Skip to main content

Arrhythmias and sleep apnea: physiopathologic link and clinical implications

Abstract

Available evidence suggests a pathogenetic role of sleep breathing disorders in both atrial and ventricular arrhythmias with non-negligible clinical implications. Scientific literature has reported convincing findings on the link between sleep breathing disorders and arrhythmias. The coexistence of these conditions should be appropriately managed because OSA treatment may reduce arrhythmia recurrence. This paper provides an overview of the main physiopathologic mechanisms underlying the association between sleep apnea and arrhythmias and discusses the impact of sleep apnea on arrhythmia management in clinical practice.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation. 2012;126(12):1495–510.

    PubMed  Article  Google Scholar 

  2. 2.

    Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, Lévy P, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. 2018;3(6):532–40.

    PubMed  Article  Google Scholar 

  3. 3.

    Goudis CA, Ketikoglou DG. Obstructive sleep and atrial fibrillation: pathophysiological mechanisms and therapeutic implications. Int J Cardiol. 2017;230:293–300.

    PubMed  Article  Google Scholar 

  4. 4.

    Eckert DJ, Jordan AS, Merchia P, Malhotr A. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131(2):595–607.

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Bradley TD, Floras JS. Sleep apnea and heart failure: part II: central sleep apnea. Circulation. 2003;107(13):1822–6.

    PubMed  Article  Google Scholar 

  6. 6.

    Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841–58.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Shiomi T, Guilleminault C, Stoohs R, Schnittger I. Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest. 1991;100:894–902.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J, et al. Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol. 2009;54(19):1797–804.

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Leung RS. Sleep-disordered breathing: autonomic mechanisms and arrhythmias. Prog Cardiovasc Dis. 2009;51(4):324–38.

    PubMed  Article  Google Scholar 

  10. 10.

    Adamantidis MM, Caron JF, Dupuis BA. Triggered activity induced by combined mild hypoxia and acidosis in guinea-pig Purkinje fibers. J Mol Cell Cardiol. 1986;18:1287–99.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Stevenson IH, Roberts-Thomson KC, Kistler PM, Edwards GA, Spence S, Sanders P, et al. Atrial electrophysiology is altered by acute hypercapnia but not hypoxemia: implications for promotion of atrial fibrillation in pulmonary disease and sleep apnea. Heart Rhythm. 2010;7(9):1263–70.

    PubMed  Article  Google Scholar 

  12. 12.

    Peyronnet R, Nerbonne JM, Kohl P. Cardiac mechano-gated ion channels and arrhythmias. Circ Res. 2016;118(2):311–29.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Dimitri H, Ng M, Brooks AG, Kuklik P, Stiles MK, Lau DH, et al. Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart Rhythm. 2012;9:321–7.

    PubMed  Article  Google Scholar 

  14. 14.

    Linz D, Schotten U, Neuberger HR, Böhm M, Wirth K. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm. 2011;8(9):1436–43.

    PubMed  Article  Google Scholar 

  15. 15.

    Iwasaki YK, Kato T, Xiong F, Shi YF, Naud P, Maguy A, et al. Atrial fibrillation promotion with long-term repetitive obstructive sleep apnea in a rat model. J Am Coll Cardiol. 2014;64(19):2013–23.

    PubMed  Article  Google Scholar 

  16. 16.

    Anter E, Di Biase L, Contreras-Valdes FM, Gianni C, Mohanty S, Tschabrunn CM, et al. Atrial substrate and triggers of paroxysmal atrial fibrillation in patients with obstructive sleep apnea. Circ Arrhythm Electrophysiol. 2017;10:e005407.

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Schlatzer C, Schwarz EI, Sievi NA, Clarenbach CF, Gaisl T, Haegeli LM, et al. Intrathoracic pressure swings induced by simulated obstructive sleep apnoea promote arrhythmias in paroxysmal atrial fibrillation. Europace. 2016;18(1):64–70.

    PubMed  Article  Google Scholar 

  18. 18.

    Harbison J, O’Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest. 2000;118:591–5.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Ryan CM, Juvet S, Leung R, Bradley TD. Timing of nocturnal ventricular ectopy in heart failure patients with sleep apnea. Chest. 2008;133(4):934–40.

    PubMed  Article  Google Scholar 

  20. 20.

    Simantirakis EN, Schiza SI, Marketou ME, Chrysostomakis SI, Chlouverakis GI, Klapsinos NC, et al. Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J. 2004;25(12):1070–6.

    PubMed  Article  Google Scholar 

  21. 21.

    Altmann DR, Ullmer E, Rickli H, Maeder MT, Sticherling C, Schaer BA, et al. Clinical impact of screening for sleep related breathing disorders in atrial fibrillation. Int J Cardiol. 2012;154:256–8.

