Not for the Faint of Heart

Abstract

This chapter evaluates strategies for obstructive sleep apnea (OSA) testing and discusses the risk for arrhythmia in patients with OSA. Arrhythmia generation has been associated with sleep apnea, and the case presented here highlights that particularly in heart failure, respiratory events can be a ventricular arrhythmia trigger secondary to OSA-related physiologic consequences such as autonomic nervous system fluctuations, intrathoracic pressure alterations, and upregulation of pathways of systemic inflammation. Untreated OSA increases the risk for sudden cardiac death, particularly between midnight and 6 a.m. Individuals with heart failure, even if they do not report sleepiness, should be evaluated for OSA, as nearly half will have this disorder. Limited data suggest that OSA treatment can decrease arrhythmogenesis in heart failure and may be a potential avenue to decrease morbidity in patients with heart failure.