Prepared by Anne Leonard MPH, BSN, RN, FAHA – Senior Science and Medicine Advisor - Lead
- Sleep Disordered Breathing (SDB) is characterized by alterations in breathing during sleep. SDB subtypes related to this statement include obstructive sleep apnea (OSA), central sleep apnea (CSA) and CSA-Cheyne strokes breathing (CSB).
- OSA is highly prevalent, affecting about one billion adults worldwide. OSA is widely undiagnosed and especially in racial/ethnic groups.
- Descriptions for the immediate, acute, and subacute and chronic SDB pathophysiology contributing to SDB are detailed in this statement.
- Definitions of sleep disordered breathing and the clinical manifestations that follow these disorders are included for both OSA and CSA.
- SDB and atrial fibrillation (AF) share several risk factors such as increasing age, male sex, obesity and race/ethnicity. The magnitude of association between SDB and AF with an HR=2.18, 95% CI:1.34-3.54. The association between obesity and AF with a HR: 1.49, 95% CI:1.67-1.87. This suggests that SDB may be a stronger AF driver than obesity.
- OSA adds to hypertension (an AF risk factor), by sympathetic nervous system excitation and vascular remodeling. Heart failure is often associated with CSA, and shares overlapping multidirectional relationships with SDB and other cardiovascular risk and disease. In these circumstances, cardiac arrhythmias can arise from comorbid risk attributable to SDB because of neurohumoral and hemodynamic alterations, changes in sympathetic drive and cardiac structure affecting underlying electrophysiology.
- Recognition of health inequities and the intersection with race/ethnicity in sleep disorder risk, screening, and diagnostic as well as therapeutic approaches such as anticoagulation use in cardiac arrhythmia carries high public health relevance and implications. As an example, while White people have a higher incidence of AF compared to Black people; race/ethnic minorities with AF frequently experience long-lasting and more frequent symptomatic AF episodes, less aggressive care, a higher stroke risk and mortality.
- Sex-specific differences in the clinical presentation of SDB impacts the tailoring of diagnostic strategies, with examples such as the recognized sex-specific differences in respiratory event arousal threshold also warranting further research.
- Sleep quality, sleep duration, sleep disruptions and SDB may each be important in the pathogenesis of AF, potentially representing a novel target for preventing occurrence, recurrence, and progression of AF.
- In addition to AF this statement discusses ventricular tachyarrhythmias and bradyarrhythmias in the setting of SDB.
- A patient-centric, integrated stepwise model of care of SDB and cardiac arrhythmias is included in this statement and gives clinicians an approach to clinical management in this patient population.
Mehra R, Chung MK, Olshansky B, Dobrev D, Jackson CL, Kundel V, Linz D, Redeker NS, Redline S, Sanders P, Somers VK; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology; and Stroke Council. Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association [published online ahead of print August 1, 2022]. Circulation. doi: 10.1161/CIR.0000000000001082