Clinical evidence for a dynamic atrial fibrillation substrate in sleep apnea

Excerpt

Sleep apnea (SA) is highly prevalent among patients with atrial fibrillation (AF) and impacts efficacy of catheter-based and pharmacological antiarrhythmic treatment [1]. Long-term severe SA has been shown to be associated with structural remodeling processes in the atrium in humans [2]. Mechanistically, obstructive respiratory events may cause structural remodeling and myocardial damage through repetitive mechanical atrial distension and atrial wall stretch as well as frequent episodes of hemoglobin desaturation-resaturation. While atrial structural remodeling is important in providing an AF-maintaining substrate in patients with chronic SA, nocturnal AF paroxysms are often temporally related to individual respiratory obstructive events, suggesting that acute transient arrhythmogenic changes during apnea may further contribute to the AF substrate [1]. …