BACKGROUND: The relationship between obstructive sleep apnea syndrome (OSAS) and cardiac arrhythmias in adults remains controversial. Earlier studies showed higher prevalence rate of dysrhythmia in association with OSAS as compared to more recent studies. Still, apneic hypoxemia remains to be possible major risk factors for dysrhythmia.
OBJECTIVES: A case of a patient with OSAS and cardiac rhythm disturbance is discussed, with an aim to implicate a possible effect of hypoxemia and sleep stage on cardiac conduction activity. This case report also documents that correction of OSA utilizing bi-level positive airway pressure (Bi-PAP) or continuous positive airway pressure resolves the arrhythmia.
CASE: A 56 year old male weighing 227 pounds, with excessive sleepiness during working hours, known hypertensive, previous smoker diagnosed to have OSAS on polysomnography with Respiratory Disturbance Index of 81.6, with noted associated non-conducted atrial depolarization. Initiation of BiPAP abolishes apneas with improvement of oxygen saturation and likewise resolution of the previously noted AV block.
SUMMARY: Presented an obese patient with obstructive sleep apnea, with episodes of first degree AV block and second degree AV block during apnea events. Initiation of BiPAP abolishes apneas and desaturations with the cardiac dysrrhytmias resolved. This indicates that Obstructive sleep apnea syndrome may predispose one to cardiac rhythm disturbances that can be controlled by bi-level positive airway pressure or continuous positive airway pressure therapy.