CHEST Guidelines-A-67-Year-Old-Man-With-Palpitations-During-Sleep

A-67-Year-Old-Man-With-Palpitations-During-Sleep_c

Pdf Summary

A 67-year-old man with a history of atrial fibrillation (AF) experienced episodic nocturnal palpitations following an otherwise successful radiofrequency ablation treatment for AF. His symptoms included nighttime palpitations and excessive daytime sleepiness, occurring exclusively during sleep. A Holter monitor showed nocturnal episodes of AF, while an echocardiogram indicated normal heart function with a mildly enlarged right atrium. His wife reported loud snoring and apneic episodes, prompting a sleep study referral. The study revealed severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) of 36 events per hour and significant desaturation during sleep. <br /><br />Continuous positive airway pressure (CPAP) therapy at 10 cm H2O effectively treated the sleep apnea and normalized his oxygen saturation, subsequently resolving his AF episodes. The follow-up Holter monitor confirmed the absence of AF after CPAP compliance. This case underscores the critical role of sleep history in cardiovascular cases, illustrating that OSA treatment can ameliorate associated cardiovascular conditions, such as AF.<br /><br />Obstructive sleep apnea is prevalent in 5-9% of the US population, frequently undiagnosed, and can present with subtle symptoms including hypertension, cognitive issues, depression, and resistant diabetes. The strong link between OSA and AF is well-documented; untreated OSA significantly increases the risk and recurrence of AF. Mechanisms proposed include cyclical hypoxemia, elevated atrial pressures, and sympathetic activation.<br /><br />CPAP therapy for OSA has been shown to decrease AF recurrence and cardiovascular risk, highlighting OSA as a potentially modifiable risk factor. In this case, adherence to CPAP was instrumental in eliminating nocturnal AF. Regular screening for OSA in patients with recurrent or refractory AF could be beneficial for reducing cardiovascular morbidity.

Keywords

atrial fibrillation

radiofrequency ablation

nocturnal palpitations

sleep apnea

Holter monitor

CPAP therapy

oxygen saturation

cardiovascular conditions

apnea-hypopnea index

sympathetic activation