HEART DISEASE AND SLEEP DISTURBANCES (R KHAYAT, SECTION EDITOR)
Interactions of Sleep Apnea, the Autonomic Nervous System,
and Its Impact on Cardiac Arrhythmias
Published online: 14 April 2018
Springer International Publishing AG, part of Springer Nature 2018
Purpose of Review Sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular disease. SDB-related
changes in the autonomic nervous system (ANS) and the association between obstructive sleep apnea and atrial fibrillation
(Afib) have been extensively researched. SDB has also been associated with occurrence of ventricular arrhythmias. We evaluated
the effects of SDB on the ANS and its relationship with ventricular and supraventricular arrhythmias.
Recent Findings The ANS is an important regulator of the cardiovascular system and contributes to the development of cardio-
vascular diseases including hypertension and coronary artery disease. SDB has an important influence on the ANS and contrib-
utes to electromechanical remodeling of the left atrium via a number of mechanisms, increasing susceptibility to Afib. There is
evidence that these mechanisms also affect the ventricular myocardium and therefore lead to ventricular arrhythmias. Effective
treatment of SDB reduces the rate of Afib recurrence and seems to reduce ventricular arrhythmogenicity.
Summary SDB has an important impact on the ANS and therefore plays a major role in the development of cardiac arrhythmias.
Although SDB screening of patients with Afib is recommended by current guidelines, SDB remains underdiagnosed. Additional
research is needed to clarify the role of SDB and its treatment in ventricular arrhythmias.
Keywords Sleep-disordered breathing
Sleep-disordered breathing (SDB) refers to a highly heteroge-
neous group of disorders of different etiologies. The common
feature of all SDB manifestations is a decrease (hypopnea) or
absence (apnea) of airflow for at least 10 s, usually associated
with a fall in blood oxygen saturation and/or arousal reaction.
SDB is a clinically relevant comorbidity in various cardiac
diseases. In these patients, SDB is classified into two main
groups—predominant obstructive sleep apnea (OSA) or pre-
dominant central sleep apnea (CSA) with or without Cheyne–
Stokes respiration (CSR).
OSA is caused by upper airway obstruction during sleep,
preventing sufficient airflow and culminating in intrathoracic
pressure swings, hypoxemia, and activation of the autonomic
nervous system (ANS). OSA is the most common form of
SDB, and recent data suggest that up to 50% of men and
23% of women are eligible for specific OSA treatment .
After arterial hypertension and obesity, increasing age is a
major risk factor for developing OSA. Therefore, the number
of patients for whom treatment is indicated is likely to rise in
parallel with the current aging demographic [2, 3]. In cardiac
patients, OSA is associated with the development and recur-
rence of arrhythmias, even after specific antiarrhythmic ther-
CSA occurs secondary to a reduction or complete cessation
of ventilatory effort accompanied by blood oxygen
desaturation. CSA is often present in patients with congestive
heart failure, strokes and cerebral tumors. With a prevalence of
1%, it is less common in the general population  but affects
up to 40% of patients with chronic heart failure (CHF) , and
prevalence rates increase in parallel with increasing NYHA
classification (heart failure severity) . In particular, the CSR
This article is part of the Topical Collection on Heart Disease and Sleep
* Fabian Roder
Clinic for Cardiology, Herz- und Diabeteszentrum NRW,
Ruhr-Universität Bochum, Georgstraße 11, 32545 Bad
Current Sleep Medicine Reports (2018) 4:160–169