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Background: Periodontal disease is a chronic disease causing an inflammatory process that affects various organs and is as­sociated with an increased risk of many diseases, including bone and cardiovascular disease. Aim: The aim of this study was to establish the prevalence of periodontal disease in continuous patients scheduled for hip or knee replacement surgery. Methods: The study was a prospective, epidemiological analysis performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for classical risk factors and had a dental evaluation performed for the diagnosis of periodontal disease. Results: The study population consisted of 228 patients. A total of 137 (60.1%) patients were scheduled for a hip replace­ment surgery, while 91 (39.9%) had a knee replacement. The mean age of the study population was 66.8 ± 12.2 years, and 83 (36.4%) patients were male. A clinically significant disease was present in 65 (28.5%) cases, while all (100%) of the patients had at least minimal signs of periodontal disease. In patients with periodontal disease the percentage of tartar involvement of the teeth was 33.1 ± 26.8%, mean dental plaque coverage was 48.1 ± 29.8%, and bleeding occurred at a rate of 35.4 ± 29%. As for the hygiene level, it was generally poor in the majority of patients with periodontal disease. No differences in terms of baseline risk factors were present between patients with and without periodontal disease. Conclusions: In conclusion, periodontal diseases are highly prevalent in patients undergoing hip and/or knee replacement surgery. The presence of the periodontal disease is possibly associated with a worse prognosis and should be treated.

Wstep: Ocena ryzyka ma szczegolne znaczenie u pacjentow poddawanych interwencjom chirurgicznym. Zabiegi ortopedyczne, w szczegolności calkowita alloplastyka stawow, są operacjami związanymi z wysokim ryzykiem okolooperacyjnym, jak rowniez jednym z najwyzszych odsetkow powiklan. Cel: Celem niniejszej pracy bylo określenie czestości wystepowania klasycznych i nieklasycznych czynnikow ryzyka sercowo-naczyniowego u pacjentow poddawanych calkowitej alloplastyce stawu biodrowego lub kolanowego. Metody: CRASH-JOINT ( Cardiovascular Risk Assessment ScHeme in JOINT alloplasty ) bylo prospektywnym badaniem epidemio­logicznym przeprowadzonym u pacjentow poddawanych operacji calkowitej alloplastyki stawu biodrowego lub kolanowego. Chorzy wlączeni do projektu byli badani pod kątem klasycznych i nieklasycznych czynnikow ryzyka sercowo-naczyniowego i przeprowadzono u nich calodobowe pomiary wartości ciśnienia tetniczego. Wyniki: Do badania wlączono 98 osob. Podczas wstepnej ewaluacji 8 pacjentow zostalo wykluczonych z badania i wylączonych z zabiegu, w wiekszości z powodu przyczyn sercowych. U 65 chorych przeprowadzono wymiane stawu biodrowego i 25 stawu kolanowego (średni wiek 63,7 ± 12,2 roku, 62,2% kobiet). Wśrod klasycznych czynnikow ryzyka zwracalo uwage 50 (55,6%) osob z rozpoznaniem nadciśnienia tetniczego w przeszlości, 10 (11,1%) pacjentow mialo cukrzyce, 2 (2,2%) wystąpil zawal serca w przeszlości, a u 24 (26,7%) w wywiadzie rodzinnym zanotowano choroby sercowo-naczyniowe. Średni wskaźnik masy ciala (BMI) wynosil 28,0 ± 5,1 kg/m 2 , nadwage zaobserwowano u 39 (43,3%) pacjentow, a u 28 (31,1%) — otylośc. Pacjenci poddawani wymianie stawu biodrowego byli istotnie mlodsi (61,8 ± 12,6 vs . 68,5 ± 10,0 lat; p = 0,02), byli cześ­ciej palaczami tytoniu (24,6% vs . 4,0%; p = 0,03), mieli istotnie nizsze BMI (26,8 ± 4,5 vs . 31,2 ± 5,3 kg/m 2 , p < 0,0001) i rzadziej byli otyli (18,5% vs . 64,0%, p < 0,0001). Nie stwierdzono istotnych roznic miedzy pacjentami zakwalifikowanymi do operacji pierwotnej i ponownej reoperacji. Wnioski: Badanie wykazalo, ze czynniki ryzyka sercowo-naczyniowego u osob poddawanych calkowitej alloplastyce stawu biodrowego lub kolanowego są obecne cześciej niz w populacji ogolnej, co moze potencjalnie przyczynic sie do podwyzszonego ryzyka rozwoju powiklan okolooperacyjnych.

