Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPGOES, Creuza M.FALCOCHIO, Paola P. N. F.DRAGER, Luciano F.2019-05-302019-05-302018EXPERT REVIEW OF CARDIOVASCULAR THERAPY, v.16, n.10, p.707-713, 20181477-9072https://observatorio.fm.usp.br/handle/OPI/31635Introduction: In the last decades, consistent data derived from experimental, epidemiological, and clinical studies pointed obstructive sleep apnea (OSA), the most common sleep disordered breathing worldwide, as a potential risk factor for incidence and recurrence of atrial fibrillation (AF). Areas covered: This review article describes the impact of OSA on AF and discusses potential strategies for managing OSA in the AF scenario. Expert commentary: Untreated OSA seems to be one important predictor of AF treatment failure after chemical or electrical cardioversion as well as after a successful AF ablation. There is biological plausibility for this association including the effects of intermittent hypoxia and sleep fragmentation promoting sympathetic activation, blood pressure instability, inflammation, and oxidative stress. The negative swings derived from the obstructive events also increases left ventricle afterload contributing to cardiac remodeling. Altogether, these factors provide a structural and electrical substrate for AF. Despite this evidence, however, OSA remains still poorly recognized and consequently undertreated in clinical practice. Therefore, active programs to incorporate valid screening for cardiologists to work in partnership to sleep medicine experts may ultimately contribute to decreasing the burden of AF.engrestrictedAccessSleep apneaatrial fibrillationscreeningtreatmentcardiovascular diseasepositive airway pressurerenal sympathetic denervationnocturnal arrhythmiasheart-failureriskrecurrencetermassociationprevalencemechanismsarticleCopyright TAYLOR & FRANCIS INC10.1080/14779072.2018.1515013Cardiac & Cardiovascular Systems1744-8344