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Mohamed B, Yarlagadda K, Self Z, Simon A, Rigueiro F, Sohooli M, Eisenschenk S, Doré S. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl Stroke Res 2024; 15:239-332. [PMID: 36922470 DOI: 10.1007/s12975-023-01123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Keerthi Yarlagadda
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Zachary Self
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Alexandra Simon
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frank Rigueiro
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maryam Sohooli
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. 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. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
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.
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Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
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3
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Adami A, Tonon D, Corica A, Trevisan D, Thijs V, Rossato G. Yield of overnight pulse oximetry in screening commercial drivers for obstructive sleep apnea. Sleep Breath 2023; 27:2175-2180. [PMID: 36971970 DOI: 10.1007/s11325-023-02814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess the efficacy of overnight pulse oximetry in screening male commercial drivers (CDs) for obstructive sleep apnea (OSA). METHODS Consecutive male CDs undergoing their annual scheduled occupational health visit were enrolled from ten transportation facilities. All subjects underwent a home sleep apnea test (HSAT) to determine the Respiratory Event Index (REI). Oxygen desaturation indices (ODIs) below the 3% and 4% thresholds were computed using the built-in HSAT pulse oximeter. We then assessed the association between ODI values and the presence of OSA (defined as an REI ≥ 5 events/hour) as well as moderate to severe OSA (REI ≥ 15 events/hour). RESULTS Of 331 CDs recruited, 278 (84%) completed the study protocol and 53 subjects were excluded due to inadequate HSAT quality. The included and excluded subjects were comparable in demographics and clinical characteristics. The included CDs had a median age of 49 years (interquartile range (IQR) = 15 years) and a median body mass index of 27 kg/m2 (IQR = 5 kg/m2). One hundred ninety-nine (72%) CDs had OSA, of which 48 (17%) were with moderate OSA and 45 (16%) with severe OSA. The ODI3 and ODI4 receiving operating characteristic curve value were 0.95 for predicting OSA and 0.98-0.96 for predicting moderate to severe OSA. CONCLUSION Overnight oxygen oximetry may be an effective means to screen CDs for OSA.
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Affiliation(s)
- Alessandro Adami
- Sleep Center, Neurology Dept, IRCCS Sacro Cuore Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy.
| | - Davide Tonon
- Sleep Center, Neurology Dept, IRCCS Sacro Cuore Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy
| | - Antonio Corica
- Sleep Center, Neurology Dept, IRCCS Sacro Cuore Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy
| | - Deborah Trevisan
- Sleep Center, Neurology Dept, IRCCS Sacro Cuore Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Gianluca Rossato
- Sleep Center, Neurology Dept, IRCCS Sacro Cuore Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy
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4
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Hereijgers MJ, van der Velden RM, el Moussaoui N, Verhaert DV, Habibi Z, Luermans J, den Uijl D, Chaldoupi SM, Vernooy K, Schotten U, Baumert M, Gietema HA, Mihl C, Koltowski L, Franssen FM, Simons SO, Linz D. Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation. IJC HEART & VASCULATURE 2023; 49:101305. [PMID: 38053981 PMCID: PMC10694302 DOI: 10.1016/j.ijcha.2023.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
Background In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients. Methods We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation. Results We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12-15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0-6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation. Conclusions In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.
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Affiliation(s)
- Maartje J.M. Hereijgers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Nora el Moussaoui
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominique V.M. Verhaert
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dennis den Uijl
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Mathias Baumert
- Discipline of Biomedical Engineering, The University of Adelaide, Adelaide, Australia
| | - Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lukasz Koltowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sami O. Simons
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Baumert M, Immanuel S, McKane S, Linz D. Transvenous phrenic nerve stimulation for the treatment of central sleep apnea reduces episodic hypoxemic burden. Int J Cardiol 2023; 378:89-95. [PMID: 36841294 DOI: 10.1016/j.ijcard.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023]
Abstract
STUDY OBJECTIVES To determine the effect of transvenous phrenic nerve stimulation (TPNS) on the composition of the nocturnal hypoxemic burden in patients with CSA. METHODS We analysed oximetry data from baseline and follow-up overnight polysomnograms (PSG) in 134 CSA patients with implanted TPNS randomised (1:1) to neurostimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off) from the remedē System Pivotal Trial. The hypoxemic burden was quantified using a battery of metrics, including the oxygen desaturation index (ODI), the relative sleep time spent below 90% SpO2 (T90) due to acute episodic desaturations (T90desat) and due to non-specific and non-cyclic drifts of SpO2 (T90non-specific). Mean change from baseline is provided. RESULTS TPNS titrated to reduce respiratory events significantly reduced the ODI in the treatment group by -15.85 h-1 ± 1.99 compared to the control group, which increased 1.32 h-1 ± 1.85 (p 〈0001) and shortened the relative T90 duration by -3.81 percentage points ± 1.23 vs. 0.49 percentage points ± 1.14 increase (p = 0.012). This shortening of T90 was primarily accomplished by reducing the brief cyclic desaturations (T90desaturation: -4.32 percentage points ± 0.98 vs. 0.52 percentage points ± 0.91, p = 0.0004) while notable non-specific drifts in SpO2 remained unchanged (T90non-specific: 0.18 percentage points ± 0.62 vs. -0.13 percentage points ± 0.57, p = 0.72). CONCLUSIONS TPNS appears to significantly reduce the nocturnal hypoxemic burden due to sleep-disordered breathing, but a considerable nocturnal hypoxemic burden from other sources remains. Further investigations are warranted to identify the best strategy to reduce the nocturnal hypoxemic burden beyond preventing respiratory events.
