Page 118 - GTM-3-4

Global Translational Medicine Sleep apnea in patients with tachyarrhythmias

population. The prevalence of AF increases with age, intervention in the Department of Electrophysiology
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reaching a maximum at 80 – 89 years of age (9.6%). and Cardiac Pacing at the Moscow City Clinical Hospital
Moreover, AF is associated with a high risk of cardiovascular named after V.M. Buyanov between July 2022 and
complications, such as acute cerebrovascular accidents or March 2024. The study was conducted in accordance
transient ischemic attacks, heart failure, cognitive decline, with the Helsinki Declaration’s principles and approved
depression, frequent hospitalization, and mortality. 2 by the Institutional Ethics Committee (No: 115/5;
AF often coexists with other conditions, particularly June 09, 2022).
obstructive sleep apnea (OSA). This coexistence is The clinical and demographic characteristics of the
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attributed to common risk factors such as age, hypertension, patients are presented in Table 1. The mean age of the
and other cardiovascular diseases CVS, which increase the patients was 63 years (interquartile range [IQR]: 55 – 68).
independent attributable risk to 21% (odds ratio [OR] 1.12 No differences were observed in sex, height, weight, or
– 1.31). A dose-dependent relationship exists between body surface area. The study included 83 (40.1%) men and
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AF risk and OSA severity. Therefore, the effectiveness 126 (60.8%) women. Of the included patients, 23 (11.1%)
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of AF management may depend on the OSA severity. had atrial flutter, 163 (78.7%) had AF, and 25 (12.1%) had
Furthermore, a moderate and severe OSA increases AF a combination of atrial flutter and AF.
recurrence after radiofrequency catheter ablation and The following were the inclusion criteria: Age >18 years,
electrical cardioversion. 7-10 presence of tachyarrhythmias, and signed informed
The arrhythmogenic mechanism of OSA involves a consent form.
transient obstruction of the upper airway that leads to The following were the exclusion criteria: moderate
chronic transient hypoxia, contributing to atrial remodeling or severe cognitive decline, inability to sign informed
through local and systemic inflammatory responses and consent, and presence of bradyarrhythmias (sick sinus
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oxidative stress. In combination with high-frequency syndrome, 2 -and 3 degree atrioventricular block, and
rd
nd
deoxygenation episodes, the negative intrathoracic AF with atrioventricular conduction disturbances) with or
pressure fluctuations during inspiration and upper without pacemaker.
airway obstruction in OSA cause myocardial stretch and
changes in transmural pressure gradients. 11,12 Obstructive After obtaining consent, patients were asked to complete
respiratory events increase venous return, which increases the Berlin Questionnaire, STOP-BANG Sleep Apnea Risk
the right atrial and right ventricular preload. 13,14 The Scale, and the Epworth Sleepiness Scale for OSA screening.
subsequent right ventricular and right atrial stretch impairs In addition, anxiety and depression were assessed using
left ventricular filling, further increasing left atrial volume the hospital anxiety and depression scale (HADS).
load and causing left atrial dilation. 11,12 2.1. Description of the questionnaires
At present, several methods are available for identifying (i) The Berlin Questionnaire comprises 11 questions
sleep apnea, such as polysomnography, portable in three sections. A positive score (≥2 points) in 2 –
respiratory monitoring (RM), and overnight pulse 3 sections is considered a high risk for OSA.
oximetry. These studies require specialized equipment, (ii) The STOP-BANG Sleep Apnea Risk Scale comprises
appropriate infrastructure, and trained medical staff. two parts: STOP and BANG. A score of 3 – 4 points
Early and accessible screening for suspected sleep apnea is (number of “yes” answers) and 5 – 8 points is considered
particularly relevant for patients with arrhythmias. Various moderate and high risk of OSA, respectively. The
questionnaires including the Berlin Questionnaire, following conditions are also considered high risk for
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STOP-BANG Sleep Apnea Risk Scale, and Epworth OSA: Two or more “yes” answers in the STOP part
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Sleepiness Scale are used for OSA screening. However, + male sex; two or more “yes” answers in the STOP
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the sensitivity and specificity of these questionnaires for part + Body mass index (BMI) of at least 35 kg/m²; or
patients with tachyarrhythmia (AF and flutter) remain two or more “yes” answers in the STOP part + neck
debatable. 18-23 Therefore, herein, we aimed to assess the circumference of ≥40 cm.
screening capabilities of the Berlin Questionnaire, STOP- (iii) The Epworth Sleepiness Scale includes eight situations
BANG Sleep Apnea Risk Scale, and Epworth Sleepiness from daily life that are assessed for causing sleepiness.
Scale in patients with tachyarrhythmia. Scores range from 0 (“would never doze off”) to 3
2. Materials and methods (“high chance of dozing”). After the total score is
calculated, a score of 0 – 10, 11 – 12, 13 – 15, and 16
This study included 207 patients with tachyarrhythmia – 24 is considered normal, mild daytime sleepiness,
who were hospitalized for a possible surgical moderate daytime sleepiness, and severe daytime

Volume 3 Issue 4 (2024) 2 doi: 10.36922/gtm.5059