ATRIAL FIBRILATION
Association Between Atrial Fibrillation and
Central Sleep Apnea
Leung RS,
Huber MA,
Rogge T,
Maimon N,
Chiu KL,
Bradley TD.
Sleep Research Laboratory of the Toronto Rehabilitation Institute, Ontario,
Canada.
BACKGROUND: We previously described an association between atrial
fibrillation and central sleep apnea in a group of patients with congestive
heart failure. We hypothesized that the prevalence of atrial fibrillation
might also be increased in patients with central sleep apnea in the absence
of other cardiac disease.
METHODS AND RESULTS: We compared the prevalence of
atrial fibrillation in a series of 60 consecutive patients with idiopathic
central sleep apnea (apnea-hypopnea index > 10 events per hour, > 50%
central events) with that in 60 patients with obstructive sleep apnea
(apnea-hypopnea index > 10, > 50% obstructive events) and 60 patients
without sleep apnea (apnea-hypopnea index < 10), matched for age, sex, and
body mass index. Subjects with a history of congestive heart failure,
coronary artery disease, or stroke were excluded from the study. The
prevalence of atrial fibrillation among patients with idiopathic central
sleep apnea was found to be significantly higher than the prevalence among
patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and
3.3%, respectively, P < .001). However, hypertension was most common and
oxygen desaturation most extreme among patients with obstructive sleep
apnea.
CONCLUSIONS: We conclude that there is a markedly increased
prevalence of atrial fibrillation among patients with idiopathic central
sleep apnea in the absence of congestive heart failure. Moreover, the high
prevalence of atrial fibrillation among patients with idiopathic central
sleep apnea is not explainable by the presence of hypertension or nocturnal
oxygen desaturation, since both of these were more strongly associated with
obstructive sleep apnea.
From Mike: Breathing and heartbeat irregularities have a
a great deal in common as fibs often reduce or disappear when breathing
improves. EFA is also
related to fibrilations
THYROID
Thyroxine Replacement Therapy Reverses
Sleep-Disordered Breathing in Patients With Primary Hypothyroidism
Jha A,
Sharma SK,
Tandon N,
Lakshmy R,
Kadhiravan T,
Handa KK,
Gupta R,
Pandey RM,
Chaturvedi PK.
Division of Pulmonary and Critical Care Medicine, Department of Medicine,
All India Institute of Medical Sciences, New Delhi 110029, India.
BACKGROUND AND PURPOSE: Anecdotal reports suggest that sleep-disordered
breathing (SDB) is common among patients with primary hypothyroidism. This
study was undertaken to determine the prevalence of SDB and to evaluate the
effect of thyroxine replacement therapy on SDB in patients with primary
hypothyroidism.
PATIENTS AND METHODS: Fifty consecutive newly diagnosed,
untreated symptomatic patients with primary hypothyroidism (age: 34+/-11
years; males: 21 [42%]) were prospectively studied. Physical examination,
anthropometry, fasting blood glucose and serum lipids were performed in all
patients at baseline. Polysomnography was done at baseline in all patients
and was repeated after adequate thyroxine replacement in those who had SDB.
RESULTS: SDB defined as apnea-hypopnea index (AHI) >/=5 was present in 15
patients (30%) at baseline and was reversible in 10 of the 12 patients
evaluated following thyroxine replacement therapy (P=0.006). Thyroxine
replacement therapy was associated with improvement in findings that reflect
a compromised upper airway, such as macroglossia (4 [33%] vs. 1 [8%];
P=0.083), myoedema (5 [42%] vs. 1 [8%]; P=0.046) and facial puffiness (10
[83%] vs. 1 [8%]; P=0.003).
CONCLUSIONS: Reversible SDB is common among
patients with primary hypothyroidism. Changes in upper airway anatomy
resulting from hypothyroidism probably contribute to the development of SDB
in these patients.
From Mike: When energy issues present, first the breathing,
next the thyroid. more about
ERECTILE DYSFUNCTION - ED
Erectile Dysfunction, Obstructive Sleep Apnea
Syndrome and Nasal CPAP Treatment
Goncalves MA,
Guilleminault C,
Ramos E,
Palha A,
Paiva T. ISTEL, Porto, Portugal.
BACKGROUND AND PURPOSE: To evaluate the effect of one month of continuous
positive airway pressure (CPAP) in a subgroup of obstructive sleep apnea (OSA)
patients with erectile dysfunction (ED) and compare this subgroup with age-
and body mass index (BMI)-matched OSA patients without ED.
PATIENTS AND
METHODS: Prospective general, sleep, psychiatric and sexologic evaluations
were conducted. Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI),
Sleep Disorders Questionnaire (SDQ), Quality of Life SF-36, and
polysomnography were used. Seventeen OSA patients with ED were compared
prior to CPAP treatment and during CPAP treatment with age- and BMI-matched
OSA patients without ED. Parametric and non-parametric statistics,
chi-square, Fisher exact test and multiple regression analyses were
performed.
RESULTS: Ninety-eight men (BMI=28.8 kg/m2, apnea-hypopnea index (AHI)=49.6
events/h, ESS=14.8, BDI=8.4, and lowest SaO2=75.3%) were divided into
subgroups of lowest SaO2>80% (A) and lowest SaO2< or =80% (B). (A) Forty-six
men had a mean lowest SaO2 of 85.7%+/-2.9, AHI=29.5+/-17.6, age=46.3+/-9.3
years, ESS=13.6+/-4.2, BMI=25.8+/-4.8. Seven of the patients had ED. (B)
Fifty-two men had a mean lowest SaO2=60.10+/-10.0%, AHI=67.4+/-24.5, BDI=9.0+/-6.9,
age=47.4+/-9.4 years, ESS=16.2+/-4.4, BMI=31.4+/-5.1. Twenty-one of the
patients had ED (chi2: P=0.006). Significant variables for ED were lowest
SaO2 and age (r=0.17). CPAP-treated subgroup: ED subjects had significantly
lower SaO2, ESS, BDI and SF-36 subscale scores than OSA controls. Nasal CPAP
eliminated the differences between groups, and ED was
resolved in 13 out of 17 cases.
CONCLUSIONS: ED in OSAS is related to
nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with
nasal CPAP showed remission at one-month follow-up, resulting in significant
improvement in quality of life.
From Mike: ERECTILE DYSFUNCTION. ED
can stem from apnea and apnea can stem from
poor breathing. For ED best to rule out both apnea and
UDB.
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