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Background: Obstructive sleep apnea (OSA) is often associated with atrial fibrillation (AF), but the impact of radiofrequency catheter ablation (RFCA) for AF on sleep apnea syndrome is unknown., Methods and Results: A total of 25 patients (3 women; 61 ± 6 years) with sleep apnea syndrome who underwent RFCA for drug-refractory, persistent AF were studied. Polysomnography was also performed 1 day before and 1 week after RFCA in all patients. The total number of central or OSA or hypopnea events was analyzed and compared. Among the 25 patients who all predominantly had obstructive apnea, the apnea-hypopnea index (AHI; median, 21, interquartile range [IQR]: 11-38 to median 15, IQR: 7-23; P=0.002) and obstructive type of apnea (median 10, IQR: 6-19 to median 7, IQR: 2-14; P=0.003) decreased after RFCA. In patients in whom sinus rhythm was restored and maintained after RFCA, the AHI decreased after RFCA (median 22, IQR: 15-38 to median 15, IQR: 7-23; P<0.01), but it did not in those who had AF recurrence (median 10, IQR: 9-11 to median 11, IQR: 10-16; P<0.05). There was a significant correlation between the outcome of RFCA and % change in the AHI (rs=0.569, P=0.003)., Conclusions: In patients with sleep apnea syndrome and AF, restoring sinus rhythm by RFCA was significantly associated with a decrease in AHI (Clinical Trial Registration: Trial number, UMIN000005538).

Background and Objectives: Sleep apnea is highly prevalent in patients with heart disease. However, the association between sleep apnea and ventricular arrhythmias is unclear. The aim of this study was to examine the relationship between sleep apnea and electrophysiologic characteristics and clinical outcome after catheter ablation in patients having ventricular arrhythmias., Methods and Results: Forty-four patients with ventricular tachycardia (VT) or premature ventricular complexes (PVCs) without structural heart diseases (57% men; mean age: 55 + or - 15 years) underwent a sleep study. Subjects with an apnea-hypopnea index (AHI) > or = 10/h were considered to have sleep apnea. Electrophysiologic studies were performed on all patients, and 35 patients underwent catheter ablation therapy. Seventeen patients (39%) had sleep apnea with an average AHI of 27 + or - 17/h. Electrophysiologic characteristics of ventricular arrhythmias showed that sites of VT/PVCs origin in the pulmonary artery and the aortic sinus of Valsalva were detected in 27% and 20% patients with sleep apnea, which was a relatively higher rate than that in patients without sleep apnea (8% and 0%, respectively). Successful catheter ablation was achieved in 11 patients (85%) with sleep apnea and 17 (77%) without sleep apnea. During a mean follow-up period of 13.5 + or - 7.3 months after catheter ablation, 5 patients (45%) with sleep apnea and 1 patient (6%) without sleep apnea experienced recurrent VT/PVCs. Comparing the outcome between the two groups, the VT/PVCs recurrence rate was significantly higher in patients with sleep apnea than in those without sleep apnea (p=0.02)., Conclusions: Ventricular arrhythmia patients with sleep apnea have a high recurrence of arrhythmias after successful catheter ablation. Patients with ventricular arrhythmias should be systematically assessed for sleep apnea owing to the potential detrimental effects of sleep apnea in the follow-up period., (Copyright 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Nasal breathing disorder has been associated with the condition and treatment of sleep disordered breathing (SDB). In the current study, we investigated the utility of measurement of nasal resistance in patients with SDB. We examined the relationship between nasal symptoms and nasal resistance in 219 patients, and how the results affected the administration of nasal continuous positive airway pressure (nCPAP) in 34 SDB patients. Total nasal resistance was not significantly different between patients who were divided into two groups: those with nasal symptoms, and those without. The left-right ratio of nasal flow in the group with nasal symptoms was higher than in the group without nasal symptoms (p < 0.01). The mean percentage of nCPAP use was not significantly different between two groups divided by total nasal resistance. The mean percentage of nCPAP use > or = 4 hours was lower in the group in which total nasal resistance was more than 0.25Pa/cm3/sec (p < 0.05). The left-right ratio of nasal flow does not affect nCPAP use. We conclude that measurement of nasal resistance for confirming nasal breathing disorder is effective in patients with SDB, whether a patient complains of nasal symptoms or not.

The prevalence and characteristics of sleep-disordered breathing (SDB) in patients with ventricular arrhythmias, such as premature ventricular complexes and ventricular tachycardia, are unknown. Therefore, this study was conducted to evaluate the prevalence of SDB in patients with severe ventricular arrhythmias and normal left ventricular (LV) function. Thirty-five patients (63% men, mean age 57.4 +/- 13.8 years) underwent a sleep study. All patients had ventricular tachycardia or frequent premature ventricular complexes (>or=300/hour) and had been referred to the cardiology department for medication, catheter ablation therapy, or the implantation of a cardioverter-defibrillator. Patients with heart failure with LV ejection fractions <50% were excluded; in the remaining patients, the mean LV ejection fraction was 63.9 +/- 8.0%. Twenty-one patients (60%) had SDB with apnea-hypopnea indexes >or=5/hour, and the average apnea-hypopnea index was 22.7 +/- 17.9/hour. Twelve patients (34%) had moderate to severe SDB, with an average apnea-hypopnea index of 33.6 +/- 16.6/hour. Central dominant sleep apnea was evident in 3 patients with SDB. The average age and body mass index were significantly higher in patients with SDB than in those without SDB (age 62.0 +/- 12.8 vs 50.6 +/- 12.7 years, body mass index 26.3 +/- 4.0 vs 21.2 +/- 2.0 kg/m2). In conclusion, this study found a high prevalence of SDB in patients with ventricular arrhythmias and normal LV function.

