Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of Sleep Medicine/Taiwan Society of Pulmonary and Critical Care Medicine joint consensus statement
Journal
Journal of the Formosan Medical Association
Journal Volume
123
Journal Issue
2
Pages
159
Date Issued
2024
Author(s)
Hao-Min Cheng
Cheng-Yi Wang
Li-Pang Chuang
Chou-Han Lin
Liang-Wen Hang
Chung-Lieh Hung
Ching-Lung Liu
Kun-Ta Chou
Mao-Chang Su
Kai-Hung Cheng
CHUN-YAO HUANG
Charles Jia-Yin Hou
Kuo-Liang Chiu
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
Recommendation
1. We suggest that a 24- to 48-hour electrocardiogram monitor, in addition to history, pulse taking, and auscultation, be used to detect AF in patients with obstructive sleep apnea (OSA).
2. We suggest using a screening questionnaire identify OSA in patients with AF.
Patients who are identified as having a high risk of OSA or a low risk with clinical
concern should undergo diagnostic testing to confirm the diagnosis of OSA.
3. We suggest that home sleep apnea testing be used for the diagnosis of OSA in patients with AF.
4. We recommend that clinicians use continuous positive airway pressure (CPAP) to treat OSA in AF patients to reduce AF recurrence after catheter ablation.
5. We suggest that clinicians screen OSA patients for hypertension by home bloodpressure monitoring following the “722” protocol (preferred method), ambulatory blood pressure monitoring or office blood pressure monitoring.
6. We suggest that clinicians screen for OSA among hypertensive patients, especially those with resistant hypertension. Initial screening could be performed with the STOPbang questionnaire and subsequent confirmation could be attained by PSG.
7. We recommend that clinicians treat hypertensive OSA patients with CPAP, which can reduce blood pressure by 2 to 4 mm Hg. Notably, there is a significant association between CPAP compliance and the magnitude of blood pressure reduction.
8. We suggest that clinicians use non-CPAP therapies, such as oral appliances, as an alternative treatment to CPAP for selected patients.
9. We recommend that clinicians use fixed-pressure CPAP to treat OSA in HFrEF patients, which can improve left ventricular ejection fraction.
10. We suggest that clinicians use fixed-pressure CPAP to treat central sleep apnea in HFrEF patients, which can improve left ventricular ejection fraction.
11. We recommend against minute ventilation-triggered adaptive servo-ventilation in patients with HFrEF and central sleep apnea.
Subjects
atrial fibrillation
continuous positive airway pressure
heart failure
hypertension
sleep apnea
obstructive
Type
journal article