Bisoprolol is one of the most widely used beta-blockers characterised by cardioselectivity, and it has no intrinsic sympathomimetic activity. It is commonly used in the treatment of coronary heart disease and heart failure.The aim of study was to assess the bioequivalence of the film-coated tablets containing 2.5 mg of bisoprolol (Bisocard® - the medicinal product) to the original medicinal product (Concor Cor 2.5® - the reference).A randomised, open-label, two-period, crossover, single-dose, relative bioavailability study was conducted in fasted healthy Caucasian volunteers. A single 10-mg oral dose (four tablets of 2.5 mg) of the test or reference product was followed by a 14-day wash-out period, after which the subjects received the alternative product. Blood was sampled within a period of 60 h post administration in pre-specified time points. Bisoprolol concentrations were determined by a validated LC-MS/MS method. The products were considered bioequivalent if the 90% confidence interval (CI) of the log-transformed geometric mean ratios (test vs. reference) for AUC(0-t), AUC(0-∞), and Cmax were within 80-125% limits. Adverse events were monitored during the study based on the subject claims and clinical parameters.Twenty-six healthy male and female volunteers (mean age ca. 29 years; body mass index 22.7 kg/m²) were in-cluded in the study, and 24 completed the clinical part. The geometric mean ratios (test/reference) for the log-transformed AUC(0-t), AUC(0-∞), and Cmax were 95.16% (90% CI 92.52-97.87%), 95.08% (90% CI 92.40-97.83%), and 100.00% (90% CI 94.83-105.45%), respectively. There were no significant differences in the pharmacokinetic parameters between the test and reference formulations. No serious adverse events were reported.The results of this single-dose study in healthy Caucasian volunteers indicate that Bisocard®; 2.5 mg film-coated tablets are bioequivalent to the reference product - Concor Cor 2.5®; 2.5 mg film-coated tablets. Both products had similar safety profile and have been well tolerated.

Background: Various conditions, including arterial hypertension, exhibit seasonal trends in their occurrence and magnitude. Those trends correspond to an interest exhibited in the number of Internet searches for the specific conditions per month. Aim: The aim of the study was to show seasonal trends in the hypertension prevalence in Poland relate to the data from the Google Trends tool. Methods: Internet search engine query data were retrieved from Google Trends from January 2008 to November 2017. Data were calculated as a monthly normalised search volume from the nine-year period. Data was presented for specific geographic regions, including Poland, the United States of America, Australia, and worldwide for the following search terms: “arterial hypertension (pol. nadciśnienie tetnicze)”, “hypertension (pol. nadciśnienie)” and “hypertension medical condition”. Seasonal effects were calculated using regression models and presented graphically. Results: In Poland the search volume is the highest between November and May, while patients exhibit the least interest in arterial hypertension during summer holidays (p < 0.05). Seasonal variations are comparable in the United States of America representing a Northern hemisphere country, while in Australia (Southern hemisphere) they exhibit a contrary trend. Conclusions: In conclusion, arterial hypertension is more likely to occur during winter months, which correlates with increased interest in the search phrase “hypertension” in Google.

