Sleep Apnea and Dyslipidemia: The Link
Mr. L is a 67-year-old man with dyslipidemia and stable CAD. He was recently treated at an outside facility for recurrent persistent atrial fibrillation (AF) before requesting to be seen in our clinic for a second opinion of his management. At this point, he has been taking dabigatran and carvedilol for anticoagulation and rate control, but he questioned whether he could have a curative ablation procedure. He has had direct current cardioversion in the past and is unclear what precipitated this recurrence. He leads an active lifestyle through yard work, chores, community activities, but notes he has been limited more than usual by fatigue. An echocardiogram report (he provided) demonstrated normal systolic, diastolic and valvular function without evidence of pericardial disease. By the time of his physical evaluation, his blood pressure was 116.70, HR 65. He was 5'8" 165lbs in no acute distress. His heart and lung evaluation was unremarkable and his abdominal exam was benign. His laboratory data was within normal limits except for dyslipidemia. The lipid panel showed LDL 130, HDL 30 and Triglycerides of 170. An ECG was performed (Figure 1). Aware of the association of AF with OSA, the decision was made to perform the sleep study shown (Figure 2). Mr. L asked if there was any way one could estimate how long he had sleep apnea. He was informed that OSA may have been present since his diagnosis of dyslipidemia.
All are postulated mechanisms in OSA-related dyslipidemia, except: