A 57-year-old male hypertensive Caucasian patient on medical treatment for 1.5 months for non-organic-related AF was hospitalized in the ICU because of high-ventricular response AF (170 per minute). Biphasic CV with 100J was performed on the patient under medical treatment, and sinus rhythm was maintained. The patient had high-ventricular response AF (160 per minute) again after 2 days, biphasic CV with 200J was conducted again, and sinus rhythm was maintained. An apnea test (AT) was performed on the same night because frequent apneas were observed during sedation, and his body mass index (BMI) was 40.9kg/m2. The results were as follows: apnea-hypopnea index (AHI) of 71 per hour, desaturation period of 28 minutes, and minimum peripheral oxygen saturation (SpO2) of 68 %. The patient was discharged with nocturnal BiPAP—expiratory positive airway pressure of 8cm H2O and inspiratory positive airway pressure of 14cm H2O—and medical treatment. The patient was in sinus rhythm at the 1-month follow-up; thus, medication doses were decreased, AT was performed under BiPAP at the 6-month follow-up, and the results were as follows: AHI of 1 per hour, desaturation period of 1 minute, and minimum SpO2 of 87 %. The patient did not have AF within these 6 months. At the 12th month, the patient decided to undergo gastric bypass surgery. Up to the time of surgery, nocturnal BiPAP and medical treatment were continued. Within 6 months after the medical surgery, the patient lost 40kg and only medical treatment was continued. In the AT conducted in the 18th month (via spontaneous breathing), results in the range of AHI of 5 per hour, apnea index of 1 per hour, and minimum SpO2 of 93 % were observed; hence, bisoprolol fumarate was ended (Fig. ).
Case 6 involved a 79-year-old man with a medical history of myocardial infarction, HT, and cardiac insufficiency. He had a BMI of 20.8 kg/m2 and presented to the emergency department with spasms and sudden loss of consciousness. He was admitted to the ICU after a right middle cerebral artery (MCA) infarction was detected in his cranial diffusion MRI. He was followed-up on in the ICU for 16 days and he was tracheostomized on day 11. He performed the apnea test with the tracheostomy mask (5L/min O2) on day 15 between 00:00 and 06:00 am. The results were as follows: AHI 34/hr, AI: 3/hr, HI: 31/hr, ODI: 7hr, min. SpO2: 79%, and max HR: 97/min. It was decided that he should be scheduled to be discharged as tracheostomized, with home care conditions assured under home ventilator support (Table ).