A-fib, Dementia... and Sleep Apnea
I read an interesting article recently on Medpage about the possible link between Atrial fibrillation and dementia. (Medpage is one of the must reads for me because several members of my A.W.A.K.E group read it daily and email me for comments. They also like to choose topics from the web page.) I found it interesting because I am seeing more and more patients in the sleep lab with A-fib. The man pictured in the article could be our poster child for A-fib: most of our "A-fibbers" look similar to him.
The article also compared the instance of A-fib with stroke and dementia. It was so interesting to me because in my small comparison group (the running list kept in my head), I have like-patient samples.
It was curious that the stroke samples did not have the same instance of dementia as the A-fib without stroke. I would have guessed that the people with A-fib and stroke would have a higher instance of developing dementia. Could this be because the A-fib was undiscovered and untreated longer than the stroke, as in the poor cardiac perfusion resulted in inadequate oxygen supply to the brain over time and was less noticeable than when the stroke occurred and signs were noticed immediately? I wonder what impact the sleep apnea had. It was not the focus of this study.
At any rate, don't you find it ironic that the list of comorbidities just sort of automatically fills itself in with OSA? There are other articles comparing OSA with of course, stroke, A-fib and dementia. I think these are the latest members of the cast to be added, and yet home sleep testing is still being forced on us. In our lab, it is rare to find a patient without at least one comorbidity to go along with the significant list of symptoms of OSA. I am always hyper-alert with patients with A-fib. Frequently it seems they also have complex sleep apnea and end up on ASV.
What's going on in your labs? Do you see many patients with A-fib? Are you one of those mythical, lucky labs I hear about where all the patients just walk in with nothing but c/o snoring and daytime fatigue? Easy peasy?