Sleep apnea and sudden death in the non-cardiac population: A systematic review

Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. To assess whether OSA increases the risk of sudden death in the non-cardiac population. This is a systematic review of the literature. The descriptors “sudden death” and “sleep apnea” and “tachyarrhythmias” and “sleep apnea” were searched in the PubMed/Medline and SciELO databases. Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. There was a cause–effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population. A apneia obstrutiva do sono (AOS) é um dos principais fatores de risco para doenças cardiovasculares e está associada a relevante morbimortalidade. A AOS também tem sido relacionada com o desenvolvimento de arritmias e morte súbita. Relacionar a AOS com o aumento do risco de morte súbita na população não cardiopata. Trata-se de revisão sistemática da literatura. Foi realizada a pesquisa dos descritores “sudden death” and “sleep apnea” e “tachyarrhythmias” and “sleep apnea” nas plataformas Pubmed/Medline e SciELO. Foram selecionados 13 estudos que abordavam a relação entre AOS e o desenvolvimento de taquiarritmias e/ou morte súbita com dados de prevalência, achados eletrocardiográficos e relação com outras comorbidades. A obstrução das vias aéreas observada na AOS desencadeia diversas repercussões sistémicas, como, por exemplo, alterações da pressão intratorácica, hipóxia intermitente, ativação do sistema nervoso simpático, ativação de quimiorreceptores e liberação de catecolami