bradyarrhythmias and episodes of asystole at night. Treatment of obstructive sleep apnea syndrome leads to an improvement in the patient’s quality of life and also reduces cardiovascular risk and eliminates associated bradyarrhythmias during night sleep.

Keywords

obstructive sleep apnea syndrome / respiratory therapy / non-invasive ventilation / bradyarrhythmias

References

[1] Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–484. doi: 10.1146/annurev.me.27.020176.002341

[2] Guilleminault C., Tilkian A., Dement W.C. The sleep apnea syndromes // Annu Rev Med. 1976. Vol. 27. P. 465–484. doi: 10.1146/annurev.me.27.020176.002341

[3] Kapur V, Strohl KP, Redline S, et al. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath. 2002;6(2):49–54. doi: 10.1007/s11325-002-0049-5

[4] Kapur V., Strohl K.P., Redline S., et al. Underdiagnosis of sleep apnea syndrome in U.S. communities // Sleep Breath. 2002. Vol. 6, N. 2. P. 49–54. doi: 10.1007/s11325-002-0049-5

[5] Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis. The Lancet. Respir Med. 2019;7(8):687–698. doi: 10.1016/S2213-2600(19)30198-5

[6] Benjafield A.V., Ayas N.T., Eastwood P.R., et al. Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis // The Lancet. Respir Med. 2019. Vol. 7, N. 8. P. 687–698. doi: 10.1016/S2213-2600(19)30198-5

[7] Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323(14):389–1400. doi: 10.1001/jama.2020.3514

[8] Gottlieb D.J., Punjabi N.M. Diagnosis and management of obstructive sleep apnea: a review // JAMA. 2020. Vol. 323, N. 14. P. 389–1400. doi: 10.1001/jama.2020.3514

[9] Manuel AR, Hart N, Stradling JR. Correlates of obesity-related chronic ventilatory failure. BMJ. 2016;3(1):e000110. doi: 10.1136/bmjresp-2015-000110

[10] Manuel A.R., Hart N., Stradling J.R. Correlates of obesity-related chronic ventilatory failure // BMJ. 2016. Vol. 3, N. 1. P. e000110. doi: 10.1136/bmjresp-2015-000110

[11] Patinkin ZW, Feinn R, Santos M. Metabolic consequences of obstructive sleep apnea in adolescents with obesity: a systematic literature review and meta-analysis. Childhood Obesity. 2017;13(2):102–110. doi: 10.1089/chi.2016.0248

[12] Patinkin Z.W., Feinn R., Santos M. Metabolic consequences of obstructive sleep apnea in adolescents with obesity: a systematic literature review and meta-analysis // Childhood Obesity. 2017. Vol. 13, N. 2. P. 102–110. doi: 10.1089/chi.2016.0248

[13] Rapoport DM, Garay SM, Epstein H, Goldring RM. Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the “Pickwickian syndrome”. Chest. 1986;89(5):627–635. doi: 10.1378/chest.89.5.627

[14] Rapoport D.M., Garay S.M., Epstein H., Goldring R.M. Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the “Pickwickian syndrome” // Chest. 1986. Vol. 89, N. 5. P. 627–635. doi: 10.1378/chest.89.5.627

[15] Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504. doi: 10.5664/jcsm.6506

[16] Kapur V.K., Auckley D.H., Chowdhuri S., et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline // J Clin Sleep Med. 2017. Vol. 13, N. 3. P. 479–504. doi: 10.5664/jcsm.6506

[17] Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;144(3):56–67. doi: 10.1161/CIR.0000000000000988

[18] Yeghiazarians Y., Jneid H., Tietjens J.R., et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association // Circulation. 2021. Vol. 144, N. 3. P. 56–67. doi: 10.1161/CIR.0000000000000988

[19] Mann D, Zipes D, Libby P, Bonow R. Braunwald’s heart disease: a textbook of cardiovascular medicine. 11th ed. Philadelphia (PA): Elsevier/Saunders; 2015.

[20] Mann D., Zipes D., Libby P., Bonow R. Braunwald’s heart disease: a textbook of cardiovascular medicine. 11th ed. Philadelphia (PA): Elsevier/Saunders, 2015.

