Sleep Apnea, Arrhythmias and Sudden Death

 Converging evidence indicates a link between sleep disordered breathing and arrhythmias. Several OSA-related immediate, intermediate and chronic pathways lead to augmented arrhythmic propensity. The more immediate and intermediate pathways include intermittent hypoxia, autonomic nervous system fluctuations during respiratory events and intrathoracic pressure swings leading to atrial stretch and hypercapnia. Chronic pathways include increased systemic inflammation, oxidative stress, enhanced prothrombotic state and vascular dysfunction. While the more immediate and intermediate pathways are linked to a reduction in the atrial effective refractory period, triggered and abnormal automaticity, the persistence of reentrant arrhythmias and the potential to prolong the QT interval, the more chronic pathways are ultimately linked to cardiac structural and electrical remodeling This paper provides an overview of the main pathophysiologic mechanisms underlying the association between sleep apnea and arrhythmias and discusses the impact of sleep apnea on arrhythmia management. 

Keywords: Atrial Fibrillation, Arrhythmia, Obstructive Sleep Apnea.