    PubMed  Article  Google Scholar 

  22. 22.

    Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364–7.

    PubMed  Article  Google Scholar 

  23. 23.

    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71.

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    van Oosten EM, Hamilton A, Petsikas D, Payne D, Redfearn DP, Zhang S, et al. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2014;113(6):919–23.

    PubMed  Article  Google Scholar 

  26. 26.

    Linz D, Brooks AG, Elliott AD, Nalliah CJ, Hendriks JML, Middeldorp ME, et al. Variability of sleep apnea severity and risk of atrial fibrillation: the VARIOSA-AF study. JACC Clin Electrophysiol. 2019;5(6):692–701.

    PubMed  Article  Google Scholar 

  27. 27.

    Tung P, Levitzky YS, Wang R, Weng J, Quan SF, Gottlieb DJ, 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. https://doi.org/10.1161/JAHA.116.004500.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173:910–6.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Salama A, Abdullah A, Wahab A, Eigbire G, Hoefen R, Kouides R, et al. Is obstructive sleep apnea associated with ventricular tachycardia? A retrospective study from the National Inpatient Sample and a literature review on the pathogenesis of Obstructive Sleep Apnea. Clin Cardiol. 2018;41(12):1543–7.

    PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013;62:610–6.

    PubMed  Article  Google Scholar 

  31. 31.

    Leung RST, Diep TM, Bowman ME, Lorenzi-Filho G, Bradley TD. Provocation of ventricular ectopy by Cheyne-Stokes respiration in patients with heart failure. Sleep. 2004;27:1337–43.

    PubMed  Article  Google Scholar 

  32. 32.

    Lanfranchi PA, Somers VK, Braghiroli A, Corra U, Eleuteri E, Giannuzzi P. Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk. Circulation. 2003;107(5):727–32.

    PubMed  Article  Google Scholar 

  33. 33.

    Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J. 2011;32:61–74.

    PubMed  Article  Google Scholar 

  34. 34.

    Serizawa N, Yumino D, Kajimoto K, Tagawa Y, Takagi A, Shoda M, et al. Impact of sleep-disordered breathing on life-threatening ventricular arrhythmia in heart failure patients with implantable cardioverter-defibrillator. Am J Cardiol. 2008;102(8):1064–8.

    PubMed  Article  Google Scholar 

  35. 35.

    Monahan K, Brewster J, Wang L, Parvez B, Goyal S, Roden DM, et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial. Am J Cardiol. 2012;110:369–72.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589–94.

    PubMed  Article  Google Scholar 

  37. 37.

    Hoyer FF, Lickfett LM, Mittmann-Braun E, Ruland C, Kreuz J, Pabst S, et al. High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol. 2010;29(1):37–41.

    PubMed  Article  Google Scholar 

  38. 38.

    Ng CY, Liu T, Shehata M, Stevens S, Chugh SS, Wang X. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108:47–51.

    PubMed  Article  Google Scholar 

  39. 39.

    Koshino Y, Satoh M, Katayose Y, Kuroki K, Sekiguchi Y, Yamasaki H, et al. Sleep apnea and ventricular arrhythmias: clinical outcome, electrophysiologic characteristics, and follow-up after catheter ablation. J Cardiol. 2010 Mar;55(2):211–6.

    PubMed  Article  Google Scholar 

  40. 40.

    Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995 Oct;96(4):1897–904.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Franz MR. Mechano-electrical feedback in ventricular myocardium. Cardiovasc Res. 1996;32:15–24.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Müller P, Grabowski C, Schiedat F, Shin DI, Dietrich JW, Mügge A, et al. Reverse remodelling of the atria after treatment of obstructive sleep apnoea with continuous positive airway pressure: evidence from electro-mechanical and endocrine markers. Heart Lung Circ. 2016;25(1):53–60.

    PubMed  Article  Google Scholar 

  43. 43.

    Guan N, Zhu Z, Kowey PR, Allen LA, Fonarow GC, Hylek EM, et al. ORBIT-AF Investigators. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation—results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2015;169(5):647–54.

    PubMed  Article  Google Scholar 

  44. 44.

    Shukla A, Aizer A, Holmes D, Fowler S, Park DS, Bernstein S, et al. Effect of obstructive sleep apnea treatment on atrial fibrillation recurrence: a meta-analysis. JACC Clin Electrophysiol. 2015;1(1–2):41–51.

    PubMed  Article  Google Scholar 

  45. 45.

    Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2013;62(4):300–5.

    PubMed  Article  Google Scholar 

  46. 46.

    Qureshi WT, Nasir UB, Alqalyoobi S, O'Neal WT, Mawri S, Sabbagh S, et al. Meta-analysis of continuous positive airway pressure as a therapy of atrial fibrillation in obstructive sleep apnea. Am J Cardiol. 2015;116(11):1767–73.

