Clinical Research in Cardiology

, Volume 107, Issue 8, pp 617–631 | Cite as

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

  • Lien DestegheEmail author
  • Jeroen M. L. Hendriks
  • R. Doug McEvoy
  • Ching Li Chai-Coetzer
  • Paul Dendale
  • Prashanthan Sanders
  • Hein Heidbuchel
  • Dominik Linz


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.


Atrial fibrillation Obstructive sleep apnea Integrated care Diagnosis 


Compliance with ethical standards

Conflict of interest

H. H. reports personal fees (before June 2017) from Abbott, Pfizer/BMS, Daiichi-Sankyo, Boehringer-Ingelheim, Cardiome; he received no personal fees after June 2017; he received research grants from Bayer, Bracco Imaging Europe, Medtronic, and St. Jude Medical through the University of Hasselt or University of Antwerp. J.H. is supported by a Postdoctoral Fellowship from the National Heart Foundation of Australia and by the Derek Frewin Lectureship from the University of Adelaide, Australia. D.M. is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia. D.M. reports receiving research funding from Philips Respironics, ResMed and Fisher&Paykel. P.S. is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. The University of Adelaide receives on behalf of P.S. research funding from Medtronic, St Jude Medical, Boston Scientific, Biotronik and Liva Nova. D.L is supported by a Beacon Research Fellowship by the University of Adelaide. D.L. reports receiving research funding from Sanofi, ResMed, Liva Nova and Medtronic.


This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Publication of this article was not funded.


  1. 1.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18(11):1609–1678PubMedCrossRefGoogle Scholar
  2. 2.
    Gallagher C, Hendriks JM, Mahajan R, Middeldorp ME, Elliott AD, Pathak RK et al (2016) Lifestyle management to prevent and treat atrial fibrillation. Expert Rev Cardiovasc Ther 14(7):799–809PubMedCrossRefGoogle Scholar
  3. 3.
    Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ et al (2011) Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 123(14):1501–1508PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D et al (2014) Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: The ARREST-AF cohort study. J Am Coll Cardiol 64(21):2222–2231PubMedCrossRefGoogle Scholar
  5. 5.
    Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME et al (2013) Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 310(19):2050–2060PubMedCrossRefGoogle Scholar
  6. 6.
    Menezes AR, Lavie CJ, De Schutter A, Milani RV, O’Keefe J, DiNicolantonio JJ et al (2015) Lifestyle modification in the prevention and treatment of atrial fibrillation. Prog Cardiovasc Dis 58(2):117–125PubMedCrossRefGoogle Scholar
  7. 7.
    Miller JD, Aronis KN, Chrispin J, Patil KD, Marine JE, Martin SS et al (2015) Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol 66(25):2899–2906PubMedCrossRefGoogle Scholar
  8. 8.
    Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX et al (2015) Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol 65(20):2159–2169PubMedCrossRefGoogle Scholar
  9. 9.
    Lau DH, Nattel S, Kalman JM, Sanders P (2017) Modifiable Risk Factors Atrial Fibrillation Circulation 136(6):583–596PubMedGoogle Scholar
  10. 10.
    Linz D, Linz B, Hohl M, Bohm M (2016) Atrial arrhythmogenesis in obstructive sleep apnea: therapeutic implications. Sleep Med Rev 26:87–94PubMedCrossRefGoogle Scholar
  11. 11.
    Digby GC, Baranchuk A (2012) Sleep apnea and atrial fibrillation; 2012 update. Curr Cardiol Rev 8(4):265–272PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE et al (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110(4):364–367PubMedCrossRefGoogle Scholar
  13. 13.
    Stevenson IH, Teichtahl H, Cunnington D, Ciavarella S, Gordon I, Kalman JM (2008) Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J 29(13):1662–1669PubMedCrossRefGoogle Scholar
  14. 14.
    Strotmann J, Fox H, Bitter T, Sauzet O, Horstkotte D, Oldenburg O (2018) Characteristics of sleep-disordered breathing in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clin Res Cardiol 107(2):120–129PubMedCrossRefGoogle Scholar
  15. 15.
    Altmann DR, Ullmer E, Rickli H, Maeder MT, Sticherling C, Schaer BA et al (2012) Clinical impact of screening for sleep related breathing disorders in atrial fibrillation. Int J Cardiol 154(3):256–258PubMedCrossRefGoogle Scholar
  16. 16.
