Editorial
Relationship between SAHS and cardiac arrhythmias
Relación entre el SAHS y las arritmias cardiacas
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Félez" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Nuria" "apellidos" => "Grau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Julio" "apellidos" => "Martí-Almor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Miquel A." "apellidos" => "Félez" "email" => array:1 [ 0 => "91435@parcdesalutmar.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Arritmias, Servicio de Cardiología, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Relación entre el SAHS y las arritmias cardiacas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac arrhythmias are a major health problem in our setting, particularly atrial fibrillation (AF), which is the most common form. In individuals over 40 years of age, the prevalence is higher than 4% in both sexes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the aging of the population is expected to cause increases in the next few years that may reach epidemic levels. Arrythmias reduce quality of life and generate high social health costs.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Current studies show that the onset of AF is related more to cardiovascular risk factors that are closely linked to lifestyle than to the presence of established structural heart disease. Thus, factors such as obesity, sedentary lifestyle, hypertension, diabetes, and sleep apnea and hypopnea syndrome (SAHS) have been described as risk factors for developing AF.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This editorial aims to set out the basic principles that prioritize the diagnosis and treatment of SAHS in patients with arrhythmias.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">SAHS and atrial fibrillation</span><p id="par0020" class="elsevierStylePara elsevierViewall">SAHS and AF share risk factors, such as increased age, obesity, heart failure, and hypertension,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> so it is not unusual to find a close relationship between the two diseases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">SAHS is more common in patients with AF (18%–74%) than in patients without AF (3%–49%).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Furthermore, in patients under 65 years of age, sleep-disordered breathing confers the highest risk for AF (HR 3.3).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The presence of SAHS is also a risk factor for recurrence of AF after electrical ablation<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> or cardioversion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Treating SAHS with CPAP can normalize this risk.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The main mechanisms by which SAHS may favor the development of AF are intermittent nocturnal hypoxemia, sympathetic activation, transmural pressure changes, and systemic inflammation. These factors contribute to atrial remodeling, both structural and electrical, that makes the atrial tissue more susceptible to the genesis and perpetuation of AF.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In short, SAHS increases the risk of AF and is a poor prognostic factor in the outcome of AF treatment. In these patients, it is important to detect and treat SAHS because CPAP treatment normalizes this risk.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">SAHS and atrial flutter</span><p id="par0045" class="elsevierStylePara elsevierViewall">AF-free atrial flutter is characterized by less unstructured atrial tissue and less fibrosis, so successful preventive treatment is more likely. In this context, it makes sense to explore a possible etiopathogenic relationship between SAHS and atrial flutter since treatment of SAHS with CPAP may also be effective in preventing progression from flutter to AF.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Increased pulmonary artery pressure increases the risk of AF and flutter and may be the mechanism by which SAHS causes the appearance of these arrhythmias. It is known that during obstructive episodes of the upper airway, the right atrial and ventricular afterload is raised by a paroxysmal increase in pressure in the pulmonary artery.</p><p id="par0055" class="elsevierStylePara elsevierViewall">There is little evidence of the relationship between the two entities, and for this reason our group studied a prospective series of 56 patients with flutter who underwent radiofrequency ablation. In this series, 82% had SAHS and 45% had severe SAHS. In follow-up after ablation, 38% of patients presented AF. In the multivariate analysis, the absence of paroxysmal AF episodes prior to ablation and CPAP therapy in patients with SAHS were the only protective factors. Thus, only 6% of the group of SAHS patients treated with CPAP developed AF. The protective effect of CPAP was only observed in patients with no previous episodes of AF, suggesting that we can only delay the progress of less fibrotic atria.