赵伊雪,马靖

• 1:北京大学第一医院呼吸和危重症医学科

摘要(Abstract)：

心房颤动（AF）是临床常见的心律失常之一。阻塞性睡眠呼吸暂停（OSA）是常见的睡眠呼吸障碍（SDB）之一。OSA以睡眠期间反复发生上气道塌陷、造成间歇低氧伴高碳酸血症为主要特征。已有证据表明SDB是AF发生和进展的危险因素。早期筛查AF人群中的OSA患者并对其进行治疗，对降低AF患者复发风险起到重要作用。本文总结了OSA与AF关系的研究及实践进展，主要阐述了二者流行病学联系和病理生理机制，OSA诊治对AF患者的重要性，OSA筛查诊断的方法以及AF合并OSA的治疗和管理。

关键词(KeyWords)： 心房颤动;阻塞性睡眠呼吸暂停;睡眠呼吸障碍;筛查

Abstract:

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基金项目(Foundation):

作者(Author): 赵伊雪,马靖

参考文献(References)：

• [1] Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea[J]. Lancet, 2014, 383(9918):736-747.
• [2] Sánchez-de-la-Torre M, Lee CH, BarbéF. Obstructive sleep apnea and atrial fibrillation:we need to go step by step[J]. J Clin Sleep Med, 2021, 17(5):869-870.
• [3] Linz D, Linz B, Hohl M, et al. Atrial arrhythmogenesis in obstructive sleep apnea:therapeutic implications[J]. Sleep Med Rev, 2016, 26:87-94.
• [4] Linz D, McEvoy RD, Cowie MR, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment:a review[J]. JAMA Cardiol, 2018, 3(6):532-540.
• [5] Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing:the sleep heart health study[J]. Am J Respir Crit Care Med, 2006,173(8):910-916.
• [6] Kwon Y, Koene RJ, Johnson AR, et al. Sleep, sleep apnea and atrial fibrillation:questions and answers[J]. Sleep Med Rev, 2018, 39:134-142.
• [7] Bauters F, Rietzschel ER, Hertegonne KB, et al. The link between obstructive sleep apnea and cardiovascular disease[J].Curr Atheroscler Rep, 2016, 18(1):1.
• [8] Hohl M, Linz B, B?hm M, et al. Obstructive sleep apnea and atrial arrhythmogenesis[J]. Curr Cardiol Rev, 2014, 10(4):362-368.
• [9] Iwasaki YK, Shi Y, Benito B, et al. Determinants of atrial fibrillation in an animal model of obesity and acute obstructive sleep apnea[J]. Heart Rhythm, 2012, 9(9):1409-1416.e1401.
• [10] Shantha G, Pelosi F, Morady F. Relationship between obstructive sleep apnoea and AF[J]. Arrhythm Electrophysiol Rev, 2019, 8(3):180-183.
• [11] Chen PS, Chen LS, Fishbein MC, et al. Role of the autonomic nervous system in atrial fibrillation:pathophysiology and therapy[J]. Circ Res, 2014, 114(9):1500-1515.
• [12] Sovari AA. Cellular and molecular mechanisms of arrhythmia by oxidative stress[J]. Cardiol Res Pract, 2016, 2016:9656078.
• [13] Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management[J]. Circ J,2015, 79(3):495-502.
• [14] Stanciu AE, Vatasescu RG, Stanciu MM, et al. The role of pro-fibrotic biomarkers in paroxysmal and persistent atrial fibrillation[J]. Cytokine, 2018, 103:63-68.
• [15] Desteghe L, Hendriks JML, McEvoy RD, et al. The why,when and how to test for obstructive sleep apnea in patients with atrial fibrillation[J]. Clin Res Cardiol, 2018, 107(8):617-631.
• [16] Lin CH, Timofeeva M, O’Brien T, et al. Obstructive sleep apnea and nocturnal attacks of paroxysmal atrial fibrillation[J].J Clin Sleep Med,2022,18(5):1279-1286.
• [17] Noubiap JJ. Atrial fibrillation and obstructive sleep apnea in African populations:uncovering a neglected association[J].Pan Afr Med J, 2021, 39:55.
• [18] Szymanski FM, Filipiak KJ, Platek AE, et al. Assessment of CHADS2 and CHA2DS2-VASc scores in obstructive sleep apnea patients with atrial fibrillation[J]. Sleep Breath, 2015, 19(2):531-537.
• [19] Yaranov DM, Smyrlis A, Usatii N, et al. Ef fect of obstructive sleep apnea on frequency of stroke in patients with atrial fibrillation[J]. Am J Cardiol, 2015, 115(4):461-465.
• [20] Dalgaard F, North R, Pieper K, et al. Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation[J]. Am Heart J, 2020,223:65-71.
• [21] Pengo MF, Faini A, Grote L, et al. Impact of sleep apnea on cardioembolic risk in patients with atrial fibrillation:data from the ESADA cohort[J]. Stroke, 2021, 52(2):712-715.
• [22] Monahan K, Brewster J, Wang L, et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter[J]. Am J Cardiol, 2012, 110(3):369-372.
• [23] Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation[J].Circulation, 2003, 107(20):2589-2594.
• [24] Congrete S, Bintvihok M, Thongprayoon C, et al. Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation:a metaanalysis[J]. J Evid Based Med, 2018, 11(3):145-151.