    Szymanski FM, Platek AE, Karpinski G, Kozluk E, Puchalski B, Filipiak KJ (2014) Obstructive sleep apnoea in patients with atrial fibrillation: prevalence, determinants and clinical characteristics of patients in Polish population. Kardiol Pol 72(8):716–724PubMedCrossRefGoogle Scholar
  17. 17.
    Bitter T, Langer C, Vogt J, Lange M, Horstkotte D, Oldenburg O (2009) Sleep-disordered breathing in patients with atrial fibrillation and normal systolic left ventricular function. Dtsch Arztebl Int 106(10):164–170PubMedPubMedCentralGoogle Scholar
  18. 18.
    Porthan KM, Melin JH, Kupila JT, Venho KK, Partinen MM (2004) Prevalence of sleep apnea syndrome in lone atrial fibrillation: a case-control study. Chest 125(3):879–885PubMedCrossRefGoogle Scholar
  19. 19.
    Holmqvist F, Guan N, Zhu Z, Kowey PR, Allen LA, Fonarow GC et al (2015) Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J 169(5):647–654 e2PubMedCrossRefGoogle Scholar
  20. 20.
    Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K et al (2013) Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol 62(4):300–305PubMedCrossRefGoogle Scholar
  21. 21.
    Naruse Y, Tada H, Satoh M, Yanagihara M, Tsuneoka H, Hirata Y et al (2013) Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy. Heart Rhythm 10(3):331–337PubMedCrossRefGoogle Scholar
  22. 22.
    Neilan TG, Farhad H, Dodson JA, Shah RV, Abbasi SA, Bakker JP et al (2013) Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. J Am Heart Assoc 2(6):e000421PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Qureshi WT, Nasir UB, Alqalyoobi S, O’Neal WT, Mawri S, Sabbagh S et al (2015) Meta-analysis of continuous positive airway pressure as a therapy of atrial fibrillation in obstructive sleep apnea. Am J Cardiol 116(11):1767–1773PubMedCrossRefGoogle Scholar
  24. 24.
    Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV et al (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107(20):2589–2594PubMedCrossRefGoogle Scholar
  25. 25.
    Patel D, Mohanty P, Di Biase L, Shaheen M, Lewis WR, Quan K et al (2010) Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circ Arrhythm Electrophysiol 3(5):445–451PubMedCrossRefGoogle Scholar
  26. 26.
    Li L, Wang ZW, Li J, Ge X, Guo LZ, Wang Y et al (2014) Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: a meta-analysis of observational studies. Europace 16(9):1309–1314PubMedCrossRefGoogle Scholar
  27. 27.
    Bazan V, Grau N, Valles E, Felez M, Sanjuas C, Cainzos-Achirica M et al (2013) Obstructive sleep apnea in patients with typical atrial flutter: prevalence and impact on arrhythmia control outcome. Chest 143(5):1277–1283PubMedCrossRefGoogle Scholar
  28. 28.
    Shukla A, Aizer A, Holmes D, Fowler S, Park DS, Bernstein S et al (2015) Effect of obstructive sleep apnea treatment on atrial fibrillation recurrence: a meta-analysis. JACC Clin Electrophysiol 1(1–2):41–51PubMedCrossRefGoogle Scholar
  29. 29.
    Anter E, Zimetbaum P, Josephson M (2012) Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence following catheter ablation. J Am Coll Cardiol 59(13):E612CrossRefGoogle Scholar
  30. 30.
    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A (2001) Improving chronic illness care: translating evidence into action. Health affairs (Project Hope) 20(6):64–78CrossRefGoogle Scholar
  31. 31.
    Chesson AL, Ferber RA, Fry JM, Grigg-Damberger M, Hartse KM, Hurwitz TD et al (1997) Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep 20(6):406–422CrossRefGoogle Scholar
  32. 32.
    Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr et al (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383(9918):736–747PubMedCrossRefGoogle Scholar
  34. 34.
    Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT (2009) The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 32(2):150–157PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    McNicholas WT (2008) Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc 5(2):154–160PubMedCrossRefGoogle Scholar
  36. 36.
    Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T et al (2007) Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 49(5):565–571PubMedCrossRefGoogle Scholar
  37. 37.
    Braga B, Poyares D, Cintra F, Guilleminault C, Cirenza C, Horbach S et al (2009) Sleep-disordered breathing and chronic atrial fibrillation. Sleep Med 10(2):212–216PubMedCrossRefGoogle Scholar
  38. 38.
    Hoyer FF, Lickfett LM, Mittmann-Braun E, Ruland C, Kreuz J, Pabst S et al (2010) High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol 29(1):37–41PubMedCrossRefGoogle Scholar
  39. 39.