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">These findings are relevant, as many patients with flutter develop AF a few years after successful AF ablation. Diagnosing and treating SAHS in patients with no previous history of AF may delay or prevent the onset of AF and its impact on morbidity and mortality.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">SAHS and ventricular tachycardia and sudden cardiac death</span><p id="par0065" class="elsevierStylePara elsevierViewall">SAHS has also been associated with ventricular arrhythmias. Up to 60% of these patients have SAHS and 22% have severe SAHS.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Factors involved in this relationship are ventricular hypertrophy, QT interval prolongation, and autonomic dysfunction in patients with SAHS.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Gami et al. demonstrated that sudden cardiac death in patients with SAHS peaks during sleep, while in the population without SAHS it occurs during the day.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This finding was subsequently confirmed in a 15-year longitudinal study that defined age >60 years, low nocturnal oxygen saturation, and apnea-hypopnea index (AHI) >20 as risk factors for sudden death.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Treatment with CPAP has been shown to protect against these serious cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Future challenges</span><p id="par0075" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0080" class="elsevierStylePara elsevierViewall">A randomized, interventional trial is still needed to demonstrate a causal relationship between SAHS and cardiac arrhythmias and to demonstrate reduced arrhythmic load by treating SAHS.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0085" class="elsevierStylePara elsevierViewall">Do we have to act sooner? Specifically in moderate SAHS (AHI 15–30), to avoid structural remodeling of the atrium.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0090" class="elsevierStylePara elsevierViewall">The medical community has conventionally seen SAHS as a problem for pulmonologists, but given an aging population, the obesity pandemic, and the lifestyle of Western countries, it is important that other specialists work together to reduce its consequences. Cardiologists and internists should be aware of the close relationship between cardiac arrhythmias and SAHS and the benefits of early diagnosis and treatment of SAHS in reducing cardiovascular morbidity and mortality. This is especially important in patients who need to undergo cardiac ablation or cardioversion.</p></li></ul></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "SAHS and atrial fibrillation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "SAHS and atrial flutter" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "SAHS and ventricular tachycardia and sudden cardiac death" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Future challenges" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Grau N, Martí-Almor J, Félez MA. Relación entre el SAHS y las arritmias cardiacas. Arch Bronconeumol. 2021;57:513–514.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología de la fibrilación auricular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Gómez-Doblas" 1 => "M.A. López-Garrido" 2 => "I. Esteve-Ruiz" 3 => "G. Barón-Esquivias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol Supl" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "2" "paginaFinal" => "7" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibrilación auricular: ¿estamos ante una epidemia?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 56 | 12 | 68 |
| 2024 September | 111 | 19 | 130 |
| 2024 August | 131 | 28 | 159 |
| 2024 July | 78 | 25 | 103 |
| 2024 June | 90 | 38 | 128 |
| 2024 May | 86 | 27 | 113 |
| 2024 April | 39 | 17 | 56 |
| 2024 March | 50 | 15 | 65 |
| 2024 February | 47 | 22 | 69 |
| 2024 January | 67 | 25 | 92 |
| 2023 December | 60 | 25 | 85 |
| 2023 November | 58 | 25 | 83 |
| 2023 October | 40 | 23 | 63 |
| 2023 September | 46 | 32 | 78 |
| 2023 August | 51 | 30 | 81 |
| 2023 July | 51 | 17 | 68 |
| 2023 June | 47 | 9 | 56 |
| 2023 May | 51 | 14 | 65 |
| 2023 April | 57 | 38 | 95 |
| 2023 March | 79 | 37 | 116 |
| 2023 February | 69 | 23 | 92 |
| 2023 January | 46 | 38 | 84 |
| 2022 December | 62 | 35 | 97 |
| 2022 November | 89 | 35 | 124 |
| 2022 October | 51 | 40 | 91 |
| 2022 September | 47 | 36 | 83 |
| 2022 August | 46 | 41 | 87 |
| 2022 July | 52 | 42 | 94 |
| 2022 June | 38 | 31 | 69 |
| 2022 May | 38 | 28 | 66 |
| 2022 April | 61 | 38 | 99 |
| 2022 March | 63 | 39 | 102 |
| 2022 February | 22 | 29 | 51 |
| 2022 January | 2 | 2 | 4 |
| 2021 August | 7 | 0 | 7 |
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