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Affiliation(s)
- Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia.
| | - Sarah Immanuel
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia; School of Business Information Systems, Torrens University, Adelaide, Australia
| | | | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, the Netherlands; Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Klobučníková K, Kollár B, Jurík M, Valovičová K, Hardoňová M, Poddaný M, Tedla M, Riant M, Klail P, Turčáni P, Šiarnik P. No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results. Life (Basel) 2023; 13:life13020517. [PMID: 36836872 PMCID: PMC9959436 DOI: 10.3390/life13020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. MATERIAL AND METHODS The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. RESULTS We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). CONCLUSIONS In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients.
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Affiliation(s)
- Katarína Klobučníková
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-2572-90147
| | - Matúš Jurík
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Katarína Valovičová
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Miroslava Hardoňová
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Michal Poddaný
- Department of Neurology, General Hospital, 031 23 Liptovsky Mikulas, Slovakia
| | - Miroslav Tedla
- Department of ENT and HNS, Faculty of Medicine, University Hospital Bratislava, Comenius University, 814 69 Bratislava, Slovakia
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2T8, UK
| | - Michal Riant
- Department of Otorhinolaryngology, University Hospital, Faculty of Medicine in Pilsen, Charles University, 100 00 Prague, Czech Republic
| | - Pavel Klail
- Department of Otorhinolaryngology, University Hospital, Faculty of Medicine in Pilsen, Charles University, 100 00 Prague, Czech Republic
| | - Peter Turčáni
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Pavel Šiarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
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8
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Baumert M, Cowie MR, Redline S, Mehra R, Arzt M, Pépin JL, Linz D. Sleep characterization with smart wearable devices: a call for standardization and consensus recommendations. Sleep 2022; 45:6652912. [PMID: 35913733 DOI: 10.1093/sleep/zsac183] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Indexed: 12/14/2022] Open
Abstract
The general public increasingly adopts smart wearable devices to quantify sleep characteristics and dedicated devices for sleep assessment. The rapid evolution of technology has outpaced the ability to implement validation approaches and demonstrate relevant clinical applicability. There are untapped opportunities to validate and refine consumer devices in partnership with scientists in academic institutions, patients, and the private sector to allow effective integration into clinical management pathways and facilitate trust in adoption once reliability and validity have been demonstrated. We call for the formation of a working group involving stakeholders from academia, clinical care and industry to develop clear professional recommendations to facilitate appropriate and optimized clinical utilization of such technologies.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
| | - Martin R Cowie
- School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, London, UK.,Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), London, UK
| | - Susan Redline
- Department of Medicine, Division of Sleep, Circadian Rhythm, and Neurobiology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Division of Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Reena Mehra
- Sleep Disorders Research Program, Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1300, Univ. Grenoble Alpes, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Mehra R, Chung MK, Olshansky B, Dobrev D, Jackson CL, Kundel V, Linz D, Redeker NS, Redline S, Sanders P, Somers VK. Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults: Mechanistic Insights and Clinical Implications: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e119-e136. [PMID: 35912643 PMCID: PMC10227720 DOI: 10.1161/cir.0000000000001082] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sleep-disordered breathing (SDB), characterized by specific underlying physiological mechanisms, comprises obstructive and central pathophysiology, affects nearly 1 billion individuals worldwide, and is associated with excessive cardiopulmonary morbidity. Strong evidence implicates SDB in cardiac arrhythmogenesis. Immediate consequences of SDB include autonomic nervous system fluctuations, recurrent hypoxia, alterations in carbon dioxide/acid-base status, disrupted sleep architecture, and accompanying increases in negative intrathoracic pressures directly affecting cardiac function. Day-night patterning and circadian biology of SDB-induced pathophysiological sequelae collectively influence the structural and electrophysiological cardiac substrate, thereby creating an ideal milieu for arrhythmogenic propensity. Cohort studies support strong associations of SDB and cardiac arrhythmia, with evidence that discrete respiratory events trigger atrial and ventricular arrhythmic events. Observational studies suggest that SDB treatment reduces atrial fibrillation recurrence after rhythm control interventions. However, high-level evidence from clinical trials that supports a role for SDB intervention on rhythm control is not available. The goals of this scientific statement are to increase knowledge and awareness of the existing science relating SDB to cardiac arrhythmias (atrial fibrillation, ventricular tachyarrhythmias, sudden cardiac death, and bradyarrhythmias), synthesizing data relevant for clinical practice and identifying current knowledge gaps, presenting best practice consensus statements, and prioritizing future scientific directions. Key opportunities identified that are specific to cardiac arrhythmia include optimizing SDB screening, characterizing SDB predictive metrics and underlying pathophysiology, elucidating sex-specific and background-related influences in SDB, assessing the role of mobile health innovations, and prioritizing the conduct of rigorous and adequately powered clinical trials.