    Farrehi PM, O’Brien LM, Bas HD, Baser K, Jongnarangsin K, Latchamsetty R et al (2015) Occult obstructive sleep apnea and clinical outcomes of radiofrequency catheter ablation in patients with atrial fibrillation. J Interv Card Electrophysiol 43(3):279–286PubMedCrossRefGoogle Scholar
  40. 40.
    Albuquerque FN, Calvin AD, Sert Kuniyoshi FH, Konecny T, Lopez-Jimenez F, Pressman GS et al (2012) Sleep-disordered breathing and excessive daytime sleepiness in patients with atrial fibrillation. Chest 141(4):967–973PubMedCrossRefGoogle Scholar
  41. 41.
    Szymanski FM, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Karpinski G, Opolski G (2015) Assessment of CHADS2 and CHA2DS2-VASc scores in obstructive sleep apnea patients with atrial fibrillation. Sleep Breathing 19(2):531–537PubMedCrossRefGoogle Scholar
  42. 42.
    Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Goyal SK, Sharma A (2013) Atrial fibrillation in obstructive sleep apnea. World J Cardiol 5(6):157–163PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Ng CY, Liu T, Shehata M, Stevens S, Chugh SS, Wang X (2011) Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol 108(1):47–51PubMedCrossRefGoogle Scholar
  45. 45.
    Goudis CA, Ketikoglou DG (2017) Obstructive sleep and atrial fibrillation: pathophysiological mechanisms and therapeutic implications. Int J Cardiol 230:293–300PubMedCrossRefGoogle Scholar
  46. 46.
    Latina JM, Estes NAM, Garlitski AC (2013) The relationship between obstructive sleep apnea and atrial fibrillation: a complex interplay. Pulm Med 2013:621736PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Oza N, Baveja S, Khayat R, Houmsse M (2014) Obstructive sleep apnea and atrial fibrillation: understanding the connection. Expert Rev Cardiovasc Ther 12(5):613–621PubMedCrossRefGoogle Scholar
  48. 48.
    Nalliah CJ, Sanders P, Kalman JM (2016) Obstructive sleep apnea treatment and atrial fibrillation: a need for definitive evidence. J Cardiovasc Electrophysiol 27(8):1001–1010PubMedCrossRefGoogle Scholar
  49. 49.
    Zhang L, Hou Y, Po SS (2015) Obstructive sleep apnoea and atrial fibrillation. Arrhythm Electrophysiol Rev 4(1):14–18PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Matassini MV, Brambatti M, Guerra F, Scappini L, Capucci A (2015) Sleep-disordered breathing and atrial fibrillation: review of the evidence. Cardiol Rev 23(2):79–86PubMedCrossRefGoogle Scholar
  51. 51.
    Needleman M, Calkins H (2011) The role of obesity and sleep apnea in atrial fibrillation. Curr Opin Cardiol 26(1):40–45PubMedCrossRefGoogle Scholar
  52. 52.
    Drew D, Qaddoura A, Baranchuk A (2014) The relationship between obstructive sleep apnea and atrial fibrillation in special patient populations. Expert Rev Cardiovasc Ther 12(11):1337–1348PubMedCrossRefGoogle Scholar
  53. 53.
    Gami AS, Friedman PA, Chung MK, Caples SM, Somers VK (2005) Therapy Insight: interactions between atrial fibrillation and obstructive sleep apnea. Nat Clin Pract Cardiovasc Med 2(3):145–149PubMedCrossRefGoogle Scholar
  54. 54.
    Dimitri H, Ng M, Brooks AG, Kuklik P, Stiles MK, Lau DH et al (2012) Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart Rhythm 9(3):321–327PubMedCrossRefGoogle Scholar
  55. 55.
    Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, Levy P et al (2018) Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. PubMedCrossRefGoogle Scholar
  56. 56.
    Cowie MR (2017) Sleep apnea: state of the art. Trends Cardiovasc Med 27(4):280–289PubMedCrossRefGoogle Scholar
  57. 57.
    Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Bohm M et al (2015) The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 104(9):705–718PubMedCrossRefGoogle Scholar
  58. 58.
    Linz D, Fox H, Bitter T, Spiesshofer J, Schobel C, Skobel E et al (2016) Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies. Clin Res Cardiol 105(7):563–570PubMedCrossRefGoogle Scholar
  59. 59.
    Fox H, Bitter T, Horstkotte D, Oldenburg O (2016) Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea. Clin Res Cardiol 105(5):451–459PubMedCrossRefGoogle Scholar
  60. 60.
    Lau DH, Linz D, Schotten U, Mahajan R, Sanders P, Kalman JM (2017) Pathophysiology of paroxysmal and persistent atrial fibrillation: rotors, foci and fibrosis. Heart Lung Circ 26(9):887–893PubMedCrossRefGoogle Scholar
  61. 61.
    Costa LE, Uchôa CHG, Harmon RR, Bortolotto LA, Lorenzi-Filho G, Drager LF (2015) Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart 101(16):1288–1292PubMedCrossRefGoogle Scholar
  62. 62.
    Loo G, Hein T, Tai BC, Khoo SM, Chan MY, Chia BL et al (2013) Screening of hospitalized patients at high risk of obstructive sleep apnea in general cardiology service. Int J Cardiol 164(3):368–370PubMedCrossRefGoogle Scholar
  63. 63.
    Monahan K, Brewster J, Wang L, Parvez B, Goyal S, Roden DM et al (2012) Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 110(3):369–372PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Mazza A, Bendini MG, Cristofori M, Nardi S, Leggio M, De Cristofaro R et al (2009) Baseline apnoea/hypopnoea index and high-sensitivity C-reactive protein for the risk of recurrence of atrial fibrillation after successful electrical cardioversion: a predictive model based upon the multiple effects of significant variables. Europace 11(7):902–909PubMedCrossRefGoogle Scholar
  65. 65.
    Jongnarangsin K, Chugh A, Good E, Mukerji S, Dey S, Crawford T et al (2008) Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 19(7):668–672PubMedCrossRefGoogle Scholar
  66. 66.
    Chilukuri K, Dalal D, Marine JE, Scherr D, Henrikson CA, Cheng A et al (2009) Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace 11(7):896–901PubMedCrossRefGoogle Scholar
  67. 67.
    Matiello M, Nadal M, Tamborero D, Berruezo A, Montserrat J, Embid C et al (2010) Low efficacy of atrial fibrillation ablation in severe obstructive sleep apnoea patients. Europace 12(8):1084–1089PubMedCrossRefGoogle Scholar
  68. 68.
    Mohanty S, Mohanty P, Di Biase L, Bai R, Trivedi C, Santangeli P et al (2014) Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes. J Cardiovasc Electrophysiol 25(9):930–938PubMedCrossRefGoogle Scholar
  69. 69.
    Szymanski FM, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Kotkowski M, Kozluk E et al (2015) Presence and severity of obstructive sleep apnea and remote outcomes of atrial fibrillation ablations - a long-term prospective, cross-sectional cohort study. Sleep Breath 19(3):849–856PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Bitter T, Nolker G, Vogt J, Prinz C, Horstkotte D, Oldenburg O (2012) Predictors of recurrence in patients undergoing cryoballoon ablation for treatment of atrial fibrillation: the independent role of sleep-disordered breathing. J Cardiovasc Electrophysiol 23(1):18–25PubMedCrossRefGoogle Scholar
  71. 71.
    Sauer WH, McKernan ML, Lin D, Gerstenfeld EP, Callans DJ, Marchlinski FE (2006) Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm 3(9):1024–1028PubMedCrossRefGoogle Scholar
  72. 72.
    Chilukuri K, Dalal D, Gadrey S, Marine JE, Macpherson E, Henrikson CA et al (2010) A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 21(5):521–525PubMedCrossRefGoogle Scholar
  73. 73.
    Yaranov DM, Smyrlis A, Usatii N, Butler A, Petrini JR, Mendez J et al (2015) Effect of obstructive sleep apnea on frequency of stroke in patients with atrial fibrillation. Am J Cardiol 115(4):461–465PubMedCrossRefGoogle Scholar
  74. 74.
    Mansukhani MP, Calvin AD, Kolla BP, Brown RD Jr, Lipford MC, Somers VK et al (2013) The association between atrial fibrillation and stroke in patients with obstructive sleep apnea: a population-based case-control study. Sleep Med 14(3):243–246PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Butt M, Dwivedi G, Khair O, Lip GY (2010) Obstructive sleep apnea and cardiovascular disease. Int J Cardiol 139(1):7–16PubMedCrossRefGoogle Scholar
  76. 76.
    Bauters F, Rietzschel ER, Hertegonne KB, Chirinos JA (2016) The link between obstructive sleep apnea and cardiovascular disease. Curr Atheroscler Rep 18(1):1PubMedCrossRefGoogle Scholar
  77. 77.
    Monahan K, Redline S (2011) Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol 26(6):541–547PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–576Google Scholar
  79. 79.
    Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M et al (2010) Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessels 25(1):63–69PubMedCrossRefGoogle Scholar
  80. 80.
    McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X et al (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375(10):919–931PubMedCrossRefGoogle Scholar
  81. 81.
    Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V et al (2017) Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. JAMA 318(2):156–166PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A et al (2010) Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 28(10):2161–2168PubMedCrossRefGoogle Scholar
  83. 83.
    Denker MG, Cohen DL (2014) Use of continuous positive airway pressure for sleep apnea in the treatment of hypertension. Curr Opin Nephrol Hypertens 23(5):462–467PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Feldstein CA (2016) Blood pressure effects of CPAP in nonresistant and resistant hypertension associated with OSA: a systematic review of randomized clinical trials. Clin Exp Hypertens 38(4):337–346PubMedCrossRefGoogle Scholar
  85. 85.
    Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A et al (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 167(8):757–764PubMedCrossRefGoogle Scholar
  86. 86.
    Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR et al (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359(9302):204–210PubMedCrossRefGoogle Scholar
  87. 87.
    Montesi SB, Edwards BA, Malhotra A, Bakker JP (2012) The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med 8(5):587–596PubMedPubMedCentralGoogle Scholar
  88. 88.
    Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M et al (2013) Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 310(22):2407–2415PubMedCrossRefGoogle Scholar
  89. 89.
    Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107(1):68–73PubMedCrossRefGoogle Scholar
  90. 90.
    Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ et al (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 307(20):2169–2176PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 50(2):417–423PubMedCrossRefGoogle Scholar
  92. 92.
    Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC et al (2014) Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest 145(4):762–771PubMedCrossRefGoogle Scholar
  93. 93.
    Duran-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Teran-Santos J, Aguirregomoscorta JI et al (2010) Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 341:c5991PubMedCrossRefGoogle Scholar
  94. 94.
    Barbe F, Duran-Cantolla J, Capote F, de la Pena M, Chiner E, Masa JF et al (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726PubMedCrossRefGoogle Scholar
  95. 95.
    Schein AS, Kerkhoff AC, Coronel CC, Plentz RD, Sbruzzi G (2014) Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients. J Hypertens 32(9):1762–1773PubMedCrossRefGoogle Scholar
  96. 96.
    Craig SE, Kohler M, Nicoll D, Bratton DJ, Nunn A, Davies R et al (2012) Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial. Thorax 67(12):1090–1096PubMedCrossRefGoogle Scholar
  97. 97.
    Malhotra A, White DP (2002) Obstructive sleep apnoea. Lancet 360(9328):237–245PubMedCrossRefGoogle Scholar
  98. 98.
    Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276PubMedGoogle Scholar
  99. 99.
    Johns MW (1990) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545CrossRefGoogle Scholar
  100. 100.
    Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J et al (2009) Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol 54(19):1797–1804PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton MT (2000) Effect of moderate alcohol upon obstructive sleep apnoea. Eur Respir J 16(5):909–913PubMedCrossRefGoogle Scholar
  102. 102.
    Taasan VC, Block AJ, Boysen PG, Wynne JW (1981) Alcohol increases sleep apnea and oxygen desaturation in asymptomatic men. Am J Med 71(2):240–245PubMedCrossRefGoogle Scholar
  103. 103.
    Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M et al (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19(12):2271–2277PubMedCrossRefGoogle Scholar
  104. 104.
    Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M (2008) Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep 31(6):795–800PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Gula LJ, Krahn AD, Skanes AC, Yee R, Klein GJ (2004) Clinical relevance of arrhythmias during sleep: guidance for clinicians. Heart 90(3):347–352PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Kawano Y, Tamura A, Ono K, Kadota J (2014) Association between obstructive sleep apnea and premature supraventricular contractions. J Cardiol 63(1):69–72PubMedCrossRefGoogle Scholar
  107. 107.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491PubMedCrossRefGoogle Scholar
  108. 108.
    Tang RB, Dong JZ, Liu XP, Kang JP, Ding SF, Wang L et al (2009) Obstructive sleep apnoea risk profile and the risk of recurrence of atrial fibrillation after catheter ablation. Europace 11(1):100–105PubMedCrossRefGoogle Scholar
  109. 109.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S et al (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5):812–821PubMedCrossRefGoogle Scholar
  110. 110.
    Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S et al (2015) Validation of the STOP-Bang Questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PloS one 10(12):e0143697PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  112. 112.
