Atrial fibrillation and Obstructive sleep apnea- Clinical Implications
Sleep is dynamic and complex process. It is a function of the brain. Sleep is divided into 2 states-Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM). There are unique autonomic influences over cardiac rhythm and hemodynamics in sleep. NREM sleep is characterized by an overall increase in parasympathetic and decrease in sympathetic tone. In REM sleep there are surges of sympathetic activity and decreased baroreceptor regulation and control. These influences can cause cardiac arrythmias which are in most part asymptomatic and benign unless accompanied by symptoms.
Atrial fibrillation (AF) is frequently encountered in clinical practice. It is associated with increased cardiovascular mortality and morbidity such as stroke. It is estimated that AF affects nearly 2.3 million people in the US; it is estimated that AF will affect more than 15 million Americans by 2050.(1) The traditional risk factors for AF include age, obesity, hypertension, diabetes, coronary artery disease and congestive cardiac failure. Advancing age, male gender, obesity is also risk factors for OSA. The prevalence of OSA in post-menopausal women is high.