USA: American Heart Association Statement on Sleep-Disordered Breathing and Cardiovascular Complications

The American Heart Association (AHA) has released a scientific statement on sleep-disordered breathing and cardiovascular complications. The scientific statement, published in the journal Circulation, outlines screening, diagnosis, and treatment recommendations for obstructive sleep apnea (OSA) and cardiovascular (CV) complications associated with the sleep disorder.

Obstructive sleep apnea (OSA) is characterized by recurrent complete and partial upper airway obstructive events, resulting in autonomic fluctuation, intermittent hypoxemia, and sleep fragmentation. Its prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse cardiovascular outcomes, OSA is often underrecognized and undertreated in cardiovascular practice.

Key Recommendations

• Screening for OSA is recommended in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation. In patients with New York Heart Association class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable.
• In patients with tachy-brady syndrome or ventricular tachycardia or survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, evaluation for sleep apnea should be considered.
• After stroke, clinical equipoise exists with respect to screening and treatment.
• Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have comorbid sleep apnea. All patients with OSA should be considered for treatment, including behavioral modifications and weight loss as indicated.
• Continuous positive airway pressure should be offered to patients with severe OSA, whereas oral appliances can be considered for those with mild to moderate OSA or for continuous positive airway pressure–intolerant patients.
• Follow-up sleep testing should be performed to assess the effectiveness of treatment.

The AHA noted in the scientific statement that there is a significant need to further explore the use of wearable devices and remote monitoring tools for screening and treatment of OSA. In addition, better CV risk stratification protocols are needed for patients with OSA, the AHA concluded.

Reference

"Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association," is published in the journal Circulation.

DOI: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000988