ATRIAL FIBRILATION

Associations Between Atrial Fibrillation, Hypothyroid, Erectile Dysfunction and Sleep Apnea

Leung RS, Huber MA, Rogge T, Maimon N, Chiu KL, Bradley TD.

Sleep Research Laboratory of the Toronto Rehabilitation Institute, Ontario, Canada.

BACKGROUND: We previously described an association between atrial fibrillation and central sleep apnea in a group of patients with congestive heart failure. We hypothesized that the prevalence of atrial fibrillation might also be increased in patients with central sleep apnea in the absence of other cardiac disease.

METHODS AND RESULTS: We compared the prevalence of atrial fibrillation in a series of 60 consecutive patients with idiopathic central sleep apnea (apnea-hypopnea index > 10 events per hour, > 50% central events) with that in 60 patients with obstructive sleep apnea (apnea-hypopnea index > 10, > 50% obstructive events) and 60 patients without sleep apnea (apnea-hypopnea index < 10), matched for age, sex, and body mass index. Subjects with a history of congestive heart failure, coronary artery disease, or stroke were excluded from the study. The prevalence of atrial fibrillation among patients with idiopathic central sleep apnea was found to be significantly higher than the prevalence among patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and 3.3%, respectively, P < .001). However, hypertension was most common and oxygen desaturation most extreme among patients with obstructive sleep apnea. 

CONCLUSIONS: We conclude that there is a markedly increased prevalence of atrial fibrillation among patients with idiopathic central sleep apnea in the absence of congestive heart failure. Moreover, the high prevalence of atrial fibrillation among patients with idiopathic central sleep apnea is not explainable by the presence of hypertension or nocturnal oxygen desaturation, since both of these were more strongly associated with obstructive sleep apnea. 

From Mike:  Breathing and heartbeat  irregularities have a great deal in common as fibs often reduce or disappear when breathing improves.  Inadequate amounts of EFAs  are strongly related to fibrilations

THYROID
Thyroxine Replacement Therapy Reverses Sleep-Disordered Breathing in Patients With Primary Hypothyroidism

Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.

BACKGROUND AND PURPOSE: Anecdotal reports suggest that sleep-disordered breathing (SDB) is common among patients with primary hypothyroidism. This study was undertaken to determine the prevalence of SDB and to evaluate the effect of thyroxine replacement therapy on SDB in patients with primary hypothyroidism. 

PATIENTS AND METHODS: Fifty consecutive newly diagnosed, untreated symptomatic patients with primary hypothyroidism (age: 34+/-11 years; males: 21 [42%]) were prospectively studied. Physical examination, anthropometry, fasting blood glucose and serum lipids were performed in all patients at baseline. Polysomnography was done at baseline in all patients and was repeated after adequate thyroxine replacement in those who had SDB. 

RESULTS: SDB defined as apnea-hypopnea index (AHI) >/=5 was present in 15 patients (30%) at baseline and was reversible in 10 of the 12 patients evaluated following thyroxine replacement therapy (P=0.006). Thyroxine replacement therapy was associated with improvement in findings that reflect a compromised upper airway, such as macroglossia (4 [33%] vs. 1 [8%]; P=0.083), myoedema (5 [42%] vs. 1 [8%]; P=0.046) and facial puffiness (10 [83%] vs. 1 [8%]; P=0.003). 

CONCLUSIONS: Reversible SDB is common among patients with primary hypothyroidism. Changes in upper airway anatomy resulting from hypothyroidism probably contribute to the development of SDB in these patients. 

From Mike: When energy issues present, first the breathing, next the thyroid. more about

ERECTILE DYSFUNCTION - ED
Erectile Dysfunction, Obstructive Sleep Apnea Syndrome and Nasal CPAP Treatment
Goncalves MA, Guilleminault C, Ramos E, Palha A, Paiva T.  ISTEL, Porto, Portugal.

BACKGROUND AND PURPOSE: To evaluate the effect of one month of continuous positive airway pressure (CPAP) in a subgroup of obstructive sleep apnea (OSA) patients with erectile dysfunction (ED) and compare this subgroup with age- and body mass index (BMI)-matched OSA patients without ED. 

PATIENTS AND METHODS: Prospective general, sleep, psychiatric and sexologic evaluations were conducted. Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Sleep Disorders Questionnaire (SDQ), Quality of Life SF-36, and polysomnography were used. Seventeen OSA patients with ED were compared prior to CPAP treatment and during CPAP treatment with age- and BMI-matched OSA patients without ED. Parametric and non-parametric statistics, chi-square, Fisher exact test and multiple regression analyses were performed. 

RESULTS: Ninety-eight men (BMI=28.8 kg/m2, apnea-hypopnea index (AHI)=49.6 events/h, ESS=14.8, BDI=8.4, and lowest SaO2=75.3%) were divided into subgroups of lowest SaO2>80% (A) and lowest SaO2< or =80% (B). (A) Forty-six men had a mean lowest SaO2 of 85.7%+/-2.9, AHI=29.5+/-17.6, age=46.3+/-9.3 years, ESS=13.6+/-4.2, BMI=25.8+/-4.8. Seven of the patients had ED. (B) Fifty-two men had a mean lowest SaO2=60.10+/-10.0%, AHI=67.4+/-24.5, BDI=9.0+/-6.9, age=47.4+/-9.4 years, ESS=16.2+/-4.4, BMI=31.4+/-5.1. Twenty-one of the patients had ED (chi2: P=0.006). Significant variables for ED were lowest SaO2 and age (r=0.17). CPAP-treated subgroup: ED subjects had significantly lower SaO2, ESS, BDI and SF-36 subscale scores than OSA controls. Nasal CPAP eliminated the differences between groups, and ED was resolved in 13 out of 17 cases. 

CONCLUSIONS: ED in OSAS is related to nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with nasal CPAP showed remission at one-month follow-up, resulting in significant improvement in quality of life. 

From Mike: ERECTILE DYSFUNCTION.  ED can stem from apnea and apnea can stem from poor breathing. For ED and Apnea best to rule out both apnea and UDB.

Diaphragm strength and sleep.
If you're like most people, you know that one of the biggest dangers of snoring and untreated sleep apnea is a reduction in the body's intake of oxygen. It's a little known fact that your diaphragm muscles can be a HUGE help in reducing sleep apnea and breathing volume. 
The diaphragm muscles are responsible for breathing – weak muscles mean your breathing isn't as strong or as easily deepened as it should be.  But there is hope!
There are a few key breathing development techniques and exercises that are meant to strengthen the diaphragm and increase lung volume and oxygen intake.  
Without the right amount of oxygen, we experience fatigue and depression, and low oxygen levels can also lead to serious health conditions such as heart failure.  By following our program in our Sleep program you'll be well on your way to a stronger diaphragm, greater lung volume and more oxygen. 

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