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SLEEP APNEA &
AFIB
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What is Sleep Apnea?1
Disruptions in breathing which are coplete !i"e" apnea# orpartial !i"e" h$popneas# with a apnea%h$popnea ine' !A(I#!)isruptions*hr# o+ , - accopanie b$ a$tie sleepiness 1./
0 ain t$pes1
Obstructive (OSA)2 bloc3age o+ upper airwa$ ue pharn$gealcollapse
4entral 2 ecrease respirator$ brain ste output
i'e
Estiate that 5SA a6ects 718 illion Aericans. /9 ileage en. 89 ile age woen
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S$ptos1.8
Lou. chronic snoring
Da$tie sleepiness
(eaaches
eor$. concentration i:culties
Fre;uent awa3ening to urinate
Dr$ or sore throat upon awa3ening
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Who (as (igher s higher =aw sie proportionalit$
Palate
4ollar sie @1 inches en. @1 inches woen
Congue sie
Obesity 2 estiate -9 o+ obese population has 5SA 11
Hypothyroidisim
Acroegal$
Sleep Position
Male gender
Advanced age
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Diagnostic Cools/
Polysomnography 2 cobintation o+ electroencephalograph$.electrooculograph$. electro$ograph$
Apnea an ($popnea episoes eterine b$ onitoring +or clearreuctions in airow*tial >oluen accopanie b$ ecrease 58 sawhich terinate with an arousal
Portable onitors
Pro>ie in+o on airow an o'$gen sat
(ighl$ Senstati>e. low specicit$
Not recoene +or patients with 4(F. cerebro>ascular or respiratoisease
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Foral DiagnosisG
Aerican Acae$ o+ Sleep eicine
5SA ene as A(I , 1-!regarless o+ s$ptos# or , - e>ents*hrwith s$ptos
A(I % ) o+ apnea*h$popnea episoes*hr
Se>erit$ o+ 5SA
ilH A(I -%1/
oerateH 1-%0
Se>ereH @0
ESS 2uestionnaire e>aluating chances o+ oing uner certainsituations
Arousal ine' 2 +re;uenc$ o+ arousals*hr uring sleep as easure b$EEJ
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4onse;uences8
(igh Bloo Pressure
(eart Attac3
Stro3eK @8 ' ris3 in en
5besit$
(eart Failure
Arr$thias
Da$tie sleepines
4ar accients
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Pathoph$siolog$ o+ 5SA in relationto 4ariac a6ects11
uic3 re>iew o+ Sleep states
N
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Pathoph$siolog$ o+ 5SA in relationto 4ariac a6ects11
4hronic A6ects o+ 5SA
Autonoic irregularities 2 BP. (< uring sleep an awa3e hrs
Inaation 2 ele>ate CNF. 4 reacti>e protein. IL. ILG
Enothelial $s+unction
etabolic isturbances
5'iati>e stress Procoagulati>e State
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5SA group >s control re>eals 09 FA >s 19
Ho"stein et al (199#)$ Pre>alence o+ arr$thias higher inpeople with obstructi>e sleep apnea ! 5SA# an increases withgreater A(I
Gami A%S% et al%(&''#)ns pre>alance o+ AFIB in 5SA group
was /O9 >s 089 +or general population o+ patients in acariolog$ practice" ! p "/# O
Mehra et al% (&'')+oun pre>alence o+ AFIB /"G9 ! sleepisorere breathing# >s "O9 ! control# a+ter coparing 8saples +ro Sleep (eart (ealth Stu$ controlle +or age. se'.race. BI" 5< / !4I 1"0%1-"/#1
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5bstructi>e Sleep Apnea !5SA# an
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5bstructi>e Sleep Apnea !5SA#an
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Stu$ 1H 4haracteristics
Create >s Tntreate 5SA group E;ual in all baseline characteristics
/ o+ /0 patients e'clue
1 ue to initial +ailure o+ cario>ersiRn
0 ue to lac3 o+ +*u ata
5ut o+ 0O patients +or +ollow%up