    PubMed  Article  Google Scholar 

  47. 47.

    Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64(21):2222–31.

    PubMed  Article  Google Scholar 

  48. 48.

    Ghias M, Scherlag BJ, Lu Z, Niu G, Moers A, Jackman WM, et al. The role of ganglionated plexi in apnea-related atrial fibrillation. J Am Coll Cardiol. 2009;54:2075–83.

    PubMed  Article  Google Scholar 

  49. 49.

    Linz D, Hohl M, Nickel A, Mahfoud F, Wagner M, Ewen S, et al. Effect of renal denervation on neurohumoral activation triggering atrial fibrillation in obstructive sleep apnea. Hypertension. 2013;62(4):767–74.

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Gao M, Zhang L, Scherlag BJ, Huang B, Stavrakis S, Hou YM, et al. Low-level vago-sympathetic trunk stimulation inhibits atrial fibrillation in a rabbit model of obstructive sleep apnea. Heart Rhythm. 2015;12(4):818–24.

    PubMed  Article  Google Scholar 

  51. 51.

    Linz D, Hohl M, Khoshkish S, Mahfoud F, Ukena C, Neuberger HR, et al. Low-level but not high-level baroreceptor stimulation inhibits atrial fibrillation in a pig model of sleep apnea. J Cardiovasc Electrophysiol. 2016;27(9):1086–92.

    PubMed  Article  Google Scholar 

  52. 52.

    Ryan CM, Usui K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax. 2005;60(9):781–5.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  53. 53.

    Caples SM, Mansukhani MP, Friedman PA, Somers VK. The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion: a randomized controlled trial. Int J Cardiol. 2019;278:133–6.

    PubMed  Article  Google Scholar 

  54. 54.

    Abumuamar AM, Newman D, Dorian P, Shapiro CM. Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation. J Interv Card Electrophysiol. 2019;54(3):289–97.

    PubMed  Article  Google Scholar 

  55. 55.

    Campos J, Ernst G, Blanco M, Cassano A, Tello-Santa-Cruz I, Cáceres-Monié C, et al. Acute response to 7-day therapy with CPAP in patients with moderate to severe obstructive sleep apnea and cardiac arrhytmia. Sleep Sci. 2018;11(1):49–53.

    PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Wang X, Qiu J, Wang Y, Cai Z, Lu X, Li T. Beneficial response of blood pressure to short-term continuous positive airway pressure in Chinese patients with obstructive sleep apnea-hypopnea syndrome. Blood Press Monit. 2018;23(4):175–84.

    PubMed  Article  Google Scholar 

  57. 57.

    Seyis S, Usalan AK, Rencuzogullari I, Kurmuş Ö, Gungen AC. The effects of continuous positive airway pressure on premature ventricular contractions and ventricular wall stress in patients with heart failure and sleep apnea. Can Respir J. 2018;2018:2027061.

    PubMed  PubMed Central  Article  Google Scholar 

  58. 58.

    Wu X, Liu Z, Chang SC, Fu C, Li W, Jiang H, et al. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study. Respir Res. 2016;17:16.

    PubMed  PubMed Central  Article  Google Scholar 

  59. 59.

    Grau N, Bazan V, Kallouchi M, Rodriguez D, Estirado C, Corral MI, et al. Long-term impact of continuous positive airway pressure therapy on arrhythmia and heart rate variability in patients with sleep apnea. Arch Bronconeumol. 2016;52(1):17–23.

    PubMed  Article  Google Scholar 

  60. 60.

    Dediu GN, Dumitrache-Rujinski S, Lungu R, Frunză S, Diaconu C, Bartoş D, et al. Positive pressure therapy in patients with cardiac arrhythmias and obstructive sleep apnea. Pneumologia. 2015;64(1):18–22.

    PubMed  Google Scholar 

  61. 61.

    Holmqvist F, Guan N, Zhu Z, Kowey PR, Allen LA, Fonarow GC, et al. ORBIT-AF Investigators. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation—results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2015;169(5):647–54 e2.

    PubMed  Article  Google Scholar 

  62. 62.

    Naruse Y, Tada H, Satoh M, Yanagihara M, Tsuneoka H, Hirata Y, et al. Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy. Heart Rhythm. 2013;10(3):331–7.

    PubMed  Article  Google Scholar 

  63. 63.

    Neilan TG, Farhad H, Dodson JA, Shah RV, Abbasi SA, Bakker JP, et al. Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. J Am Heart Assoc. 2013;2(6):e000421.

    PubMed  PubMed Central  Article  Google Scholar 

  64. 64.

    Bazan V, Grau N, Valles E, Felez M, Sanjuas C, Cainzos-Achirica M, et al. Obstructive sleep apnea in patients with typical atrial flutter: prevalence and impact on arrhythmia control outcome. Chest. 2013;143:1277–83.

