The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation

Lien Desteghe, Jeroen M.L. Hendriks, R. Doug McEvoy, Ching Li Chai-Coetzer, Paul Dendale, Prash Sanders, Hein Heidbuchel, Dominik Linz

Research output: Contribution to journalReview articlepeer-review

49 Citations (Scopus)

Abstract

Sleep apnea is associated with increased cardiovascular risk and may be important in atrial fibrillation (AF) management. It is present in up to 62% of the AF population and is highly under-recognized and underdiagnosed. Obstructive sleep apnea (OSA) is strongly associated with AF and non-randomized trials have shown that its treatment can help to reduce AF recurrences and maintain sinus rhythm. The 2016 European Society of Cardiology guidelines for the management of AF recommend that AF patients should be questioned regarding the symptoms of OSA and that OSA-treatment should be optimized to improve AF treatment results. However, strategies on how to implement OSA testing in the standard work-up of AF patients are not provided in the guidelines. Additionally, overnight OSA monitoring rather than interrogation for OSA-related clinical signs alone may be necessary to reliably identify OSA in the majority of AF patients. This review summarizes the available clinical data on OSA in AF patients, and discusses the following key questions: Why and When is testing for OSA needed in AF patients? How and Where should it be performed and coordinated? and Who should test for OSA? To implement OSA testing in a cardiology or electrophysiology clinic, we propose a multidisciplinary integrated care approach based on a chronic care model. We describe the tools, infrastructure and coordination needed to test for OSA in the standard workup of patients with symptomatic AF prior to the initiation of directed invasive or pharmacological rhythm control management.

Original languageEnglish
Pages (from-to)617-631
Number of pages15
JournalClinical Research in Cardiology
Volume107
Issue number8
DOIs
Publication statusPublished or Issued - 1 Aug 2018

Keywords

  • Atrial fibrillation
  • Diagnosis
  • Integrated care
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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