    Takegami M, Hayashino Y, Chin K, Sokejima S, Kadotani H, Akashiba T et al (2009) Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep 32(7):939–948PubMedPubMedCentralGoogle Scholar
  113. 113.
    Chai-Coetzer CL, Antic NA, Rowland LS, Catcheside PG, Esterman A, Reed RL et al (2011) A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care. Thorax 66(3):213–219PubMedCrossRefGoogle Scholar
  114. 114.
    Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M et al (2016) The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med 4(9):742–748PubMedCrossRefGoogle Scholar
  115. 115.
    Arzt M, Young T, Peppard PE, Finn L, Ryan CM, Bayley M et al (2010) Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke. Stroke 41(3):e129-34PubMedCrossRefGoogle Scholar
  116. 116.
    Arzt M, Young T, Finn L, Skatrud JB, Ryan CM, Newton GE et al (2006) Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 166(16):1716–1722PubMedCrossRefGoogle Scholar
  117. 117.
    Ferber R, Millman R, Coppola M, Fleetham J, Murray CF, Iber C et al (1994) Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 17(4):378–392PubMedCrossRefGoogle Scholar
  118. 118.
    Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Frohnhofen H et al (2017) German S3 Guideline Nonrestorative Sleep/Sleep Disorders, chapter “Sleep-Related Breathing Disorders in Adults,” short version: German Sleep Society (Deutsche Gesellschaft fur Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl) 21(4):290–301CrossRefGoogle Scholar
  119. 119.
    Blackman A, McGregor C, Dales R, Driver HS, Dumov I, Fleming J et al (2010) Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults. Can Respir J 17(5):229–232PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Kapoor M, Greenough G (2015) Home Sleep Tests for Obstructive Sleep Apnea (OSA). J Am Board Fam Pract 28(4):504–509CrossRefGoogle Scholar
  121. 121.
    Flemons WW, Littner MR, Rowley JA, Gay P, Anderson WM, Hudgel DW et al (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124(4):1543–1579PubMedCrossRefGoogle Scholar
  122. 122.
    Malhotra A, Younes M, Kuna ST, Benca R, Kushida CA, Walsh J et al (2013) Performance of an automated polysomnography scoring system versus computer-assisted manual scoring. Sleep 36(4):573–582PubMedPubMedCentralCrossRefGoogle Scholar
  123. 123.
    Pittman SD, MacDonald MM, Fogel RB, Malhotra A, Todros K, Levy B et al (2004) Assessment of automated scoring of polysomnographic recordings in a population with suspected sleep-disordered breathing. Sleep 27(7):1394–1403PubMedCrossRefGoogle Scholar
  124. 124.
    Aurora RN, Swartz R, Punjabi NM (2015) Misclassification of OSA Severity with automated scoring of home sleep recordings. Chest 147(3):719–727PubMedCrossRefGoogle Scholar
  125. 125.
    Rosen CL, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V et al (2012) A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep 35(6):757–767PubMedPubMedCentralCrossRefGoogle Scholar
  126. 126.
    Kuna ST, Gurubhagavatula I, Maislin G, Hin S, Hartwig KC, McCloskey S et al (2011) Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med 183(9):1238–1244PubMedCrossRefGoogle Scholar
  127. 127.
    Berry RB, Hill G, Thompson L, McLaurin V (2008) Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep 31(10):1423–1431PubMedPubMedCentralGoogle Scholar
  128. 128.
    Chai-Coetzer C, Antic NA, Hamilton GS et al (2017) Physician decision making and clinical outcomes with laboratory polysomnography or limited-channel sleep studies for obstructive sleep apnea: a randomized trial. Ann Intern Med 166(5):332–340PubMedCrossRefGoogle Scholar
  129. 129.
    Corral J, Sanchez-Quiroga MA, Carmona-Bernal C, Sanchez-Armengol A, Sanchez-de-la-Torre A, Duran-Cantolla J et al (2017) Conventional polysomnography is not necessary for the management of most patients with suspected obstructive sleep apnea. Am J Respir Crit Care Med 196(9):1181–1190PubMedCrossRefGoogle Scholar
  130. 130.
    El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D (2014) Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 186(1):E25-E51PubMedCentralCrossRefGoogle Scholar
  131. 131.
    Nerfeldt P, Aoki F, Friberg D (2014) Polygraphy vs. polysomnography: missing osas in symptomatic snorers—a reminder for clinicians. Sleep Breath 18(2):297–303PubMedCrossRefGoogle Scholar
  132. 132.
    Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice guideline. J Clin Sleep Med 13(3):479–504PubMedPubMedCentralCrossRefGoogle Scholar
  133. 133.