Background: Dyslipidaemia, especially elevated low-density lipoprotein cholesterol (LDL-C), is one of the most important cardiovascular risk factors. Treatment of dyslipidaemia and prevention of cardiovascular disease (CVD) with lipid-lowering drugs is one of the key issues in reducing cardiovascular mortality. Nevertheless, underutilisation of statins and lipid-lowering drugs is still a problem globally. Aim: The present study aimed to describe the utilisation of lipid-lowering drugs in groups of patients with indications for statin treatment and elevated LDL-C. Methods: The study included adult patients with an indication for the use of a lipid-lowering therapy, currently using or not using such therapy because of contraindications or statin intolerance, in whom LDL-C concentration was > 70 mg/dL, treated in outpatient settings. All patients were screened for CVD and had blood cholesterol concentration assessed. Patients were also divided into: (1) patients with vascular disease; (2) patients with diabetes mellitus; (3) aged ≥ 65 years; and (4) patients without the three mentioned risk factors. Results: The study group consisted of 2812 (51.4% male) patients. Major cardiovascular risk factors including arterial hyper­tension, type 2 diabetes mellitus, and smoking were highly prevalent in the study population (86.2%, 44.1%, and 23.3%, respectively). Out of the prespecified risk factors (vascular disease, diabetes mellitus, age ≥ 65 years) the study population was divided into patients without any of the mentioned risk factors (n = 520), those with all the three risk factors (n = 368), two out of three risk factors (n = 934), and one risk factor (n = 990). The study showed that 89.6% of patients were treated with statins (47.8% with atorvastatin, 27.8% with rosuvastatin, and 13.8% with simvastatin). Fenofibrate was used in 5.8% of the population and ezetimibe in 2.7%. In the whole group, 7.1% of patients did not receive any type of lipid-lowering therapy. Atorvastatin was more often used in patients with all the three prespecified risk factors, while rosuvastatin was used in patients without any of the risk factors. Conclusions: The most often-used lipid-lowering drugs in Poland are statins, with atorvastatin and rosuvastatin being used the most common of these. The present study shows that some patients with LDL-C concentration > 70 mg/dL and indications for lipid-lowering are not treated accordingly.

Professional drivers are a group exposed to many cardiovascular risk factors. Non-systematic working hours, prolonged stress, low physical activity, along with irregular, and in most cases, unhealthy meals are common aspects of the normal working schedule of most of the professional drivers. These translate into high risk of cardiovascular disease (CVD).The aim of the current analysis was to establish the prevalence of dyslipidaemia in a group of continuous professional drivers.The RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland - Ambulatory Blood Pressure Monitoring) study is a prospective study focused on assessing cardiovascular risk factors in professional drivers. Patients included in the study were screened for classical and non-classical cardiovascular risk factors and had an ambulatory blood pressure monitoring (ABPM) performed. Out of the whole RACER study population, 144 drivers were included into the RACER-ABPM study.Out of this group 135 (95.7%) were male, and the mean age was 50.2 ± 9.3 years, and mean body mass index was 32.3 ± 3.0 kg/m². A family history of CVD was noted in 21.3% of patients, 28.1% were current smokers, and 2.9% had diabetes mellitus. Out of those patients, 72.2% had low-density lipoprotein cholesterol (LDL-C) level115 mg/dL, 85.5% had LDL-C100 mg/dL, and 96.7% had LDL-C70 mg/dL. High-density lipoprotein cholesterol40 mg/dL in men and45 mg/dL in women was present in 84.4% of cases. Triglycerides150 mg/dL were found in 28.9% of cases.In conclusion, dyslipidaemia is highly prevalent in professional drivers. Obesity is one of the major contributors to the cardiovascular risk, and dyslipidaemia along with other risk factors highly prevalent in this subgroup accounts for poorer prognosis.

