Novel Insights to Sleep Disorders

Although atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, underlying etiologic risk remains largely unknown. While several risk factors have been established, these fail to explain approximately one-half of all AF in community-based populations. Furthermore, up to 30% of all patients with AF harbor no recognizable risk factors. Therefore, identifying new risk factors for AF, and particularly those that are at least theoretically modifiable, is currently a high priority.

Population-based studies have identified disorders of sleep and sleep curtailment as factors that increase incident cardiovascular and atrial arrhythmogenic risk, with experimental models implicating autonomic fluctuations and upregulation of pathways of systemic inflammation. In terms of sleep disorders, the most evidence has amassed to support sleep-disordered breathing (SDB), that is, both OSA and central sleep apnea, as promulgators of AF.4 Along with episodic hypoxemia and juxtaposition of postevent sympathetic nervous system surges with enhanced parasympathetic tone during respiratory events, alterations in intrathoracic pressures result in direct mechanical effects on the thin-walled atria, in sum operating to enhance atrial arrhythmogenesis.

 

  • • Sustained arrhythmia
  • • Atrial fibrillation
  • • Respiratory events
  • • Atrial arrhythmogenesis

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