• [25] Szymanski FM, Filipiak KJ, Platek AE, et al. Presence and severity of obstructive sleep apnea and remote outcomes of atrial fibrillation ablations-a long-term prospective, cross-sectional cohort study[J]. Sleep Breath, 2015, 19(3):849-856.
• [26] Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults[J]. J Clin Sleep Med, 2009, 5(3):263-276.
• [27] Shukla A, Aizer A, Holmes D, et al. Ef fect of obstructive sleep apnea treatment on atrial fibrillation recurrence:a metaanalysis[J]. JACC Clin Electrophysiol, 2015, 1(1-2):41-51.
• [28] Holmqvist F, Guan N, Zhu Z, et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-results from the outcomes registry for better informed treatment of atrial fibrillation(ORBIT-AF)[J]. Am Heart J, 2015, 169(5):647-654.e642.
• [29] Fein AS, Shvilkin A, Shah D, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation[J]. J Am Coll Cardiol, 2013, 62(4):300-305.
• [30] Naruse Y, Tada H, Satoh M, et al. Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation:clinical impact of continuous positive airway pressure therapy[J]. Heart Rhythm, 2013, 10(3):331-337.
• [31] Neilan TG, Farhad H, Dodson JA, et al. Ef fect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation[J]. J Am Heart Assoc, 2013,2(6):e000421.
• [32] Deng F, Raza A, Guo J. Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation:a meta-analysis[J]. Sleep Med, 2018, 46:5-11.
• [33] Lee CJ, Kim TH, Park S, et al. Obstructive sleep apnea is closely related to cardiovascular risk factors, but not to clinical recurrence of atrial fibrillation after catheter ablation:an analysis of atrial fibrillation patients[J]. Pulse(Basel), 2018, 6(1-2):103-111.
• [34] Anter E, Di Biase L, Contreras-Valdes FM, et al.A t r i a l substrate and triggers of paroxysmal atrial fibrillation in patients with obstructive sleep apnea[J]. Circ Arrhythm Electrophysiol, 2017, 10(11):e005407.
• [35] Caples SM, Mansukhani MP, Friedman PA, et al. The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion:a randomized controlled trial[J]. Int J Cardiol, 2019, 278:133-136.
• [36] Cowie MR. Sleep apnea:state of the art[J]. Trends Cardiovasc Med, 2017, 27(4):280-289.
• [37] Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults[J]. Am Fam Physician,2016, 94(5):355-360.
• [38] Costa LE, Uch?a CH, Harmon RR, et al. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting[J].Heart, 2015, 101(16):1288-1292.
• [39] Albuquerque FN, Calvin AD, Sert Kuniyoshi FH, et al.Sleep-disordered breathing and excessive daytime sleepiness in patients with atrial fibrillation[J]. Chest, 2012, 141(4):967-973.
• [40] Monahan K, Storfer-Isser A, Mehra R, et al. Triggering of nocturnal arrhythmias by sleep-disordered breathing events[J].J Am Coll Cardiol, 2009, 54(19):1797-1804.
• [41] Laratta CR, Ayas NT, Povitz M, et al. Diagnosis and treatment of obstructive sleep apnea in adults[J]. Cmaj,2017, 189(48):E1481-E1488.
• [42] Di Fusco SA, Pignalberi C, Santini L, et al. Arrhythmias and sleep apnea:physiopathologic link and clinical implications[J].J Interv Card Electrophysiol, 2020, 57(3):387-397.
• [43] Hla KM, Young T, Finn L, et al. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the wisconsin sleep cohort study[J]. Sleep,2008, 31(6):795-800.
• [44] Netzer NC, Stoohs RA, Netzer CM, et al. Using the berlin questionnaire to identify patients at risk for the sleep apnea syndrome[J]. Ann Intern Med, 1999, 131(7):485-491.
• [45] Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea[J]. Circulation,2004, 110(4):364-367.
• [46] Tang RB, Dong JZ, Liu XP, et al. Obstructive sleep apnoea risk profile and the risk of recurrence of atrial fibrillation after catheter ablation[J]. Europace, 2009, 11(1):100-105.
• [47] Farrehi PM, O’Brien LM, Bas HD, et al. Occult obstructive sleep apnea and clinical outcomes of radiofrequency catheter ablation in patients with atrial fibrillation[J]. J Interv Card Electrophysiol, 2015, 43(3):279-286.
• [48] Marti-Soler H, Hirotsu C, Marques-Vidal P, et al.The NoSAS score for screening of sleep-disordered breathing:a derivation and validation study[J]. Lancet Respir Med,2016, 4(9):742-748.
