Figure - available from: Annals of Noninvasive Electrocardiology
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Introduction
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder with important cardiovascular implications. Left atrial abnormality can be identified by electrocardiographic P‐wave morphology and is considered an important risk for atrial fibrillation (AF) and stroke, both of which have been associated with OSA. We hypothesized that...
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Purpose
The prevalence of rapid eye movement obstructive sleep apnea (REM-OSA) varies among reports. It remains unclear whether or not patients with REM-OSA experience more severe daytime sleepiness and poorer sleep quality than those with sleep-stage-independent obstructive sleep apnea (IND-OSA). We investigated the prevalence of REM-OSA in a Kore...
Context: Obstructive sleep apnea (OSA) considered classically to be a male-dominant disease, may have significant gender-based differences in clinical presentation and diagnosis. Aims: To evaluate gender-based differences in the clinical profile and polysomnographic features of Indian patients with OSA. Settings and Design: A prospective observatio...
Introduction:
To investigate the relationship between body mass index (BMI) and the severity of obstructive sleep apnea (OSA) and to determine the BMI cut-off values for sleep-disordered breathing among adult population.
Materials and methods:
Data from 515 patients were evaluated retrospectively. These included demographic data, BMI, apnea-hypo...
Background and Objective Patients with position-dependent obstructive sleep apnea have a > 2-fold higher apnea-hypopnea index when sleeping in a supine position compared with a non-supine position. We investigated the effect of body pillow use on sleeping body position and sleep architecture in healthy young adults.
Methods In experiment 1, we eva...
Obstructive sleep apnea (OSA) is a serious medical condition with a high prevalence, although diagnosis remains a challenge. Existing home sleep tests may provide acceptable diagnosis performance but have shown several limitations. In this retrospective study, we used 12,923 polysomnography recordings from six independent databases to develop and e...
Citations
... Only patients with a total sleep time (TST) >4 hours were included. 16,17 The diagnosis of AF was confirmed via independent chart review by two authors who were blinded to PSG results. We only included patients whose AF diagnosis preceded the timing of their diagnostic PSG. ...
Introduction: Sleep apnea is highly prevalent in patients with atrial fibrillation (AF).
Obstructive sleep apnea (OSA) is the most common type, and best studied in the
context of AF. However, recent investigations have indicated that central sleep apnea
(CSA) may be a risk factor for incident AF. We evaluated the burden of CSA events
in patients referred for diagnostic polysomnography (PSG) and whether AF is associated with CSA.
Methods: We identified patients with and without a history of AF who underwent
clinically indicated PSG in a matched manner. OSA was defined as obstructive apnea-hypopnea index (AHI) ≥15/h, and CSA was defined as central apnea index (CAI)
≥5/h. The association between AF and CSA was evaluated using multivariable logistic
regression.
Results: Among 465 patients included, mean AHI was 25.5/h, and mean CAI was
1.7/h. OSA prevalence was 53.3%, while CSA prevalence was 8.4%. The prevalence
of OSA in the AF and non-AF groups (54.7% vs 52.0%, P = .56) was similar. CSA was
more common in the AF group (12.3% vs 4.4%, P = .002). In multivariable analysis, AF
(OR: 2.19 [1.02, 5.03], P = .05), male gender (OR: 2.5 [1.17, 5.84], P = .02), and older
age (OR: 2.44, [1.16, 5.46], P = .02) were associated with CSA.
Conclusion: Though CSA is much less common than OSA in patients with AF, the
presence of AF is independently associated with CSA.
... are warranted to identify high-risk groups for incident or recurrent AF among patients with OSA [20]. For example, it is possible that patients with OSA with either electrographic or structural left atrial pathology may be at much higher risk for developing AF [21][22][23]. Such information can help to arrive at treatment decisions in patients without obvious symptoms. ...
Scientific investigations in the past few decades have supported the important role of sleep in various domains of health. Sleep apnea is a highly prevalent yet underdiagnosed sleep disorder representing a valid cardiovascular risk factor, particularly for hypertension. While several studies have demonstrated the benefits of sleep apnea treatment on subclinical cardiovascular measures, there is a paucity of studies proving reduction of cardiovascular events and mortality. Sufficient and highquality sleep is also important in the maintenance of cardiovascular health. Future investigations should focus on improving identification of patients at greatest risk of adverse cardiovascular sequelae of sleep apnea and testing the therapeutic benefit of sleep apnea treatment in this vulnerable group.
Interatrial block (IAB) is an electrocardiographic pattern describing the conduction delay between the right and left atria. IAB is classified into 3 degrees of block that correspond to decreasing conduction in the region of Bachmann's bundle. Although initially considered benign in nature, specific subsets of IAB have been associated with atrial arrhythmias, elevated thromboembolic stroke risk, cognitive impairment, and mortality. As the pathophysiologic relationships between IAB and stroke are reinforced, investigation has now turned to the potential benefit of early detection, atrial imaging, cardiovascular risk factor modification, antiarrhythmic pharmacotherapy, and stroke prevention with oral anticoagulation. This review provides a contemporary overview of the epidemiology, pathophysiology, diagnosis, and management of IAB, with a focus on future directions. (J Am Coll Cardiol 2022;79:1199-1211)
Background
P wave indices represent electrocardiographic marker of left atrial pathology. We hypothesized that P wave would be more abnormal in patients presenting with ischemic stroke than a comparable group without ischemic stroke.
Methods
We compared P wave terminal force in V1 (PTFV1) between patients admitted with ischemic stroke (case) and patients followed in cardiology clinic (control) at a single medical center. Using logistic regression models, we tested for an association between abnormal PTFV1 (> 4000 µV ms) and ischemic stroke. We also defined several optimal cut-off values of PTFV1 using a LOESS plot and estimated odds ratio of ischemic stroke when moving from one cut-point level to the next higher-level.
Results
A total of 297 patients (case 147, control 150) were included. PTFV1 was higher in patients with vs. those without ischemic stroke (median 4620 vs 3994 µV ms; p=0.006). PTFV1 was similar between cardioembolic/cryptogenic and other stroke subtypes. In multivariable analyses adjusting for sex, obesity, age, and hypertension, the association between abnormal PTFV1 and ischemic stroke ceased to be significant (OR 1.53 [0.95, 2.50], p=0.083). Increase to the next cutoff level of PTFV1 (900, 2000, 3000, 4000, 5000, and 6000 µV ms) was associated with 18% increase in odds of having ischemic stroke (vs. no ischemic stroke) (OR 1.18 [1.02, 1.36], p=0.026).
Conclusion
Patients presenting with acute ischemic stroke are more likely to have abnormal PTFV1. These findings from a real-world clinical setting support the results of cohort studies that left atrial pathology manifested as abnormal PTFV1 is associated with ischemic stroke.