Background: Identification of factors interfering with adequate control of arterial hypertension (HT) in the course of antihypertensive therapy is necessary to reduce the incidence of cardiovascular disorders and optimise clinical practice guidelines. Aim: The study objective was to conduct a screening assessment of the rate of uncontrolled hypertension among hypertensive patients coming to a routine follow-up visit, and to characterise patients with inadequate control of HT in the aspect of their cardiovascular risk profile and therapeutic strategies used. Methods: The CONTROL NT registry was a nationwide observational study performed by physicians in the outpatient setting in Poland. Patient data were collected twice: between April and September 2011 and between January and August 2012. Dur­ing screening, the physician completed a questionnaire with patient basic clinical information. The impact of the selected demographic and clinical parameters on treatment success defined as blood pressure (BP) lowering to < 140/90 mmHg when measured in the office at the second visit was investigated with univariate and multivariate logistic regression models. Results: In total 1288 outpatient physicians participated in the CONTROL NT registry. In the screened group of 34,919 patients with a history of HT, 66.9% had abnormal BP readings in the office. In 15,262 patients with inadequate control of hypertension included in further analysis, the mean age was 59.3 ± 11.9 years, 47.9% were women, the disease duration was 8.2 ± 6.5 years and antihypertensive therapy was used for 7.4 ± 6.0 years. At least three cardiovascular risk factors were found in 46% of patients, with the most common dyslipidaemia (77.4%) and abdominal obesity (74.8%). In 56.6% of patients at least one concomitant disease was diagnosed, the most common being diabetes (29.8%). At the time of enrolment 21.5% of patients received no antihypertensive drugs, one, two, three (or more) drug combinations and fixed-dose combina­tions were received by 16.8%, 28.5%, 31.5% and 4.0% of patients, respectively. The most commonly used drug class was angiotensin-converting enzyme inhibitors (50%), followed by beta-blockers (42%) and diuretics (39%). Significant negative predictors of BP control included: body mass index ≥ 30 kg/m 2 , heart rate ≥ 70 bpm, history of hypertension ≥ 7 years, and kidney disease (the odds ratios adjusted by age and gender — 0.61; 0.76; 0.79; and 0.76, respectively). Conclusions: The percentage of Polish outpatients with adequate HT control is unsatisfactory. Patients with diabetes, chronic kidney disease, dyslipidaemia, overweight or obesity, longer disease and treatment duration and poor treatment compliance require a particularly careful assessment of risk factors and comorbidities, appropriate therapy intensification, and more frequent use of antihypertensive fixed-dose combinations.

Background: Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA). Aim: Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes. Methods: The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A — patients with OSA, and group B — patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests. Discussion: The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to increased oxidative stress and vascular endothelial injury associated with OSA, patients afflicted with this condition will not only have more advanced atherosclerotic lesions, but also in their histopathological examination their atherosclerotic plaque will exhibit evidence of greater instability and adverse morphology. We also expect to show that in patients with OSA, achieving cor¬rect control of cardiovascular risk factors will be more difficult. The study may improve PAD control through assuring better multispecialty care in PAD patients.

Background: Cardiovascular diseases are the leading cause of death worldwide. One of the most important diseases in this group is myocardial infarction (MI). According to the universal definition developed by the European Society of Cardiology (ESC), MI is divided into five main types based on its cause. Type 2 MI is secondary to ischaemia due to either increased demand or decreased supply of oxygen (for example due to coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension). Aim: To assess the occurrence and aetiology of type 2 acute MI (AMI), and to describe the clinical characteristics and prognosisof study patients. Methods: Into a retrospective study, we enrolled 2,882 patients in the Cardiology Department with an initial diagnosis of AMI between 2009 and 2012. Diagnosis of AMI was made based on ESC criteria. In all patients, coronary angiography was performed in order to exclude haemodynamically significant coronary lesions. Results: Among 2,882 patients hospitalised in the described time period, 58 (2%) patients were diagnosed with type 2 AMI.The mean age of the study group was 67.3 ± 13.2 years; and the majority of the study group, 60.3%, were women. Out of them, 23 (39.6%) patients experienced AMI due to coronary artery spasm, 15 (25.9%) due to arrhythmias, 11 (19%) due to severe anaemia, and nine (15.5%) due to hypertension, without significant coronary artery disease. 42 (72.4%) patients, were diagnosed as non-ST-segment elevation MI, 14 (24.1%) as ST-segment elevation MI, and two (3.5%) as AMI in the presence of ventricular paced rhythm. History of classical cardiovascular risk factors including hypertension, diabetes, dyslipidaemia, family history of heart diseases, and smoking was reported in 42 (72.4%), 14 (24.1%), 23 (39.7%), 24 (41.4%), and 16 (27.6%) cases, respectively. All-cause 30-day mortality rate was 5.2%, and six-month was 6.9%. Conclusions: Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation MI. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading causeof AMI was coronary artery spasm.

