How is OSA diagnosed? Unfortunately, many people with OSA are not aware they have it and thus go untreated. Polysomnography The primary method to diagnosis sleep-disordered breathing is polysomnography or PSG. PSG is a multi-parametric test.  A PSG records physiological changes that occur during sleep such as electrical activity in the brain measured by electroencephalography (EEG), eye movement measured by Electrooculography (EOG), muscle activity and/or skeletal muscle activation measured by electromyography (EMG), and heart rhythm determined by electrocardiography (ECG). Most importantly respiratory airflow, respiratory effort and oxygen saturation are also examined. A PSG involves recording at least 12 channels using at least 22 wires connected to the patient while sleeping. Snoring may also be recorded using a sound probe placed across the neck. Apnea–Hypopnea Index While there are several outcomes to these tests, diagnosis primarily depends on the Apnea–Hypopnea Index or Apnoea–Hypopnoea Index (AHI). The level of severity is determined by the AIH. The AHI index is a number determined from the number of apnea (cessations in breathing lasting at least 10 sec accompanied by decreased blood flow) and/or hypopnea (Shallow breathing) events that occur during sleep, and the decrease in oxygen saturation.  AHI is determined by dividing the number of apnea events that occur during sleep by the number of hours slept.

Therapies that mechanically open the upper airway Continuous positive airway pressure (CPAP) therapy CPAP therapy is the most common treatment for OSA. CPAP therapy involves increasing the positive air pressure in the upper airway to prevent the airway from collapsing from negative pressure created when breathing in during sleep. The CPAP machine consists of the motor, hose and mask. The CPAP motor pressurizes and in some cases adds moisture to the air. The pressurized air is then sent through the hose to the mask. Prior to using the CPAP machine, users undergo a titration study to determine the ideal air pressure for sleep. During the study, the user is fitted for a mask. While the user is sleeping, the clinicians slowly increase the pressure of the air released into the mask until the patient no longer wakes up while sleeping. There are three types of masks: nasal pillows, nasal masks and full face masks. Effects are experienced almost immediately. Treatment often reduces snoring and breathing obstructions, improves sleep quality, reduces risk for cardiovascular diseases, lowers blood pressure, increases alertness during the day and reduces daytime drowsiness. One disadvantage of CPAP is that while it initially gradually increases to the optimal pressure level at the beginning of sleep, it stays at that optimal pressure setting, regardless of how the individual’s pressure changes with changes in sleep position, body size or sleep state.

What is cardiac arrhythmia? Cardiac arrhythmia is an irregular heartbeat. Irregular in the sense the heart can beat too fast (tachycardia), too slow (bradycardia) or have an abnormal rhythm. There is a wide variety of cardiac arrhythmia and some are harmless while others could be life-threatening. Arrhythmias are concerning because they can potentially reduce the amount of blood being pumped through the body. Because blood carries oxygen to all the tissues in the body, a reduction in blood flow could lead to organ damage. How is the heartbeat generated? The heart consists of 4 chambers: two upper chambers called the atria and two lower chambers called the ventricles. A heartbeat is initiated by an electrical signal generated in a group of cells at the top of the right atrium called the sinus node or sinoatrial (SA) node. The signal travels down through the atria which causes them to contract and pump blood into the ventricles. The signal moves down to a second node between the atria and ventricles called the atrioventricular (AV) node. Once the ventricles are full of blood, the signal travels down the ventricles on a pathway called the bundle of His. This causes the ventricles to contract and pump blood to the lungs or other areas of the body.

What are the symptoms of cardiac arrhythmia? Symptoms of cardiac arrhythmia conditions depend on disease type, frequency and severity. Common symptoms of cardiac arrhythmias include:        Sensation of fluttering the chest        Rapid heartbeat        Slow heartbeat        Chest pain        Shortness of breath        Lightheadedness        Dizziness        Sweating        Fainting How is cardiac arrhythmia diagnosed? Several factors and test results are used to diagnose cardiac arrhythmia including personal and family medical histories, physical examination, and results of various tests. These conditions may be diagnosed by the primary care physician or specialists such as cardiologists or electrophysiologists (cardiologists specialized in arrhythmias). Diagnostic tests include Electrocardiogram (EKG, ECG) An EKG is a non-invasive test to record the heart’s electrical activity. It shows the speed and rhythm at which the heart is beating and the strength and timing of the electrical signals in the heart. A standard EKG records the heart beat for a few seconds. An irregular heartbeat can only be detected while the heartbeat is being recorded. Thus, to detect infrequent episodes of AF, portable EKGs are often used. These include Holter and Event Monitors. A Holter monitor records electrical activity for 1 to 2 days continuously. It involves where electrodes on the chest that are connected to a portable recorder that can be worn around the neck or on a belt.

What treatments are available for cardiac arrhythmia? There are several different types of treatments for cardiac arrhythmias. Blood Clot Prevention Some cardiac arrhythmic conditions run the risk of inducing stroke (such as A Fib). Thus, blood-thinning mediations may be recommended such as warfarin, dabigatran, heparin and aspirin. Rate Control (Beta and Calcium Channel Blockers) Medication Rate control medicine may also be prescribed to reduce the heart beat rate of the ventricles. These medications are recommended for most individuals with A Fib. While they may not bring the heart beat to a normal level, they significantly reduce the work the heart has to do. Heart rate is typically controlled with beta blockers (such as metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil) and digitalis (digoxin). Cardio sinus massage This form of massage is provided by a trained professional. It involves putting pressure on the neck where the carotid artery divides into two sections, causing it to release chemicals that slow down the heart. Rhythm Control Procedures Medications Rhythm controlling medications include the new generations; amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide and older therapies; quinidine, procainamide, disopyramide. Cardioversion The procedure entails shocking the heart using electrodes placed on the chest and possibly the back.