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10
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Linz D. Longitudinal sleep apnea burden monitoring: Implications for future smart wearable- and implantable- devices. Int J Cardiol 2022; 357:46-47. [PMID: 35304188 DOI: 10.1016/j.ijcard.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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11
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Linz D, Norup Hertel J, Hendriks J, Saljic A, Dobrev D, Baumert M, Jespersen T, Linz D. Sleep apnea and atrial fibrillation: challenges in clinical and translational research. Expert Rev Cardiovasc Ther 2022; 20:101-109. [PMID: 35094618 DOI: 10.1080/14779072.2022.2036606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) is present in 21-74% of all patients with atrial fibrillation (AF). Treatment of SDB by positive airway pressure may help to prevent recurrence of AF after electrical cardioversion and help to improve AF ablation success rates in non-randomized studies. AREAS COVERED In this review, the current understanding of the atrial arrhythmogenic pathophysiology of SDB is summarized, and diagnostic and therapeutic challenges in AF patients are discussed. Current international recommendations are presented, and a comprehensive literature search is undertaken. EXPERT OPINION AF patients with SDB rarely report SDB-related symptoms such as daytime sleepiness. Therefore, systematic home sleep testing evaluation should be considered for all patients eligible for rhythm control strategy. A close interdisciplinary collaboration between the electrophysiologist/cardiologist, nurses and sleep-specialists are required for the management of SDB in AF patients. An arrhythmia-orientated assessment of SDB may better quantify SDB-related AF risk in an individual patient and may help to better guide targeted and personalized SDB treatment in AF patients as a component of rhythm and symptom control strategies. Finally, randomized controlled trials are needed to confirm the relationship between SDB and AF, and the benefits of routine testing and treatment of SDB in AF patients.
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Affiliation(s)
- Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Norup Hertel
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
| | - Arnela Saljic
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Mathias Baumert
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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12
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Mittal S, Golombeck D, Pimienta J. Sleep Apnoea and AF: Where Do We Stand? Practical Advice for Clinicians. Arrhythm Electrophysiol Rev 2021; 10:140-146. [PMID: 34777817 PMCID: PMC8576511 DOI: 10.15420/aer.2021.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022] Open
Abstract
AF is the most common sustained arrhythmia encountered in clinical practice. Among the largest contributing factors to the rapid increase in the incidence of AF are aging and obesity within the global population. Obstructive sleep apnoea (OSA) is a risk factor for AF that is clearly linked to obesity. Guidelines have advocated interrogation for clinical signs of OSA in all AF patients. The aim of this article is to provide practical advice for clinicians seeking to manage patients with AF and OSA. The authors discuss questionnaires to screen for OSA, various types of tests available for the diagnosis of OSA and data to assess the impact of treatment of OSA after various treatment options in AF patients. Finally, they outline the many areas that warrant further investigation in this patient population.