    Gantner D, Ge JY, Li LH, Antic N, Windler S, Wong K et al (2010) Diagnostic accuracy of a questionnaire and simple home monitoring device in detecting obstructive sleep apnoea in a Chinese population at high cardiovascular risk. Respirology 15(6):952–960PubMedCrossRefGoogle Scholar
  134. 134.
    Aaronson JA, van Bezeij T, van den Aardweg JG, van Bennekom CA, Hofman WF (2012) Diagnostic accuracy of nocturnal oximetry for detection of sleep apnea syndrome in stroke rehabilitation. Stroke 43(9):2491–2493PubMedCrossRefGoogle Scholar
  135. 135.
    Golpe R, Jimenez A, Carpizo R, Cifrian JM (1999) Utility of home oximetry as a screening test for patients with moderate to severe symptoms of obstructive sleep apnea. Sleep 22(7):932–937PubMedGoogle Scholar
  136. 136.
    Williams AJ, Yu G, Santiago S, Stein M (1991) Screening for sleep apnea using pulse oximetry and a clinical score. Chest 100(3):631–635PubMedCrossRefGoogle Scholar
  137. 137.
    Ryan PJ, Hilton MF, Boldy DA, Evans A, Bradbury S, Sapiano S et al (1995) Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided? Thorax 50(9):972–975PubMedPubMedCentralCrossRefGoogle Scholar
  138. 138.
    Levy P, Pepin JL, Deschaux-Blanc C, Paramelle B, Brambilla C (1996) Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest 109(2):395–399PubMedCrossRefGoogle Scholar
  139. 139.
    Epstein LJ, Dorlac GR (1998) Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest 113(1):97–103PubMedCrossRefGoogle Scholar
  140. 140.
    Fox H, Bitter T, Gutleben KJ, Horstkotte D, Oldenburg O (2014) Cardiac or other implantable electronic devices and sleep-disordered breathing—implications for diagnosis and therapy. Arrhythm Electrophysiol Rev 3(2):116–119PubMedPubMedCentralCrossRefGoogle Scholar
  141. 141.
    Defaye P, de la Cruz I, Marti-Almor J, Villuendas R, Bru P, Senechal J et al (2014) A pacemaker transthoracic impedance sensor with an advanced algorithm to identify severe sleep apnea: the DREAM European study. Heart Rhythm 11(5):842–848PubMedCrossRefGoogle Scholar
  142. 142.
    Shalaby A, Atwood C, Hansen C, Konermann M, Jamnadas P, Lee K et al (2006) Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor. Pacing Clin Electrophysiol 29(10):1036–1043PubMedCrossRefGoogle Scholar
  143. 143.
    Scharf C, Cho YK, Bloch KE, Brunckhorst C, Duru F, Balaban K et al (2004) Diagnosis of sleep-related breathing disorders by visual analysis of transthoracic impedance signals in pacemakers. Circulation 110(17):2562–2567PubMedCrossRefGoogle Scholar
  144. 144.
    Defaye P, Pepin JL, Poezevara Y, Mabo P, Murgatroyd F, Levy P et al (2004) Automatic recognition of abnormal respiratory events during sleep by a pacemaker transthoracic impedance sensor. J Cardiovasc Electrophysiol 15(9):1034–1040PubMedCrossRefGoogle Scholar
  145. 145.
    Mazza A, Bendini MG, De Cristofaro R, Lovecchio M, Valsecchi S, Boriani G (2017) Pacemaker-detected severe sleep apnea predicts new-onset atrial fibrillation. Europace 19(12):1937–1943PubMedCrossRefGoogle Scholar
  146. 146.
    Stippig A, Hubers U, Emerich M (2015) Apps in sleep medicine. Sleep Breath 19(1):411–417PubMedCrossRefGoogle Scholar
  147. 147.
    Lorenz CP, Williams AJ (2017) Sleep apps: what role do they play in clinical medicine? Curr Opin Pulm Med 23(6):512–516PubMedCrossRefGoogle Scholar
  148. 148.
    Antic NA, Buchan C, Esterman A, Hensley M, Naughton MT, Rowland S et al (2009) A randomized controlled trial of nurse-led care for symptomatic moderate–severe obstructive sleep apnea. Am J Respir Crit Care Med 179(6):501–508PubMedCrossRefGoogle Scholar
  149. 149.
    Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R et al (2015) Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT Study. J Am Coll Cardiol 66(9):985–996PubMedCrossRefGoogle Scholar
  150. 150.