A 61-year-old obese (body mass index 36.6 kg/m2) male with diabetes mellitus was admitted to the hospital due to an exacerbation of chronic heart failure. He had poorly controlled arterial hypertension complicated by heart muscle hypertrophy and grade III retinopathy. Arterial hypertension was treated with renal denervation in the past, but the procedure did not result in any significant improvement in blood pressure (BP) control (prior to the hospitalisation the patient was receiving four hypotensive agents, including diuretic). On admission his office BP values were 170/85 mm Hg. The patient had his BP pharmacologically lowered, and was scheduled to have 24-h electrocardiography (ECG) Holter monitoring. ECG monitoring showed sinus rhythm with a mean heart rate of 56 bpm, and numerous ventricular extrasystoles. Also 975 sinus pauses lasting less than 2.55 s were recorded. The histograms depicted in Figure 1A show an association between the number of pauses per hour and the time of day. Interestingly, the pauses and most of the episodes of bradycardia were recorded in the nighttime. Few sinus pauses were also recorded during the patient’s nap in the late evening. Because of obesity and daytime sleepiness the patient was scheduled to have a whole-night polygraph examination (Embletta® MPR PG, Ontario, Canada), along with same-time ECG monitoring. The study revealed severe obstructive sleep apnoea (OSA) with an apnoea-hypopnea index of 48.3 per hour. The apnoea episodes were in close time-association with the bradycardia episodes, and pauses were directly induced by apnoea episodes. Figure 1B depicts a fragment of the polygraph study with visible, repetitive apnoea episodes associated with desaturation. The patient received treatment with continuous positive airway pressure (auto CPAP, ResMed S9 EscapeTM). He tolerated the treatment well. The patient had good compliance — he used the CPAP for at least 5.5 h every night. After 7 and 30 nights of treatment, extended 72-h ECG monitoring was performed. This time the study showed no episodes of bradycardia with heart rate lower than 52 bpm. The number of pauses was reduced by over 90%. Modification of hypertension pharmacotherapy along with CPAP use resulted also in significant lowering of the BP values, and ambulatory BP monitoring revealed normalisation of nocturnal values, with preserved dipping profile (Fig. 2). Six months after the hospitalisation the patient is doing well, he is tolerating the CPAP treatment perfectly, has good BP control, and has not suffered any heart failure exacerbations. The present case highlights the importance of OSA in the pathogenesis of cardiac arrhythmias and resistant hypertension. OSA is associated with repetitive episodes of hypoxaemia, desaturation, and microarousals, which, along with changes in the transthoracic pressure, promotes autonomic dysregulation and cardiac arrhythmias. Figure 2. Results of ambulatory blood pressure monitoring after continuous positive airway pressure treatment Figure 1. Daytime and nighttime distribution of electrocardio gram-proven sinus pauses (A), and potentially responsible, obstructive sleep apnoea episodes recorded in the polygraph study (B) A

Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause haemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in AF triggering and exacerbation. Coexistence of OSA and AF influences the course of both diseases, and therefore should be taken into consideration in patient management strategy planning.To assess the prevalence of OSA in Polish AF patients, and to describe the clinical characteristics of patients with concomitant OSA and AF.We enrolled into the study 289 consecutive patients hospitalised in a tertiary, high-volume Cardiology Department with a primary diagnosis of AF. In addition to standard examination, all patients underwent an overnight sleep study to diagnose OSA, which was defined as apnoea-hypopnoea index (AHI) ≥ 5 per hour.After applying exclusion criteria, the final analysis covered 266 patients (65.0% male, mean age 57.6 ± 10.1 years). OSA was present in 121 (45.49%) patients. Patients with OSA were older (59.6 ± 8.0 vs. 56.0 ± 11.4 years; p = 0.02), had higher body mass index (BMI; 30.9 ± 5.4 vs. 28.7 ± 4.4 kg/m²; p0.01) larger neck size (41.2 ± 3.8 vs. 39.3 ± 3.3 cm; p = 0.0001) and waist circumference (108.5 ± 13.1 vs. 107.7 ± 85.4 cm; p0.0001) than patients without OSA. There were no significant differences between the groups in terms of systolic and diastolic blood pressure or history of comorbidities (p0.05). OSA patients were less likely than non-OSA patients to have paroxysmal AF (62.0% vs. 75.9%; p = 0.02). Dividing newly diagnosed OSA patients according to the disease severity showed that mild OSA (AHI ≥ 5/h and15/h) was present in 27.82% of the study population, moderate OSA (AHI ≤ 15/h and ≥ 30/h) in 13.16% of patients, and severe OSA (30/h) in 4.51% of patients. No significant differences in terms of comorbidities and anthropometric features were seen between mild and moderate, between moderate and severe, and between mild and severe OSA.OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.

Background: Sleep duration and sleep quality affect patients’ general condition and self-reported health status. Aim: The aims of this study were: (1) to describe the clinical characteristic of ST-elevation myocardial infarction (STEMI) patients who sleep too little or too much; and (2) to determine whether sleep duration is independently associated witha higher risk of all-cause mortality. Methods: We enrolled into the study 407 consecutive patients admitted with a diagnosis of STEMI. All patients were asked for sleep duration in the first three months after being discharged from the hospital. According to the sleep duration, we divided patients into three groups: A — the reference category defined as 6–8 sleep hours, B — short sleep with 8 h. Results: The final analysis covered 379 patients (271 males; mean age 59.4 ± 10.61). 36 (9.5%) patients slept less than 6 h, 26 (6.9%) slept more than 8 h per night. The all-cause three-year mortality was 1.9% in the reference category, 13.9% in patients who slept less than 6 h, and 30.8% in patients who slept more than 8 h per night (p < 0.0001). In the multiple logistic regression analysis, short (OR 10.2, 95% CI 2.1–50, p = 0.004) and long sleep duration (OR 33.3, 95% CI 6.8–163.4, p < 0.001) were strong and independent predictors of all-cause mortality. Conclusions: Too short and especially too long duration of sleep in the first months after myocardial infarction are strong,independent predictors of all-cause mortality.

A 37 year-old male patient was admitted to the intensive care unit after an out-of-hospital cardiac arrest due to ventricular fibrillation in a course of ST-segment elevation acute coronary syndrome. On admission, the patient was unconscious with a Glasgow Coma Scale (GCS) score of 5. A percutaneous coronary intervention and mild therapeutic hypothermia (HT), defined as maintaining body temperature between 32°C and 34°C, were performed. During HT on ECG, we observed Osborn waves, which resolved spontaneously after re-warming. After five days of recovery, the patient scored 15 on GCS and did not show any neurological deficits.

We report a case of a 61-year-old male patient who presented with reduced exercise capacity, dyspnea, lower limbs oedema,irregular heart rhythm, loud, irregular snoring, history of poorly controlled hypertension, nocturnal hypertension spikes, andmorning headaches. Patient underwent ECG Holter monitoring and polygraphy, which revealed severe obstructive sleepapnea. In ECG Holter monitoring atrial fibrillation with pauses to 6.5 s were observed. Patient was referred for continuouspositive airway pressure (CPAP) treatment. Three-months of CPAP therapy resulted in significant decrease in apnea-hypopneaindex (31.6/h vs. 5.1/h) and better control of hypertension and heart failure. CPAP treatment allowed us to reduce patient's cardiovascular risk. Cardiologist should routinely screen and evaluate patients for sleep disordered breathing, especially when patients are obese, have hypertension and/or arrhythmias.