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 1 involved a 70-year-old man with a medical history of chronic obstructive pulmonary disease (COPD), hypertension (HT), and rectal cancer. He had a body mass index (BMI) of 28.3kg/m2 and a score of 2 on Epworth sleepiness scale (ESS) and was scheduled for an open abdominal surgery. One day prior to the surgery, he performed an apnea test (via ApneaLink™) between 00:00 and 06:00 am which yielded the following results: AHI: 17/hr, AI: 3/hr, HI: 14/hr; ODI: 3/hr, minimum SpO2 (min. SpO2) 79%, and maximum HR (max. HR): 124/min. A decision was made for postoperative ICU follow-up of the patient.\nFollowing the three-hour long surgery, the intubated patient was admitted to the ICU, where he was extubated four hours later and given O2 mask support (5L/min). The results of an apnea test conducted on the operation day between 00:00 and 06:00 am were as follows: AHI: 21/hr, AI: 4/hr, HI: 17/hr, ODI: 1/hr, min. SpO2: 84%, and max. HR:131/min. It was decided that he should be scheduled for postoperative noninvasive mechanical ventilation (NIMV) support (Table ).