    PubMed  Article  Google Scholar 

  65. 65.

    Patel D, Mohanty P, Di Biase L, Shaheen M, Lewis WR, Quan K, et al. Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circ Arrhythm Electrophysiol. 2010;3(5):445–51.

    PubMed  Article  Google Scholar 

  66. 66.

    Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M, et al. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessel. 2010;25(1):63–9.

    Article  Google Scholar 

  67. 67.

    Jongnarangsin K, Chugh A, Good E, Mukerji S, Dey S, Crawford T, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19:668–72.

    PubMed  Article  Google Scholar 

  68. 68.

    Craig S, Pepperell JC, Kohler M, Crosthwaite N, Davies RJ, Stradling JR. Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trial. J Sleep Res. 2009;18(3):329–36.

    PubMed  Article  Google Scholar 

  69. 69.

    Javaheri S. Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure. Circulation. 2000;101(4):392–7.

    CAS  PubMed  Article  Google Scholar 

  70. 70.

    Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490–4.

    CAS  PubMed  Article  Google Scholar 

  71. 71.

    Koehler U, Fus E, Grimm W, Pankow W, Schafer H, Stammnitz A, et al. Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment. Eur Respir J. 1998;11:434–9.

    CAS  PubMed  Article  Google Scholar 

  72. 72.

    Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest. 1982;69:1286–92.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  73. 73.

    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;151:215–8.

    CAS  PubMed  Article  Google Scholar 

  74. 74.

    Grimm W, Hoffmann J, Menz V, Kohler U, Heitmann J, Peter JH, 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;77:1310–4.

    CAS  PubMed  Article  Google Scholar 

  75. 75.

    Garrigue S, Pépin JL, Defaye P, Murgatroyd F, Poezevara Y, Clémenty J, et al. High prevalence of sleep apnea syndrome in patients with long-term pacing: the European Multicenter Polysomnographic Study. Circulation. 2007;115:1703–9.

    PubMed  Article  Google Scholar 

  76. 76.

    Proclemer A, Zecchin M, Lunati M, Bongiorni MG, Padeletti L. Registro Italiano Pacemaker e Defibrillatori – Bollettino Periodico 2011. GIAC. 2012;15:145–72.

    Google Scholar 

  77. 77.

    Croce D, Banfi G, Braghiroli A, Castiglioni Rusconi M, Desanti A, Ferini-Strambi L, et al. Il costo delle malattie: valutazione dell’impatto della sindrome da apnea ostruttiva nel sonno sull’economia italiana. Sanità Pubblica e Privata. 2006;5:26–43.

    Google Scholar 

  78. 78.

    Defaye P, de la Cruz I, Martí-Almor J, Villuendas R, Bru P, Sénéchal J, et al. A pacemaker transthoracic impedance sensor with an advanced algorithm to identify severe sleep apnea: the DREAM European study. Heart Rhythm. 2014;11:842–8.

    PubMed  Article  Google Scholar 

  79. 79.

    Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, et al. 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. 2017;19(2):190–225.

    PubMed  Google Scholar 

  80. 80.

    Desteghe L, Hendriks JML, McEvoy RD, Chai-Coetzer CL, Dendale P, Sanders P, et al. The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation. Clin Res Cardiol. 2018;107(8):617–31.

  81. 81.

    Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–e160.

    PubMed  Article  Google Scholar 

  82. 82.

    Kadhim K, Middeldorp ME, Elliott AD, Jones D, Hendriks JML, Gallagher C, et al. Self-reported daytime sleepiness and sleep-disordered breathing in patients with atrial fibrillation: SNOozE-AF. Can J Cardiol. 2019;35(11):1457–64.

    PubMed  Article  Google Scholar 

  83. 83.

    Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, et al. Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy. J Am Heart Assoc. 2019 Jan 8;8(1):e010440. https://doi.org/10.1161/JAHA.

    CAS  Article  PubMed  Google Scholar 

  84. 84.

    Della Rocca DG, Albanese M, Placidi F, Forleo GB, Di Biase L, Ribatti V, et al. Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording. J Interv Card Electrophysiol. 2019;56:327–33. https://doi.org/10.1007/s10840-019-00631-x.

    Article  PubMed  Google Scholar 

  85. 85.

    Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–867.

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Stefania Angela Di Fusco.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Di Fusco, S.A., Pignalberi, C., Santini, L. et al. Arrhythmias and sleep apnea: physiopathologic link and clinical implications. J Interv Card Electrophysiol 57, 387–397 (2020). https://doi.org/10.1007/s10840-020-00707-z

Download citation

Keywords

  • Obstructive sleep apnea
  • Sleep-related breathing disorders
  • Arrhythmias
  • Continuous positive airway pressure