Arrhythmogenic mechanisms of obstructive sleep apnea in heart failure patients.

Sleep
Karan R ChaddaKamalan Jeevaratnam

Abstract

Heart failure (HF) affects 23 million people worldwide and results in 300000 annual deaths. It is associated with many comorbidities, such as obstructive sleep apnea (OSA), and risk factors for both conditions overlap. Eleven percent of HF patients have OSA and 7.7% of OSA patients have left ventricular ejection fraction <50% with arrhythmias being a significant comorbidity in HF and OSA patients. Forty percent of HF patients develop atrial fibrillation (AF) and 30%-50% of deaths from cardiac causes in HF patients are from sudden cardiac death. OSA is prevalent in 32%-49% of patients with AF and there is a dose-dependent relationship between OSA severity and resistance to anti-arrhythmic therapies. HF and OSA lead to various downstream arrhythmogenic mechanisms, including metabolic derangement, remodeling, inflammation, and autonomic imbalance. (1) Metabolic derangement and production of reactive oxidative species increase late Na+ currents, decrease outward K+ currents and downregulate connexin-43 and cell-cell coupling. (2) remodeling also features downregulated K+ currents in addition to decreased Na+/K+ ATPase currents, altered Ca2+ homeostasis, and increased density of If current. (3) Chronic inflammation leads to downregu...Continue Reading

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Citations

Jan 1, 2019·Circulation Reports·Jacob N BlackwellYounghoon Kwon
Mar 26, 2020·Annals of the New York Academy of Sciences·Ibrahim T FazminKamalan Jeevaratnam
Jul 28, 2021·Pacing and Clinical Electrophysiology : PACE·Gianluigi BencardinoFilippo Crea

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