Arrhythmias
Cardiac arrhythmias, especially tachy-brady syndrome, ventricular ectopy, and atrial fibrillation are commonly identified in patients with OSA.[11-13] The Sleep Heart Health Study noted that patients with sleep-disordered breathing have a higher likelihood of having complex arrhythmias compared with control patients.[12] Specifically, these patients had a fourfold increase in atrial fibrillation, a threefold increase in nonsustained ventricular tachycardia, and a twofold increase in complex ventricular ectopy.[12] These rhythm disturbances likely correlate with nocturnal hypoxia, sleep fragmentation, and elevated sympathetic tone. Treatment of OSA in patients with known congestive heart failure has been shown to reduce the frequency of premature beats, which in turn may decrease the morbidity of ventricular arrhythmias.[22] In addition, CPAP therapy has been shown to reduce the rate of arrhythmias even after controlling for heart failure and other independent variables.[13]

Final Perspective and Clinical Recommendations

Regardless of whether a true causal relationship can be proven, it is known that cardiovascular disease is common among patients with OSA and is associated with worse outcomes. It appears that OSA likely causes, or at least potentiates, cardiovascular disease. Although OSA clearly affects quality of life, the growing evidence that it also affects cardiovascular health should further compel clinicians to evaluate patients with OSA for these potential consequences and at least consider underlying sleep-disordered breathing in patients with known cardiovascular diseases.

Recommendations for Practitioners Managing Patients With OSA
  * OSA increases the risk for cardiovascular disease. Patients with OSA should be regularly screened for these potential complications;
  * Given the common association of these disorders, patients with cardiovascular disease should be screened for OSA and patients with OSA should be monitored for the development of cardiovascular sequelae, particularly hypertension;
  * OSA is one of the most significant causes of secondary hypertension, which occurs in half of all patients with sleep apnea;
  * Ischemic heart disease is significantly more common in patients with OSA and may increase the risk for both fatal and nonfatal cardiovascular events;
  * Patients with heart failure should be assessed for OSA because treatment of the underlying sleep-disordered breathing may improve both cardiac function and quality of life;
  * OSA is commonly associated with atrial fibrillation, and untreated OSA may impair the success of cardioversion; and
  * Treatment of OSA improves quality of life and may reduce the development or progression of cardiovascular complications. Practitioners must stress the importance of therapeutic adherence.

—
Christopher J. Lettieri, MD

Associate Professor of Medicine, Uniformed Services University, Bethesda, Maryland; Staff Physician, Pulmonary, Critical Care and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC

Disclosure: Christopher Lettieri, MD, has disclosed the following financial relationships:
Received grants for clinical research from: Sepracor Inc.
Served as a speaker or member of the speakers bureau for: Cephalon, Inc.

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