• [49] Starkey SY, Jonasson DR, Alexis S, et al. Screening for obstructive sleep apnea in an atrial fibrillation population:what’s the best test[J]? CJC Open, 2021, 3(4):442-449.
• [50] Delesie M, Knaepen L, Hendrickx B, et al. The value of screening questionnaires/scoring scales for obstructive sleep apnoea in patients with atrial fibrillation[J]. Arch Cardiovasc Dis, 2021, 114(11):737-747.
• [51] May AM, Wang L, Kwon DH, et al. Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population[J]. Int J Cardiol Heart Vasc, 2020, 31:100624.
• [52] Ferber R, Millman R, Coppola M, et al. Portable recording in the assessment of obstructive sleep apnea[J]. Sleep, 1994,17(4):378-392.
• [53] January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society[J]. Heart Rhythm, 2019, 16(8):e66-e93.
• [54] Tietjens JR, Claman D, Kezirian EJ, et al. Obstructive sleep apnea in cardiovascular disease:a review of the literature and proposed multidisciplinary clinical management strategy[J]. J Am Heart Assoc, 2019, 8(1):e010440.
• [55] Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Eur Heart J, 2016, 37(38):2893-2962.
• [56] Gorenek B, Pelliccia A, Benjamin EJ, et al. European heart rhythm association(ehra)/european association of cardiovascular prevention and rehabilitation(eacpr)position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society(HRS)and Asia Pacific Heart Rhythm Society(APHRS)[J]. Eur J Prev Cardiol, 2017, 24(1):4-40.
• [57] Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Heart Rhythm,2017, 14(10):e275-e444.
• [58] Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and risk factor modification for reduction of atrial fibrillation:a scientific statement from the american heart association[J]. Circulation,2020, 141(16):e750-e772.
• [59] Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea:an american academy of sleep medicine clinical practice guideline[J]. J Clin Sleep Med, 2017, 13(3):479-504.
• [60] Fox H, Bitter T, Gutleben KJ, et al. Cardiac or other implantable electronic devices and sleep-disordered breathing-implications for diagnosis and therapy[J]. Arrhythm Electrophysiol Rev, 2014, 3(2):116-119.
• [61] Mazza A, Bendini MG, De Cristofaro R, et al. Pacemakerdetected severe sleep apnea predicts new-onset atrial fibrillation[J].Europace, 2017, 19(12):1937-1943.
• [62] Mazza A, Bendini MG, Leggio M, et al. Continuous monitoring of sleep-disordered breathing with pacemakers:indexes for risk stratification of atrial fibrillation and risk of stroke[J]. Clin Cardiol, 2020, 43(12):1609-1615.
• [63] Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure:an american academy of sleep medicine clinical practice guideline[J].J Clin Sleep Med, 2019, 15(2):335-343.
• [64] Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy:an update for 2015[J]. J Clin Sleep Med,2015, 11(7):773-827.
• [65] Huang B, Liu H, Scherlag BJ, et al. Atrial fibrillation in obstructive sleep apnea:neural mechanisms and emerging therapies[J]. Trends Cardiovasc Med, 2021, 31(2):127-132.
• [66] Sun L, Yan S, Wang X, et al. Metoprolol prevents chronic obstructive sleep apnea-induced atrial fibrillation by inhibiting structural, sympathetic nervous and metabolic remodeling of the atria[J]. Sci Rep, 2017, 7(1):14941.
• [67] Linz D, Hohl M, Khoshkish S, et al. Low-level but not highlevel baroreceptor stimulation inhibits atrial fibrillation in a pig model of sleep apnea[J]. J Cardiovasc Electrophysiol, 2016,27(9):1086-1092.
• [68] Yu L, Li X, Huang B, et al. Atrial fibrillation in acute obstructive sleep apnea:autonomic nervous mechanism and modulation[J]. J Am Heart Assoc, 2017, 6(9):e006264.
• [69] Yang X, Zhang L, Liu H, et al. Cardiac sympathetic denervation suppresses atrial fibrillation and blood pressure in a chronic intermittent hypoxia rat model of obstructive sleep apnea[J]. J Am Heart Assoc, 2019, 8(4):e010254.
• [70] Zhang L, Guo Y, Xiaokereti J, et al. Ganglionated plexi ablation suppresses chronic obstructive sleep apnea-related atrial fibrillation by inhibiting cardiac autonomic hyperactivation[J].Front Physiol, 2021, 12:640295.