From the Guidelines
Relationship Between Sleep Apnea, Bradycardia, and Hypotension
Sleep apnea is strongly associated with bradycardia and other cardiac arrhythmias, and treatment of sleep apnea can significantly reduce the frequency of these arrhythmias, as well as offer cardiovascular benefits 1.
- The presence of nocturnal bradyarrhythmias should prompt screening for sleep apnea, as the treatment of sleep apnea can effectively suppress nocturnal arrhythmias associated with obstructive sleep apnea.
- Continuous positive airway pressure (CPAP) therapy has been shown to dramatically improve both metrics of sleep-disordered breathing and sleep-related bradyarrhythmias, reducing episodes of profound sinus bradycardia, prolonged sinus pauses, and atrioventricular conduction block by 72% to 89% 1.
- While the relationship between sleep apnea and hypotension is less clear, sleep apnea is a risk factor for several cardiovascular diseases, including hypertension, which can have a complex interaction with hypotension in certain contexts 1.
- The prevalence of undiagnosed sleep apnea may be high in patients with cardiovascular diseases, and screening for sleep apnea in these patients may be beneficial in reducing cardiac events and cardiac death 1.
- CPAP adherence is crucial in managing sleep apnea and its associated cardiovascular risks, with studies showing that CPAP can improve sleep architecture, decrease the risk of cardiovascular morbidity and mortality, and improve quality of life 1.
From the Research
Relationship Between Sleep Apnea, Bradycardia, and Hypotension
- Sleep apnea is associated with bradycardia, with a pooled prevalence of daytime and nocturnal bradycardia of 25% and 69.8%, respectively, among patients with obstructive sleep apnea (OSA) 2.
- The bradycardia of sleep apnea is a consistent feature of apnea and results from the combined effect of cessation of breathing plus hypoxemia 3.
- Obstructive sleep apnea is also linked to arrhythmia, with evidence supporting a strong link between OSA and cardiovascular mortality 4.
- Sleep apnea can lead to autonomic disturbances, which can increase blood pressure variability, including nocturnal, circadian, short-term, and long-term variations 5.
- Asymptomatic bradyarrhythmias can be a marker for sleep apnea, and appropriate recognition and treatment of sleep apnea may reduce the need for pacemaker therapy 6.
Mechanisms and Treatment
- The mechanism of bradycardia in sleep apnea involves the cessation of breathing and hypoxemia, which can lead to a slowing of the heart rate 3.
- Continuous positive airway pressure (CPAP) therapy may reduce the risk of bradycardia and other cardiovascular consequences of OSA, although the evidence is not yet conclusive 2, 4.
- Treatment of sleep apnea can improve symptoms of bradycardia and reduce the need for pacemaker therapy 6.