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- W2937787002 abstract "Arrhythmogenesis in obstructive sleep apnea in a known but under-recognized phenomenon, which may be due to autonomic nervous system imbalance triggered by a combination of apnea and hypoxemia, as well as cardiac remodeling. This case demonstrates a dose-dependent reduction in atrial arrhythmia with increasing continuous positive airway pressure (CPAP) in the setting of moderate sleep apnea, AHI 17.8. A 74-year-old female presents for sleep apnea evaluation. Past history of excessive daytime sleepiness and restless leg syndrome, asthma, hypertension, lupus. Vital signs blood pressure 140/80 saturation, HR72, 94% on room air weight 212 pounds, BMI 42.82 pounds per inches. Cardiovascular exam shows an apical impulse on the left fifth intercostal space midclavicular line, normal rate and rhythm without murmurs no pedal edema. Current medications include hydrochlorothiazide 25 mg, enalapril 10 mg, albuterol HFA, hydroxychloroquine 200 mg. During PSG and CPAP titration, multiple atrial arrhythmias were noted during REM sleep with associated hypoxia. Patient was noted to have a total of 53 desaturation events, with 13 being less than 80%. The lowest SaO2% reached 67.0%. AHI was noted to be 17.8 with resolution to < 5 on 11cm/h20. Mean heart rate during REM elevated to 139 bmp. Following titration of pressures up to 11 cm/H20, not only did the apnea and hypoxia index normalize, the patient no longer experienced episodes of SVT. Unfortunately, after PSG completion, patient ultimately refused to tolerate PAP therapy due to mask intolerance and claustrophobia. Appropriate titration of CPAP not only reduced OH/OA respiratory events and decreased AHI, but increases baseline saturation and normalization of heart rate. This case highlights a possible future clinical patter. Criteria of a successful titration may not be limited to supine AHI reduction, but a more complex evaluation of baseline SaO2 and normalization of heart rate. With more evidence, further assessment and re-evaluation of the gold standard of a successful titration may be warranted. Furthermore, patient compliance with PAP therapy may be emphasized to serve a long term cardio-protective role." @default.
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- W2937787002 date "2019-04-01" @default.
- W2937787002 modified "2023-09-24" @default.
- W2937787002 title "1033 Hypoxia Induced Supraventricular Tachycardia, Resolved with Continuous Positive Airway Pressure Titration" @default.
- W2937787002 doi "https://doi.org/10.1093/sleep/zsz069.1030" @default.
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