Case Report: Combination oral appliance therapy acute influence on cardiac electrophysiology and hemodynamics in OSA patient with paroxysmal atrial fibrillation.

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Frontiers in sleep Pub Date : 2025-10-30 eCollection Date: 2025-01-01 DOI:10.3389/frsle.2025.1580381

Preetam Schramm, Emet Schneiderman, Jason Hui, Zohre German, Ju Ying Lin

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Abstract

Background and objectives: Sleep apnea-related autonomic responses may increase cardiac arrhythmias. Ablation, cardioversion, and pharmacologic therapies for paroxysmal atrial fibrillation (AF) could benefit from adjunctive oral appliance therapy with a mouth shield (OAT+) compared to auto-adjusting positive airway pressure (APAP).

Methods: A 67-year-old male with moderate obstructive sleep apnea (OSA), AF history, three ablations, and on Carvedilol (10 mg daily) underwent home sleep recordings with APAP and with OAT+ after 4 weeks. Randomly selected premature atrial contractions (PACs; n=20) and time-linked plethysmography waves from each intervention were compared.

Results: OAT+ reduced the PAC index (-61.9%), cardiac conduction intervals (nR-R, p = 0.025; pre-PAC R-R, p = 0.003; R-PAC-R, p = 0.051; PAC R-post systolic pause-R, p < 0.001) except for a P-R interval increase (p = 0.032). PAC-associated plethysmography wave amplitudes increased with OAT+ (pre-PAC wave-1, p < 0.001; PAC wave-2, p = 0.023; post-PAC wave-3, p < 0.001).

Conclusions: OAT+ shows promise as an adjunct AF therapy in OSA patients, improving cardiac conduction and vascular function over APAP.

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病例报告：联合口腔器械治疗对OSA合并阵发性心房颤动患者心脏电生理和血流动力学的急性影响。

背景和目的：睡眠呼吸暂停相关的自主神经反应可能增加心律失常。与自动调节气道正压通气（APAP）相比，治疗阵发性心房颤动（AF）的消融术、心律转复和药物治疗可以从带有口罩的辅助口腔器械治疗（OAT+）中获益。方法：67岁男性，有中度阻塞性睡眠呼吸暂停（OSA）， AF病史，3次消融，卡维地洛（10mg / d）治疗，4周后应用APAP和OAT+进行家庭睡眠记录。随机选择心房早搏（PACs, n=20）和每次干预的时间相关容积脉搏波进行比较。结果：OAT+降低PAC指数（-61.9%），心传导间期（nR-R, p = 0.025； PAC前R-R， p = 0.003; R-PAC-R, p = 0.051； PAC后r -收缩暂停- r， p < 0.001），但p - r间期升高（p = 0.032）。PAC相关容积脉搏波振幅随OAT+而增加（PAC前波1，p < 0.001； PAC波2，p = 0.023； PAC后波3，p < 0.001）。结论：与APAP相比，OAT+作为OSA患者辅助房颤治疗有希望改善心脏传导和血管功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Frontiers in sleep

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