Obstructive Sleep Apnea Syndrome as a Trigger of Cardiac Arrhythmias

New Insights of Cardiac Arrhythmias Associated with Sleep-Disordered Breathing: From Mechanisms to Clinical Implications-A Narrative Review

Although most research has concentrated on the link between sleep apnea and atrial fibrillation, obstructive sleep apnea (OSA) is also associated with ventricular arrhythmias. These cardiac arrhythmias can be triggered by repeated episodes of hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and other mechanisms that occur during apnea and hypopnea. Studies show that OSA reduces the effectiveness of arrhythmia treatments, such as antiarrhythmic medications and radiofrequency current ablation. Several non-randomized studies indicate that treating sleep apnea syndrome with continuous positive airway pressure (CPAP) may help maintain sinus rhythm following electrical cardioversion and increase the success rates of catheter ablation. This review aims to thoroughly examine the role of OSA in the development of cardiac arrhythmias. Screening for OSA and arrhythmias in patients with OSA provides vital information on the need for additional interventions, such as CPAP therapy, anticoagulation, antiarrhythmic drug therapy, catheter ablation for specific arrhythmias, or device therapy. New therapies for OSA treatment have the potential to significantly influence arrhythmia development in patients with sleep-disordered breathing. However, further research is required to validate these findings and formulate comprehensive treatment protocols.

The Role of Sleep in Cardiovascular Disease

PURPOSE OF REVIEW

Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD.

RECENT FINDINGS

Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.

Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.

Single channel photoplethysmography-based obstructive sleep apnea detection and arrhythmia classification

BACKGROUND

Simplified and easy-to-use monitoring approaches are crucial for the early diagnosis and prevention of obstructive sleep apnea (OSA) and its complications.

OBJECTIVE

In this study, the OSA detection and arrhythmia classification algorithms based on single-channel photoplethysmography (PPG) are proposed for the early screening of OSA.

METHODS

Thirty clinically diagnosed OSA patients participated in this study. Fourteen features were extracted from the PPG signals. The relationship between the number of features as inputs of the support vector machine (SVM) and performance of apnea events detection was evaluated. Also, a multi-classification algorithm based on the modified Hausdorff distance was proposed to recognize sinus rhythm and four arrhythmias highly related with SA.

RESULTS

The feature set composed of meanPP, SDPP, RMSSD, meanAm, and meank1 could provide a satisfactory balance between the performance and complexity of the algorithm for OSA detection. Also, the arrhythmia classification algorithm achieves the average sensitivity, specificity and accuracy of 83.79%, 95.91% and 93.47%, respectively in the classification of all four types of arrhythmia and regular rhythm.

CONCLUSION

Single channel PPG-based OSA detection and arrhythmia classification in this study can provide a feasible and promising approach for the early screening and diagnosis of OSA and OSA-related arrhythmias.