CPAP Treatment for Sleep Apnea and Dysrhythmias

Effects of CPAP Treatment for Sleep Apnea on Dysrhythmias

Obstructive sleep apnea is a treatable and chronic disorder that has been estimated to affect over 18 million Americans. It is often characterized by either recurrent or partial closure of the upper airway. In most cases, it is dealt with using brief arousals. It has been linked with intrathoracic pressure changes, which gives rise to sleep fragmentation, increases nervous system stimulation at night and a rise in circulating the inflammatory markers of the endothelial dysfunction (Raghuram, Clay, & Kumbam, 2014). This paper will carry an assessment of the effects of using CPAP for sleep apnea on dysrhythmias during hospitalization period in the ICU in male patients aged 40 years and above and who have suffered a myocardial infarction. 

Studies have highlighted a connection between obstructive sleep apnea and myocardial infarction. It is estimated that over 65% of the patients who seek medical attention for a cardiovascular event are diagnosed with OSA (Porto, Sakamoto, & Salles, 2017). An increase in the severity of the obstructive sleep apnea has been associated with increased sleep fragmentation, which subsequently increases the risk of cardiac arrhythmias. Patients with congestive heart failure face a higher risk of sudden cardiac death from ventricular arrhythmias hence important to deal with it (Raghuram, et al., 2014).

In severe cases of obstructive sleep apnea, continuous positive airway pressure (CPAP, is used. CPAP is a treatment that aims at delivering positive pressure through a mask with an objective of maintaining the opening of the upper airways during sleep. In their study, Abumuamar, Molleyeva, and Sandor (2017) indicated the potential effect of improved nocturnal breathing with CPAP application on altered cardiac impulse formulation and impulse conduction, which are critical in the mechanism of cardiac arrhythmia. From their research, there were notable improvements in the cardiac pathology among patients with sleep apnea treated with CPAP application. Their analysis indicated a significant decrease in the frequency of the nocturnal ventricular arrhythmia immediately after the use of CPAP treatment. After a 6-month period of CPAP initiation, there was a notable reduction in the severity of the ventricular arrhythmias (Abumuamar, et al., 2017). The severity of the male patient in ICU is severe, and this will assist in attaining more benefits on the preventive role of CPAP treatment in dealing with ventricular arrhythmia since the treatment has more impact in severe cases of the sleep apnea. It was indicated that withdrawal of the application of the CPAP treatment led to the prolongation of ventricular repolarization measures which are precursors for ventricular arrhythmia and may cause sudden cardiac death (Abumuamar, et al., 2017).

It has been indicated that obstructive sleep apnea-induced hypoxia increases the carotid chemoreceptor activity, which in case of obstruction leads to vagal stimulation of the heart. This has been known to trigger bradyarrhythmia. The use of CPAP treatment method has been noted to restore normal breathing thereby reducing the adverse effects of the hypoxia. Studies have associated the use of CPAP, for an even short duration, to lead to a decline in the frequency of nocturnal sinus bradycardia, AV block, and sinus arrest. Different studies have indicated that the use of CPAP treatment among patients suffering from obstructive sleep apnea reduces the possibilities of AF relapse after cardioversion treatment. A study by Holmqvist et al. (2015) noted the absence of significant differences in mortality rates and major adverse cardiovascular event among patients with obstructive sleep apnea under CPAP treatment and those with no CPAP treatment.

References

Abumuamar, A. M., Mollayeva, T., Sandor, P., Newman, D., Nanthakumar, K., & Shapiro, C. M. (2017). Efficacy of continuous positive airway pressure treatment in patients with cardiac arrhythmia and obstructive sleep apnea: what is the evidence?. Clinical Medicine Insights: Therapeutics, 9, doi. 1179559X17734227.

Holmqvist, F., Guan, N., Zhu, Z., Kowey, P. R., Allen, L. A., Fonarow, G. C., … & Holmes, D. N. (2015). Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation—Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). American heart journal, 169(5), 647-654.

Porto, F., Sakamoto, Y. S., & Salles, C. (2017). Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review. Arquivos Brasileiros de Cardiologia, 108(4), 361–369.

Raghuram, A., Clay, R., Kumbam, A., Tereshchenko, L. G., & Khan, A. (2014). A Systematic Review of the Association between Obstructive Sleep Apnea and Ventricular Arrhythmias. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 10(10), 1155–1160.