18 recei>e 4PAP treatent
8 untreate
8- non copliant
8 non copliant ! 1 +or using cPAP 8*wee3. 1 +or +re;uent reo>al
4ontrol baseline group ! Ab alone#
O patients
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Stu$ 1 H s /8 9 treate 5SA group !p "10#
-09 recurrence rate in the control group !ab alone# !p "O
Inten to treat anal$sis woul ha>e prouce recurrence rates o
o+ 1/ o+ treate 5SA group
8 o+ 8- o+ untreate 5SA group UUUU- >s G9 !p "-#
1O9 o+ 5SA pts with AFIB recurrence treate appropiatel$ with4PAP >s -G9 5SA pts without recurrence
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Creatents
ontinuos Positive Air*ay Pressure (PAP) +evice
A4P strong ience !G#
A4P re>iew 810 2 4PAP ipro>es sleep easures !A(I. ESS. Arousal Ine'# in patients witoerate V s$ptos !A(I , 1-# but no high grae e>ience ! i"e" ational stuies show reuction in ortalit$ !G#
% Benets
Ieiate re>ersal o+ apnea an h$popnea episoes ! /#
Decrease sonolence an ipro>e oL Decrease snoring to relie+ o+ others
Decrease a$tie sleepiness
Issues
4opliance is -%G9 % obtrusi>e. nasal congestion
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4PAP !cont# 2 A(I. ESS. AIeasures Fi'e >s Auto a=uste 2 e;uall$ e:cacious
Bile>el 4PAP >s Fi'e 4PAP 2 insu:cient e>ience. longer use in B
Fle'ibile 4PAP >s Fi'e 4PAP 2 insu:cient e>ience. no i6erence
Nasal >s 5ral 2 insu:cient e>ience. no i6erence in stuies
4PAP w* or w*o huiication 2 insu:cient e>ience
4%Fle' >s 'e 4PAP 2 e;ual +or ESS. insu:cient e>ience +or otheeasures
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5ther Strategies ! /#
Weight Loss !A4P strong recoenation. low ;ualit$ e>ience# eical 2 one stu$ showe 8 9 reuction in A(I with 19 weight loss
Surgical 2 reuction o+ A(I +ro O to 11 in one stu$
No stuies coparing the
Lateral Sleeping Position
A>oiance o+ Et%5( an seati>es
anibular & Congue A>anceent De>ices !AD# !G#
4an reuce A(I & a$tie sleepiness ! G#. 4PAP ore e6ecti>e in these Xreas !G# No e>ience +or long ter clinical easures
No e>ience to suggest who benets with AD >s 4PAP
Surger$
Liite e>ience. a$ be less e6ecti>e than oral appliances
Pharacotherap$
Insu:cient e>ience 2 inconsistent ata +ro i6erent agents V 4PAP >s 4PAP alone ! G#
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*health*health%topics*topics*sleepapnea*signs"htl 8" Sleep Apnea" (ealth Copics" National (eart. Lung. & Blooe Institute" Accesse G*01*1/"
httpH**www"nhlbi"nih"go>*health*health%topics*topics*sleepapnea*
0" 5bstructi>e Sleep Apnea" Tni>ersit$ o+ ar$lan eical 4enter"httpH**u"eu*health*eical*enc$*articles*obstructi>e%sleep%apnea
/" Fleons W" W" 5bstructi>e Sleep Apnea" New Englian Yournal o+ eicine 88" 0/H /OG%-/httpH**www"ne="org*oi*+ull*1"1-*NEYcp18G/O
-" Finle$ LY" Autoobile accients in>ol>ing patients with obstructi>e sleep apnea" 1OGG" AugK10G!8# 00%/ !Abstract#httpH**www"ncbi"nl"nih"go>*pube*01O-G08
"Arias "A" Fibrilacion auricular $ apnea obstructi>a el suenoH algo as ;ue una coinciencia" Atrias "A. Baranchuc3 A"ista Espanola e 4ariologia" 810K !#H -8O%-01
" Qanagala e sleep apnea an the recurrence o+ atrial brillation" 4irculation" 80K 1H 8-GO%O/ G" asee A" et al" anageent o+ 5bstructi>e Sleep Apnea in Aults" A 4linical Practice Juieline +ro the Aerican
4ollege o+ Ph$sicians" Annals o+ Internal eicine 810K 1-OH /1%/G0
O" Jai AS et al" 5bstructi>e sleep apnea. obesit$. an the ris3 o+ incient atrial brillation" Y" Aerican 4ollege o+ 4ariolo8K /OH --%1
1" ehra
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