[21] Vetulli HM, Elizari MV, Naccarelli GV, Gonzalez MD. Cardiac automaticity: basic concepts and clinical observations. J Interv Card Electrophysiol. 2018;52(3):263–270. doi: 10.1007/s10840-018-0423-2

[22] Vetulli H.M., Elizari M.V., Naccarelli G.V., Gonzalez M.D. Cardiac automaticity: basic concepts and clinical observations // J Interv Card Electrophysiol. 2018. Vol. 52, N. 3. P. 263–270. doi: 10.1007/s10840-018-0423-2

[23] Drager LF, Bortolotto LA, Figueiredo AC, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest. 2007;131(5):1379–1386. doi: 10.1378/chest.06-2703

[24] Drager L.F., Bortolotto L.A., Figueiredo A.C., et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling // Chest. 2007. Vol. 131, N. 5. P. 1379–1386. doi: 10.1378/chest.06-2703

[25] Chadda KR, Fazmin IT, Ahmad S, et al. Arrhythmogenic mechanisms of obstructive sleep apnea in heart failure patients. Sleep. 2018;41(9):zsy136. doi: 10.1093/sleep/zsy136

[26] Chadda K.R., Fazmin I.T., Ahmad S., et al. Arrhythmogenic mechanisms of obstructive sleep apnea in heart failure patients // Sleep. 2018. Vol. 41, N 9. P. zsy136. doi: 10.1093/sleep/zsy136

[27] Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician. 2016;94(5): 355–360.

[28] Semelka M., Wilson J., Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults // Am Fam Physician. 2016. Vol. 94, N. 5. P. 355–360.

[29] Tung P, Levitzky YS, Wang R, et al. Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women. J Am Heart Assoc. 2017;6(7):e004500. doi: 10.1161/JAHA.116.004500

[30] Tung P., Levitzky Y.S., Wang R., et al. Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women // J Am Heart Assoc. 2017. Vol. 6, N. 7. P. e004500. doi: 10.1161/JAHA.116.004500

[31] Kharats VE. The problem of association between obstructive sleep apnea and atrial fibrillation in cardiology practice. The Siberian Journal of Clinical and Experimental Medicine. 2022;37(3):41–48. (In Russ.) EDN: SEKBFJ doi: 10.29001/2073-8552-2022-37-3-41-48

[32] Харац В.Е. Проблема ассоциации обструктивного апноэ сна и фибрилляции предсердий в условиях кардиологической практики // Сибирский журнал клинической и экспериментальной медицины. 2022. Т. 37, № 3. С. 41–48. EDN: SEKBFJ doi: 10.29001/2073-8552-2022-37-3-41-48

[33] Linz D, McEvoy RD, Cowie MR, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiology. 2018;3(6):532–540. doi: 10.1001/jamacardio.2018.0095

[34] Linz D., McEvoy R.D., Cowie M.R., et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review // JAMA Cardiology. 2018. Vol. 3, N. 6. P. 532–540. doi: 10.1001/jamacardio.2018.0095

[35] Poluektov MG. Primary and secondary insomnias and sleep related breathing disturbances. S.S. Korsakov Journal of Neurology and Psychiatry. 2011;111(9(2)):10–18. (In Russ.) EDN: PYWSMD

[36] Полуэктов М.Г. Первичные и вторичные инсомнии и расстройства дыхания во сне // Журнал неврологии и психиатрии им. С.С. Корсакова. 2011. Т. 111, № 9–2. С. 10–18. EDN: PYWSMD

[37] Lipford MC, Flemming KD, Calvin AD, et al. Associations between cardioembolic stroke and obstructive sleep apnea. Sleep. 2015;38(11):1699–1705. doi: 10.5665/sleep.5146

[38] Lipford M.C., Flemming K.D., Calvin A.D., et al. Associations between cardioembolic stroke and obstructive sleep apnea // Sleep. 2015. Vol. 38, N. 11. P. 1699–1705. doi: 10.5665/sleep.5146

[39] Zorina AV, Kulagina AM, Kazarina AV, et al. Obstructive sleep apnea in patients with atrial fibrillation. Neurological Journal. 2017;22(4): 177-81. (In Russ.) doi: 10.18821/1560-9545-2017-22-4-177-181

[40] Зорина А. В., Кулагина А. М., Казарина А. В. и др. Синдром обструктивного апноэ сна у пациентов с фибрилляцией предсердий // Неврологический журнал. 2017. Т. 22, № 4. С. 177–81. doi: 10.18821/1560-9545-2017-22-4-177-181

[41] Buzunov RV, Legeyda IV, Tsareva EV. Snoring and obstructive sleep apnea in adults and children. Guidelines for doctors. Moscow; 2013. 124 p. (In Russ.)

[42] Бузунов Р.В., Легейда И.В., Царева Е.В. Храп и синдром обструктивного апноэ сна у взрослых и детей. Практическое руководство для врачей. Москва, 2013. 124 c.

