If we talk about the causes of cardiac arrhythmias, then there can be a huge variety of them. In this article, we would like to discuss one of them, which is given undeservedly little attention in the medical literature. We are talking about the syndrome of obstructive sleep apnea (a disease of respiratory arrest during sleep). This type of breathing disorder during sleep is caused by periodic collapse of the upper respiratory tract during sleep, which entails the cessation of air supply to the lungs and periodic cessation of breathing in the sleeper. Apnea syndrome occurs against the background of snoring and is its complicated form.
Watch a video about the causes and consequences of this dangerous disease.
In obstructive sleep apnea syndrome, arrhythmias occur due to the stress reaction that occurs in the body during respiratory arrest, due to an increase in the load on the heart, and also due to oxygen starvation of the myocardium.
With apnea, all types of cardiac arrhythmias can be observed, and they are recorded mainly during nocturnal sleep, and their number increases with increasing severity of the apnea syndrome. In many cases, the moments of occurrence of arrhythmias are directly related to periods of respiratory arrest. Respiratory disorders during sleep lead to a rapid depletion of the resources of the heart muscle, worsening of arrhythmias and a worsening of the prognosis of existing heart diseases.
Sinus arrhythmia (bradycardia, tachycardia) is a characteristic symptom of obstructive sleep apnea syndrome. At the time of respiratory arrest (apnea), sinus bradycardia is usually recorded – a slowing of the heart rate. In the phase of recovery of breathing after apnea, it is replaced by sinus tachycardia – acceleration of the heart rate. After a temporary cessation of breathing, paroxysmal disorders can also develop: supraventricular and ventricular tachycardia.
With prolonged respiratory arrest in the case of a severe form of the disease, another type of cardiac arrhythmia most often develops – heart blockade. Atrioventricular blocks and sinus arrest occur in 10% of patients with sleep apnea. The duration of cardiac arrest after respiratory arrest in sleep sometimes reaches 10 (!) seconds . It is noticed that heart blockades appear more often in patients with already developed coronary heart disease and lung diseases.
The occurrence of cardiac arrhythmias at night in patients with sleep apnea is a risk factor for sudden death during sleep. Based on this, we can confidently talk about the urgent need to identify and treat obstructive sleep apnea.
The use of CPAP therapy is the main and effective method of treating sleep apnea. It reduces or completely eliminates cardiac arrhythmias, and the positive effects of this method begin to appear from the first night of treatment. The use of CPAP therapy allows many patients to avoid taking large amounts of antiarrhythmic drugs and implanting a pacemaker.
It covers in detail all the main issues that arise with CPAP therapy.
At present, improved Prisma Line CPAP devices from the new line of Weinmann – Loewenstein , Germany have been developed. Their use allows the most effective and comfortable treatment of the entire spectrum of respiratory disorders in patients with obstructive sleep apnea syndrome.
It has been proven that with adequate treatment of obstructive sleep apnea syndrome, the development of cardiovascular complications in patients occurs 3-6 times less than in the absence of therapy.
Obstructive sleep apnea is one of the causes of insulin resistance.
An important cause of insulin resistance has been identified – respiratory failure during sleep, in particular, obstructive sleep apnea syndrome.
Insulin resistance is the reduced sensitivity of tissues to insulin. This means that glucose in the presence of a normal amount of insulin is not absorbed by the cells, and an increased amount of insulin is needed for its absorption. At the same time, the processes of burning fat are slowed down, and fat formation, on the contrary, is more intense.
There are quite a few patients whose insulin resistance can be considered as a complication or manifestation of sleep apnea. In the development of insulin resistance in obstructive sleep apnea, the main role is played by sleep fragmentation (violation of its structure), increased release of stress hormones and oxygen starvation.
There is a lot of evidence that short sleep or its fragmentation negatively affects glucose metabolism. With sleep apnea syndrome, due to frequent stops in breathing, constant micro -awakenings of the brain occur. The structure of sleep is disturbed, this causes a breakdown in the production of tropic pituitary hormones and ultimately affects the production of insulin and glucose metabolism. Insulin resistance develops.
Episodes of pauses in breathing during sleep apnea are accompanied by a stress reaction: the release of anxiety hormones (catecholamines and cortisol). Their elevated levels lead to impaired glucose tolerance, insulin resistance and may contribute to the development of diabetes.
Repetitive episodes of oxygen deprivation in OSAS also provoke impaired insulin sensitivity. As the severity of apnea increases, fasting and postprandial blood glucose levels increase in patients.
Of no small importance in the development of insulin resistance is low physical activity, which appears in patients with sleep apnea due to increased daytime sleepiness.
Given the relationship between obstructive sleep apnea and impaired glucose metabolism, there is a need for timely diagnosis and treatment of sleep apnea. Cardiorespiratory monitoring and polysomnography will help determine the degree of respiratory failure and the severity of the disease.
Sleep apnea is usually treated with CPAP machines. The technique is called CPAP therapy and is one of the effective treatments for patients suffering from moderate to severe obstructive sleep apnea. The CPAP device provides constant pressure to maintain airway tone during sleep.
The method of treatment may have a beneficial effect on glucose metabolism in such patients. There are studies that confirm the fact that metabolic disorders are completely or partially corrected by CPAP therapy. A significant increase in insulin sensitivity was noted already after 3 months of treatment using the device for at least 4 hours per night. Many other symptoms of sleep apnea (drowsiness, snoring, sleep sweating, etc.) disappear already on the first night of therapy.
At present, improved Prisma Line CPAP devices from the new line of Weinmann – Loewenstein (Germany) have been developed. Their use allows the most effective and comfortable treatment of the entire spectrum of respiratory disorders in patients with obstructive sleep apnea and insulin resistance.