Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea

Clin Res Cardiol. 2016 May;105(5):451-9. doi: 10.1007/s00392-015-0940-2. Epub 2015 Nov 9.

Abstract

Aims: Sleep-disordered breathing (SDB), in particular obstructive sleep apnoea, is associated with an increased risk of onset or recurrence of atrial fibrillation (AF) and atrial flutter. This prospective study investigated the relationship between restoration of sinus rhythm and SDB in patients with AF or atrial flutter.

Methods and results: 138 consecutive patients (age 67.8 ± 10.3 years, 67.4 % male) with AF (86.2 %) or atrial flutter (13.8 %) were enrolled and underwent multichannel cardiorespiratory polygraphy the night before and immediately after electrical cardioversion (CV). None of the patients was treated with ventilation therapy before or during the study. Overall prevalence of SDB [apnoea-hypopnoea index (AHI) ≥5/h] was 92 % and prevalence of moderate-to-severe SDB (AHI) ≥15/h was 64 %. Within the first night after CV, AHI decreased from 23.4 ± 16.3 to 16.3 ± 11.5/h, p < 0.001. This was due to a significant decrease in central respiratory events, with a total reduction of patients showing central sleep apnoea (n = 53 at baseline vs n = 23 immediately after CV; p < 0.001).

Conclusions: In conclusion, SDB represents a highly prevalent comorbidity in patients with atrial arrhythmias. Through cardioversion, an immediate reduction of SDB can be detected due to a significant reduction in central respiratory events.

Keywords: Atrial fibrillation; Atrial flutter; Cardioversion; Obstructive sleep apnoea; Sleep-disordered breathing.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Atrial Flutter / diagnosis
  • Atrial Flutter / epidemiology
  • Atrial Flutter / physiopathology
  • Atrial Flutter / surgery*
  • Comorbidity
  • Electric Countershock*
  • Female
  • Germany / epidemiology
  • Humans
  • Lung / innervation
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Respiration*
  • Respiratory Center / physiopathology
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / physiopathology
  • Treatment Outcome