[43] Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med. 2008;168(3):297–301. doi: 10.1001/archinternmed.2007.70

[44] Sahlin C., Sandberg O., Gustafson Y., et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up // Arch Intern Med. 2008. Vol. 168, N. 3. P. 297–301. doi: 10.1001/archinternmed.2007.70

[45] Kuznetsov AN, Vinogradov O1. Ischemic stroke. Diagnosis, treatment, prevention. Pocket guide. 3rd ed. Moscow: RAEN; 2014. 90 p. (In Russ.)

[46] Кузнецов А.Н., Виноградов О.И. Ишемический инсульт. Диагностика. Лечение. Профилактика. Карманный справочник. 3-е изд. Москва: РАЕН, 2014. 90 c.

[47] Lavergne F, Morin L, Armitstead J, et al. Atrial fibrillation and sleep-disordered breathing. J Thorac Dis. 2015;7(12):575–584. doi: 10.3978/j.issn.2072-1439.2015.12.57

[48] Lavergne F., Morin L., Armitstead J., et al. Atrial fibrillation and sleep-disordered breathing // J Thorac Dis. 2015. Vol. 7, N. 12. P. 575–584. doi: 10.3978/j.issn.2072-1439.2015.12.57

[49] Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):1–88. doi: 10.1093/ejcts/ezw313

[50] Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // Eur J Cardiothorac Surg. 2016. Vol. 50, N. 5. P. 1–88. doi: 10.1093/ejcts/ezw313

[51] Zwillich C, Devlin T, White D, et al. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest. 1982;69(6):1286–1292. doi: 10.1172/jci110568

[52] Zwillich C., Devlin T., White D., et al. Bradycardia during sleep apnea. Characteristics and mechanism // J Clin Invest. 1982. Vol. 69, N. 6. P. 1286–1292. doi: 10.1172/jci110568

[53] Becker H, Brandenburg U, Peter JH, Von Wichert P. Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure. Am J Respir Crit Care Med. 1995;151(1):215–218. doi: 10.1164/ajrccm.151.1.7812557

[54] Becker H., Brandenburg U., Peter J.H., Von Wichert P. Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure // Am J Respir Crit Care Med. 1995. Vol. 151, N. 1. P. 215–218. doi: 10.1164/ajrccm.151.1.7812557

[55] Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and grade assessment. J Clin Sleep Med. 2019;15(2):301–334. doi: 10.5664/jcsm.7638

[56] Patil S.P., Ayappa I.A., Caples S.M., et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and grade assessment // J Clin Sleep Med. 2019. Vol. 15, N. 2. P. 301–334. doi: 10.5664/jcsm.7638

[57] Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019;200(3):6–24. doi: 10.1164/rccm.201905-1071ST

[58] Mokhlesi B., Masa J.F., Brozek J.L., et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline // Am J Respir Crit Care Med. 2019. Vol. 200, N. 3. P. 6–24. doi: 10.1164/rccm.201905-1071ST

[59] Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862–865. doi: 10.1016/s0140-6736(81)92140-1

[60] Sullivan C.E., Issa F.G., Berthon-Jones M., Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares // Lancet. 1981. Vol. 1, N. 8225. P. 862–865. doi: 10.1016/s0140-6736(81)92140-1

[61] Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335–343. doi: 10.5664/jcsm.7640

[62] Patil S.P., Ayappa I.A., Caples S.M., et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline // J Clin Sleep Med. 2019. Vol. 15, N. 2. P. 335–343. doi: 10.5664/jcsm.7640

[63] Buzunov RV, Palman AD, Melnikov AYu, et al. Diagnostics and treatment of obstructive sleep apnea syndrome in adults. Recommendations of the Russian society of sleep medicine. Effective pharmacotherapy. Neurology and Psychiatry. Special issue «Sleep and Sleep Disorders». 2018;35:34–45. (In Russ.)

[64] Бузунов Р.В., Пальман А.Д., Мельников А.Ю., и др. Диагностика и лечение синдрома обструктивного апноэ сна у взрослых. Рекомендации Российского общества сомнологов // Эффективная фармакотерапия. Неврология. Спецвыпуск «Сон и его расстройства». 2018. № 35. С. 34–45.

[65] Grimm W, Hoffmann J, Menz V, et al. Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea. Am J Cardiol. 1996;77(15):1310–1314. doi: 10.1016/s0002-9149(96)00197-x

[66] Grimm W., Hoffmann J., Menz V., et al. Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea // Am J Cardiol. 1996. Vol. 77, N. 15. P. 1310–1314. doi: 10.1016/s0002-9149(96)00197-x

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