Can Central Sleep Apnea Predict Atrial Fibrillation Onset?

According to a new study, central sleep apnea can predict new onset atrial fibrillation (AF), especially in older patients.

A group including investigators from the Cleveland Clinic and Brigham and Women’s Hospital conducted an ancillary analysis of the Osteoporotic Fractures in Men Study, including 843 of that study’s original 5,994 community-living men aged 65 and older, who had 2 sleep studies and no baseline AF. Over a 6-year follow-up period, 99 men developed AF, with the researchers finding incident AF 2.58 times more likely to develop in that timeframe among men with central sleep apnea.
________________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Obstructive Sleep Apnea and Effects on Metabolic Derangements
Obstructive Sleep Apnea Linked to Diabetes
________________________________________________________________________________________________________________________________________________________________________

In addition, central apnea and Cheyne-Stokes respiration had a significant interaction with age, according to the authors, who note that participants 76 and older with central sleep apnea demonstrated a nearly 10-fold greater chance of AF onset. The odds of AF onset among those who had experienced Cheyne-Stokes respiration, meanwhile, increased six-fold, with this group also seeing a 22% relative increase in risk for every 5 units higher apnea-hypopnea index, none of which were noteworthy in the 65 to 75 age group.

While the findings don’t establish that central sleep apnea causes atrial fibrillation, the data “support that central sleep apnea appears to be a marker of [the] future development of atrial fibrillation,” says Reena Mehra, MD, MS, FCCP, FAASM, associate professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Research University, and co-author of the study.

As such, the results of this study suggests that “identification of central sleep apnea allows risk stratification, in terms of atrial fibrillation risk,” says Mehra, adding that further investigation is needed to determine whether treatment of central sleep apnea reduces atrial fibrillation and its associated morbidity and mortality—stroke, reduced quality of life, and mortality, for example.

The challenge is that sleep apnea identification is “not as straightforward or obvious as obstructive sleep apnea,” she says, noting that symptoms of obstructive sleep apnea include snoring, witnessed apneas, and daytime sleepiness.

Patients with central sleep apnea, however, do not show snoring symptoms, and often don’t experience daytime sleepiness, continues Mehra.

“Symptoms of central sleep apnea may include irregularities of breathing during sleep, sleep disruption, and difficulty maintaining continuous sleep, i.e., insomnia,” she says. “Therefore, if an older male patient, in particular, has these symptoms, consider diagnostic sleep testing.”

—Mark McGraw

Reference

May A, Blackwell T, et al. Central Sleep Disordered Breathing Predicts Incident Atrial Fibrillation in Older Males. Am J Respir Crit Care Med. November 2015 [epub ahead of print] DOI: 10.1164/rccm.201508-1523OC.