    Pathak RK, Evans M, Middeldorp ME, Mahajan R, Mehta AB, Meredith M et al. (2017) Cost-effectiveness and clinical effectiveness of the risk factor management clinic in atrial fibrillation: the CENT study. JACC Clin Electrophysiol ;3(5):436 – 47PubMedCrossRefGoogle Scholar
  151. 151.
    Kirchhof P (2017) The future of atrial fibrillation management: integrated care and stratified therapy. Lancet 390(10105):1873–1887PubMedCrossRefGoogle Scholar
  152. 152.
    Berti D, Hendriks JM, Brandes A, Deaton C, Crijns HJ, Camm AJ et al (2013) A proposal for interdisciplinary, nurse-coordinated atrial fibrillation expert programmes as a way to structure daily practice. Eur Heart J 34(35):2725–2730PubMedCrossRefGoogle Scholar
  153. 153.
    Gallagher C, Elliott AD, Wong CX, Rangnekar G, Middeldorp ME, Mahajan R et al (2017) Integrated care in atrial fibrillation: a systematic review and meta-analysis. Heart 103(24):1947–1953PubMedGoogle Scholar
  154. 154.
    Hendriks JM, de Wit R, Crijns HJ, Vrijhoef HJ, Prins MH, Pisters R et al (2012) Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J 33(21):2692–2699PubMedCrossRefGoogle Scholar
  155. 155.
    Hendriks J, Tomini F, van Asselt T, Crijns H, Vrijhoef H (2013) Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation. Europace 15(8):1128–1135PubMedCrossRefGoogle Scholar
  156. 156.
    Stewart S, Ball J, Horowitz JD, Marwick TH, Mahadevan G, Wong C et al (2015) Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet 385(9970):775–784PubMedCrossRefGoogle Scholar
  157. 157.
    Carter L, Gardner M, Magee K, Fearon A, Morgulis I, Doucette S et al (2016) An Integrated management approach to atrial fibrillation. J Am Heart Assoc 5(1):e002950PubMedPubMedCentralCrossRefGoogle Scholar
  158. 158.
    Inglis S, McLennan S, Dawson A, Birchmore L, Horowitz JD, Wilkinson D et al (2004) A new solution for an old problem? Effects of a nurse-led, multidisciplinary, home-based intervention on readmission and mortality in patients with chronic atrial fibrillation. J Cardiovasc Nurs 19(2):118–127PubMedCrossRefGoogle Scholar
  159. 159.
    Qvist I, Hendriks JM, Moller DS, Albertsen AE, Mogensen HM, Oddershede GD et al (2016) Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population. Open Heart 3(1):e000335PubMedPubMedCentralCrossRefGoogle Scholar
  160. 160.
    Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG et al (2013) Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA 309(10):997–1004PubMedCrossRefGoogle Scholar
  161. 161.
    McEvoy RD, Chai-Coetzer CL, Antic NA (2016) Ambulatory diagnosis and management of obstructive sleep apnea: Screening Questionnaires, Diagnostic Tests, and the Care Team. Sleep Med Clin 11(3):265–272PubMedCrossRefGoogle Scholar
  162. 162.
    Chai-Coetzer CL, Aiyappan V, Antic NA (2014) Ambulatory management strategies for obstructive sleep apnea. Semin Respir Crit Care Med 35(5):545–551PubMedCrossRefGoogle Scholar
  163. 163.
    Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M (2008) Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 15(7):365–369PubMedPubMedCentralCrossRefGoogle Scholar
  164. 164.
    Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M (2014) Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study. BMC Pulm Med 14:188PubMedPubMedCentralCrossRefGoogle Scholar
  165. 165.
    Sin DD, Mayers I, Man GCW, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121(2):430–435PubMedCrossRefGoogle Scholar
  166. 166.
    Gulati A, Ali M, Davies M, Quinnell T, Smith I (2017) A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome. BMC Pulm Med 17(1):56PubMedPubMedCentralCrossRefGoogle Scholar
  167. 167.
    McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Medicine and Life SciencesHasselt UniversityHasseltBelgium
  2. 2.Heart Center HasseltJessa HospitalHasseltBelgium
  3. 3.Centre for Heart Rhythm Disorders, South Australian Health and Medical Research InstituteUniversity of Adelaide and Royal Adelaide HospitalAdelaideAustralia
  4. 4.Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University and Sleep Health Service, Respiratory and Sleep ServicesSouthern Adelaide Local Health NetworkAdelaideAustralia
  5. 5.University of Antwerp and Antwerp University HospitalEdegemBelgium

Personalised recommendations