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

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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.

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Acknowledgments

English language editorial assistance was provided by Nicola Ryan, independent medical writer, on behalf of ResMed.

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    Authors and Affiliations

    1. Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany

      Henrik Fox, Thomas Bitter, Dieter Horstkotte & Olaf Oldenburg

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    1. Henrik Fox
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    2. Thomas Bitter
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    3. Dieter Horstkotte
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    4. Olaf Oldenburg
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    Correspondence to Henrik Fox.

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    The study was conducted as a non-commercial trial with capital resources of the Department of Cardiology at the Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.

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    The authors state that there are no disclosures to be declared related to this study.

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    Henrik Fox and Thomas Bitter have contributed equally to this work.

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    Fox, H., Bitter, T., Horstkotte, D. et al. Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea. Clin Res Cardiol 105, 451–459 (2016). https://doi.org/10.1007/s00392-015-0940-2

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