Association of Cardiac Arrhythmias with Obstructive Sleep Apnea & Role of CPAP

Sleep related breathing disorders (SRBD), manifesting as hypopneas and apneas include Obstructive sleep apnea (OSA) in its ultimate form. Obstructive sleep apnea is characterized by episodic incomplete or complete obstruction of the upper airways, manifesting as apnea, which is complete cessation of breathing and closure of pharyngeal airways. Besides other medical complications, cardiac arrhythmias are one of the commonest medical complications associated with OSA. Cardiac arrhythmias, depending on their complexities are directly related to morbidity and mortality in patients of OSA. Recurrent stressful episodes of complete breathing cessation followed by restlessness due to arousals leads to hypoxemia and neuroharmonal catecholamine surge as a suggested trigger for cardiac arrhythmias orchestrating acute and chronic cardiovascular changes. Despite of advancement in diagnosis and treatment modalities, it is impossible to predict the prognosis and response to various modalities of treatment like continuous positive airway pressure (CPAP), cardioversion, and tracheostomy. Therefore, this update review of the literature is aimed to elaborate epidemiology and underlying pathophysiology of cardiac arrhythmias associated with OSA and to assess the impact of OSA management on cardiac arrhythmia.