Information on obstructive sleep apnea-hypopnea syndrome (OSAHS) in Japan has been limited. The purposes of this clinical study were to evaluate the demographic characteristics of Japanese OSAHS patients and to assess how demographic factors are associated with OSAHS severity. We analyzed 3,659 OSAHS patients who underwent polysomnographic evaluation between January 2000 and December 2004 at 11 hospitals in Niigata Prefecture, Japan. Data consisted of apnea-hypopnea index (AHI) and demographic characteristics, including sex, age, and body-mass index, for statistical analysis. Levels of obesity were classified according to the WHO criteria. The male-to-female patient ratio for OSAHS was 4.6, and male patients presented more severe OSAHS than female patients. High AHI and a high proportion of moderate to serious OSAHS (AHI > or = 15) were found among the patients in their 30s, as well as female patients in their 70s and male patients in their 80s. The AHI and the proportion of moderate-to-serious OSAHS (AHI > or = 15) were greater in patients classified as underweight than in normal weight patients. In conclusion, there is a higher male predominance in the prevalence of OSAHS, and in both sexes, the results suggest different pathophysiological mechanisms of deteriorating OSAHS between adults under age 55 and adults 55 years or over. In addition, underweight patients exhibit more severe OSAHS than normal weight patients.

Patients with OSAS (obstructive sleep apnoea syndrome) demonstrate renal signs such as proteinuria, glomerular hypertrophy and focal glomerular sclerosis. We performed a clinical study to investigate the glomerular function in OSAS patients and the short-term effect of CPAP (continuous positive airway pressure) on it. OSAS patients underwent a sodium thiosulphate and p-aminohippurate double clearance test, polysomnography and ambulatory blood pressure monitoring before and a week after the induction of CPAP. Twenty-seven consecutive patients (24 males) with moderate-to-severe OSAS admitted to our hospital for the induction of CPAP, and 32 healthy donors for renal transplantation as controls participated in the study. Before treatment, the glomerular filtration rate, estimated by the sodium thiosulphate clearance test, was within normal range, and the renal plasma flow was significantly lower than normal in the OSAS patients, thus the FF (filtration fraction) value was much higher than normal. FF before CPAP was not significantly correlated with age, body mass index or blood pressure; however, indices of increased hypoxaemia correlated with increased FF values. Polysomnographic variables after CPAP showed significant improvements in all patients, and only the nocturnal blood pressures were slightly lower than before CPAP. In 21 patients who underwent the clearance test after CPAP, FF significantly decreased from 0.26 +/- 0.04 to 0.23 +/- 0.03 (P < 0.001). OSAS patients were generally in a glomerular-hyperfiltrating condition that appeared to cause the renal findings associated with OSAS. CPAP might prevent nephropathy by ameliorating the glomerular hyperfiltration in OSAS patients.

This review will trace the elements of neurostimulation for obstructive sleep apnea and details on its implementation, efficacy and safety, immediate clinical outcomes, and future prospects. The literature on upper airway neurostimulation was surveyed from July 2013 to July 2019, with a focus on the components of devices, evidence for clinical utility, and adverse events. Current technology is focused on the hypoglossal nerve stimulation (HNS). The most long-term experience is with the Inspire Medical System (Maple Grove, MN USA) which has both FDA and European regulatory approval. Given the inclusion criteria- BMI < 35 (ideally < 32), AHI 15–65/h, and a favorable anterior–posterior velopharyngeal collapse pattern on DISE, across many centers ~ 65% of patients who are intolerant to primary therapy achieve clinical success (AHI < 20/h with a reduction of < 50% in AHI), and more have symptomatic relief. Adverse events are generally mild, often self-limited, with occasional need for uncomplicated surgical adjustments or replacement of the implantable generator. Three other devices are in various phases of development, each with differences in nerve electrodes, implantable components, power sources, proprietary programming, and activation patterns. Hypoglossal nerve stimulation (HNS) is not considered a first-line treatment option. HNS therapy, however, should be considered as one alternative therapeutic option for patients meeting the inclusion criteria when more traditional therapeutic options have been considered. [ABSTRACT FROM AUTHOR]

The objective was to examine whether abnormal breathing during sleep may affect regulation of ventilation after awakening in patients with obstructive sleep apnoea (OSAS). In 19 patients with OSA and 12 normal subjects we examined ventilatory responses to hypoxia (HVR) and to hypercapnia (HCVR) before and after sleep (BS and AS), and compared the changes in ventilatory responses with respiratory events during sleep. In the OSA group, the values of resting ventilation were significantly smaller in AS than those in BS and end-tidal partial pressure of CO2 in arterial blood (P CO2 ) (P ET CO2 ) rose significantly from BS to AS. The slopes of the HVR or HCVR did not differ between BS and AS. However, both the response lines shifted downward and minute ventilation (VE )80 (VE at arterial oxygen saturation (S aO2 ) of 80%) in HVR and VE 60 (VE at P ET CO2 of 60 mmHg) in HCVR decreased significantly from BS to AS. The percentage changes of VE 80 and VE 60 were significantly correlated with mean S aO2 , total sleep time below S aO2 of 90% and lowest S aO2 during sleep. However, in normal subjects we observed no circadian variation in their ventilatory responses. These data support the hypothesis that repeated episodes of nocturnal hypoxia and hypercapnia may modify the regulation of ventilation after awakening in patients with OSA. [ABSTRACT FROM AUTHOR]