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10.05.2022 | Sleep Breathing Physiology and Disorders • Original Article

Positional obstructive sleep apnea in patients with atrial fibrillation

verfasst von: Patrick L. Stafford, Evan Harmon, Paras Patel, McCall Walker, Nazem Akoum, Seung-Jung Park, Yeilim Cho, Kenneth Bilchick, Nishaki Mehta, Sula Mazimba, Yoonsik Cho, Younghoon Kwon

Erschienen in: Sleep and Breathing | Ausgabe 2/2023

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Abstract

Purpose

Obstructive sleep apnea (OSA) is a common, potentially modifiable condition implicated in the pathogenesis of atrial fibrillation (AF). The presence and severity of OSA is largely sleep position–dependent, yet there is high variability in positional dependence among patients with OSA. We investigated the prevalence of positional OSA (POSA) and examined associated factors in patients with AF.

Methods

We recruited an equal number of patients with and without AF who underwent diagnostic polysomnography. Patients included had ≥ 120 min of total sleep time with 30 min of sleep in both supine and lateral positions. POSA was defined as an overall apnea hypopnea index (AHI) ≥ 5/h, supine AHI (sAHI) ≥ 5/h, and sAHI greater than twice the non-supine AHI. POSA prevalence was compared in patients with and without AF adjusting for age, sex, OSA severity, and heart failure.

Results

A total of patients (male: 56%, mean age 62 years) were included. POSA prevalence was similar between the two groups (46% vs. 39%; p = 0.33). Obesity and severe OSA (AHI ≥ 30/h) were associated with low likelihood of POSA (OR [CI] of 0.17 [0.09–0.32] and 0.28 [0.12–0.62]). In patients with AF, male sex was associated with a higher likelihood of POSA (OR [CI] of 3.16 [1.06–10.4]).

Conclusion

POSA is common, affecting more than half of patients with AF, but the prevalence was similar in those without AF. Obesity and more severe OSA are associated with lower odds of POSA. Positional therapy should be considered in patients with mild OSA and POSA.

Kwon Y, Koene RJ, Johnson AR et al (2018) Sleep, sleep apnea and atrial fibrillation: questions and answers. Sleep Med Rev 39:134–142. https://doi.org/10.1016/j.smrv.2017.08.005CrossRefPubMed

Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375. https://doi.org/10.1001/jama.285.18.2370CrossRefPubMed

Calkins H, Hindricks G, Cappato R et al (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Arrhythm 33:369–409. https://doi.org/10.1016/j.joa.2017.08.001CrossRefPubMedPubMedCentral

Patel D, Mohanty P, Di Biase L et al (2010) Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circ Arrhythm Electrophysiol 3:445–451. https://doi.org/10.1161/CIRCEP.109.858381CrossRefPubMed

Monahan K, Brewster J, Wang L et al (2012) Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 110:369–372. https://doi.org/10.1016/j.amjcard.2012.03.037CrossRefPubMedPubMedCentral

Kwon Y, Logan J, Pusalavidyasagar S et al (2019) Sleep apnea and heart. Sleep Med Res 10:67–74. https://doi.org/10.17241/smr.2019.00493CrossRefPubMedPubMedCentral

Hla KM, Young T, Hagen EW et al (2015) Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. Sleep 38:677–684. https://doi.org/10.5665/sleep.4654CrossRefPubMedPubMedCentral

Oldenburg O, Lamp B, Faber L et al (2007) Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 9:251–257. https://doi.org/10.1016/j.ejheart.2006.08.003CrossRefPubMed

Yumino D, Wang H, Floras JS et al (2009) Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail 15:279–285. https://doi.org/10.1016/j.cardfail.2008.11.015CrossRefPubMed

10.

Ferrier K, Campbell A, Yee B et al (2005) Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest 128:2116–2122. https://doi.org/10.1378/chest.128.4.2116CrossRefPubMed

11.

Chahal CAA, Somers VK (2015) Sleep apnoea, heart failure, and atrial fibrillation—quo vadis? Nat Rev Cardiol 12:263–264. https://doi.org/10.1038/nrcardio.2015.31CrossRefPubMedPubMedCentral

12.

Pinna GD, Robbi E, Rovere MTL et al (2015) Differential impact of body position on the severity of disordered breathing in heart failure patients with obstructive vs. central sleep apnoea. Eur J Heart Fail 17:1302–1309. https://doi.org/10.1002/ejhf.410CrossRefPubMed

13.

Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143. https://doi.org/10.1513/pats.200709-155MGCrossRefPubMedPubMedCentral

14.

Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291:2013–2016. https://doi.org/10.1001/jama.291.16.2013CrossRefPubMed

15.

Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7:110–114. https://doi.org/10.1093/sleep/7.2.110CrossRefPubMed

16.

Frank MH, Ravesloot MJL, van Maanen JP et al (2015) Positional OSA part 1: towards a clinical classification system for position-dependent obstructive sleep apnoea. Sleep Breath 19:473–480. https://doi.org/10.1007/s11325-014-1022-9CrossRefPubMed

17.

Ravesloot MJL, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 17:39–49. https://doi.org/10.1007/s11325-012-0683-5CrossRefPubMed

18.

Oksenberg A, Arons E, Nasser K et al (2010) REM-related obstructive sleep apnea: the effect of body position. J Clin Sleep Med 6:343–348CrossRefPubMedPubMedCentral

19.

Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A (2000) Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 118:1018–1024. https://doi.org/10.1378/chest.118.4.1018CrossRefPubMed

20.

Oksenberg A, Arons E, Greenberg-Dotan S et al (2009) The significance of body posture on breathing abnormalities during sleep: data analysis of 2077 obstructive sleep apnea patients. Harefuah 148:304–309, 351, 350PubMed

21.

Baranowski R, Kalin K, Marcinkiewicz K et al (2019) Positional sleep disordered breathing in patients with arrhythmia. Should we advise our patients to avoid supine position during sleep? J Electrocardiol 57:138–142. https://doi.org/10.1016/j.jelectrocard.2019.09.019CrossRefPubMed

22.

Kwon Y, Gadi S, Shah NR et al (2018) Atrial fibrillation and objective sleep quality by slow wave sleep. J Atr Fibrillation 11.https://doi.org/10.4022/jafib.2031

23.

Iber C American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine

24.

Berry RB, Quan SF, Abreu AR, Bibbs ML, DelRosso L, Harding SM et al (2020) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.6. Darien, IL: American Academy of Sleep Medicine; 2020

25.

Mador MJ, Kufel TJ, Magalang UJ et al (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128:2130–2137. https://doi.org/10.1378/chest.128.4.2130CrossRefPubMed

26.

Sabil A, Blanchard M, Trzepizur W et al Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes. J Clin Sleep Med 16:2037–2046. https://doi.org/10.5664/jcsm.8752

27.

Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318. https://doi.org/10.1016/S2213-2600(15)00043-0CrossRefPubMedPubMedCentral

28.

Morris JL, Mazzotti DR, Gottlieb DJ, Hall MH (2021) Sex differences within symptom subtypes of mild obstructive sleep apnea. Sleep Med 84:253–258. https://doi.org/10.1016/j.sleep.2021.06.001CrossRefPubMedPubMedCentral

29.

Akita Y, Kawakatsu K, Hattori C et al (2003) Posture of patients with sleep apnea during sleep. Acta Otolaryngol 123:41–45. https://doi.org/10.1080/0365523031000062CrossRefPubMed

30.

Marklund M, Persson M, Franklin KA (1998) Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 114:1630–1635. https://doi.org/10.1378/chest.114.6.1630CrossRefPubMed

31.

Permut I, Diaz-Abad M, Chatila W et al (2010) Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. J Clin Sleep Med 6:238–243CrossRefPubMedPubMedCentral

32.

Oksenberg A, Silverberg D, Offenbach D, Arons E (2006) Positional therapy for obstructive sleep apnea patients: a 6-month follow-up study. Laryngoscope 116:1995–2000. https://doi.org/10.1097/01.mlg.0000237674.66716.a7CrossRefPubMed

Titel: Positional obstructive sleep apnea in patients with atrial fibrillation
verfasst von: Patrick L. Stafford
Evan Harmon
Paras Patel
McCall Walker
Nazem Akoum
Seung-Jung Park
Yeilim Cho
Kenneth Bilchick
Nishaki Mehta
Sula Mazimba
Yoonsik Cho
Younghoon Kwon
Publikationsdatum: 10.05.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2023
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02625-y

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Positional obstructive sleep apnea in patients with atrial fibrillation