Clues to the Pathophysiology of Sudden Cardiac Death in Obstructive Sleep Apnea

Abstract

Background: Risk assessment of sudden cardiac death (SCD) is multifactorial and complex, especially among individuals without established cardiovascular disease. There are insufficiently investigated conditions that can affect arrhythmogenesis. One such condition is obstructive sleep apnea (OSA) syndrome, which is not on the list of risk factors of the Russian National Society of Arrhythmology. Objective: The aim of this review article is to discuss clues to the pathophysiology of SCD in OSA subjects. Methods: We searched the literature for data reporting the impact of apnea on arrhythmogenesis. The preferred languages were English and Russian. The most important clinical reports, as well as biochemistry and pathophysiology guides, were selected for inclusion in the review. Results: It was clearly observed in the searched literature that OSA is the crucial aspect of arrhythmogenesis. Among the clues are intermittent nocturnal hypoxia, reactive oxygen species, cardiomyocyte metabolism disturbances, myocardial electric heterogeneity, and intrathoracic pressure changes. Conclusion: This review emphasizes the importance of the inclusion of OSA in the list of risk factors of the Russian National Society of Arrhythmology.