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

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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.

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Author notes

  1. Lien Desteghe and Jeroen M. L. Hendriks shared first authorship; Hein Heidbuchel, Dominik Linz shared last authorship.

Authors and Affiliations

  1. Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium

    Lien Desteghe, Paul Dendale & Hein Heidbuchel

  2. Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium

    Lien Desteghe & Paul Dendale

  3. Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

    Jeroen M. L. Hendriks, Prashanthan Sanders & Dominik Linz

  4. Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, 5042, Australia

    R. Doug McEvoy & Ching Li Chai-Coetzer

  5. University of Antwerp and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Hein Heidbuchel

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  1. Lien Desteghe
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  2. Jeroen M. L. Hendriks
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  4. Ching Li Chai-Coetzer
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  5. Paul Dendale
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  8. Dominik Linz
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Correspondence to Lien Desteghe.

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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.

Funding

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.

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Desteghe, L., Hendriks, J.M.L., McEvoy, R.D. et al. The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation. Clin Res Cardiol 107, 617–631 (2018). https://doi.org/10.1007/s00392-018-1248-9

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