Interactions between sleep apnea and atrial fibrillation Pathophysiology and symptoms

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. Central as well as obstructive sleep apnea interact with this condition. Intermittent hypoxia, oxidative stress, repeated awakening, intrathoracic pressure swings, and atrial remodeling as part of sleep-disordered breathing (SDB) can lead to AF. Objectives This article focuses on the complex relationship and recent research findings concerning SDB and AF, as well as the therapeutic options. Materials and Methods A literature search was conducted of original and review articles, as well as meta-analyses, published in the PubMed database between 1963 and 2020. Results The findings of the studies indicate a bidirectional relationship between SDB and AF. The pathophysiological consequences of obstructive and central sleep apnea vary. The studies evaluating the effects SDB treatment on the recurrence of AF after intervention (e.g., cardioversion and pulmonary vein isolation) do not yet provide a clear picture. Conclusions Previous studies suggest multiple interactions between SDB and AF. Considering the conflicting results on the effects of positive airway pressure treatment on the risk of recurrence of AF after intervention, further studies are needed.