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Affiliation(s)
- Suneet Mittal
- Snyder Center for Comprehensive Atrial Fibrillation, Paramus, NJ, US.,Valley Health System, Ridgewood, NJ, US
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13
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Delesie M, Knaepen L, Hendrickx B, Huygen L, Verbraecken J, Weytjens K, Dendale P, Heidbuchel H, Desteghe L. The value of screening questionnaires/scoring scales for obstructive sleep apnoea in patients with atrial fibrillation. Arch Cardiovasc Dis 2021; 114:737-747. [PMID: 34593342 DOI: 10.1016/j.acvd.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an important modifiable risk factor for atrial fibrillation (AF) but is underdiagnosed in this population. Currently, polysomnography is the gold standard for diagnosing OSA, but is expensive and requires overnight examination. Alternatively, home sleep apnoea testing can be used as a diagnostic tool, but also requires a complete data review. Therefore, these OSA diagnostic modalities are not ideal screening methods. Several OSA screening tools exist, but their value in patients with AF remains unclear. AIM To test the performance of existing screening questionnaires/scales for clinically relevant OSA in patients with AF referred for diagnostic polysomnography. METHODS This prospective study compared the performance of seven screening tools (Epworth Sleepiness Scale, Berlin Questionnaire, Sleep Apnea Clinical Score, NoSAS, OSA50, STOP-Bang and MOODS) with polysomnography in the detection of clinically relevant OSA in consecutive patients with AF referred to two sleep clinics. RESULTS A total of 100 patients referred for polysomnography and known previous AF were included. Polysomnography indicated at least clinically relevant OSA (i.e., apnoea-hypopnoea index≥15 events/hour) in 69% of cases, and 33% had severe OSA (apnoea-hypopnoea index>30 events/hour). In screening for clinically relevant OSA, only the SACS and NoSAS scores had fair areas under the curve (0.704 and 0.712, respectively). None of the seven screening tools was performant enough (i.e., had a fair area under the curve>0.7) in the detection of severe OSA. CONCLUSIONS In this AF cohort referred for polysomnography, clinically relevant OSA was prevalent. None of the selected screening tools showed sufficient performance as a good discriminative screening tool for clinically relevant OSA in patients with AF. Given these findings, other screening modalities for OSA should be considered in the work-up of patients with AF.
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Affiliation(s)
- Michiel Delesie
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium; Antwerp University Hospital, 2650 Edegem, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium.
| | - Lieselotte Knaepen
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium; Antwerp University Hospital, 2650 Edegem, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Bart Hendrickx
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Lisa Huygen
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and Research Group LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, 2650 Edegem, Belgium
| | | | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium; Antwerp University Hospital, 2650 Edegem, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium; Antwerp University Hospital, 2650 Edegem, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
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14
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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15
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Sleep Apnea Testing and Management in Patients With Atrial Fibrillation: Why is it So Difficult? J Cardiovasc Nurs 2021; 35:324-326. [PMID: 32541607 DOI: 10.1097/jcn.0000000000000668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:608-624. [PMID: 34353537 DOI: 10.1016/j.jacc.2021.05.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.
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17
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Lin CH, Yu CC. Apnea-hypopnea index versus oxygen desaturation index for diagnosis of obstructive sleep apnea in patients with atrial fibrillation: six of one, half a dozen of the other? J Clin Sleep Med 2021; 17:2333-2334. [PMID: 34251333 DOI: 10.5664/jcsm.9524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chou-Han Lin
- Division of Respiratory Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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18
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Gallagher C, Fitzgerald JL, Stokes MB, Noubiap JJ, Elliott AD, Hendriks JM, Middeldorp ME, Sanders P, Lau DH. Risk Factor Management in Atrial Fibrillation: How to Deliver a Successful Clinic. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00671-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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19
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Mohammadieh AM, Sutherland K, Kanagaratnam LB, Whalley DW, Gillett MJ, Cistulli PA. Clinical screening tools for obstructive sleep apnea in a population with atrial fibrillation: a diagnostic accuracy trial. J Clin Sleep Med 2021; 17:1015-1024. [PMID: 33560210 DOI: 10.5664/jcsm.9098] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF), there is a paucity of data around its diagnosis and management in patients with AF. The objectives of this study were to compare the diagnostic accuracy of commonly used OSA screening tools in an AF population, including a level 3 portable sleep study device, and to examine the epidemiology of OSA in a hospital cohort with AF. METHODS One hundred seven patients with AF recruited from 2 tertiary centers underwent a panel of OSA screening tools and in-laboratory polysomnography in randomized order. RESULTS Oxygen desaturation index derived from a level 3 portable sleep study device performed best for moderate to severe and severe OSA, with excellent diagnostic accuracy (area under the curve, 0.899; 95% confidence interval, 0.838-0.960 and area under the curve, 0.925; 95% confidence interval, 0.859-0.991, respectively). Sixty-seven patients (62.6%) were newly diagnosed with OSA (31.8% mild, 18.7% moderate, 12.1% severe). CONCLUSIONS Undiagnosed OSA is highly prevalent in a hospital AF cohort. However, it is characterized by a relative paucity of symptoms, markedly limiting the usefulness of history or screening questionnaires. This is the first study to find that a level 3 home sleep study device shows excellent diagnostic accuracy in patients with AF. This finding may inform AF management guidelines. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: The validity and reliability of a portable device for the diagnosis of Obstructive Sleep Apnoea in patients with Atrial Fibrillation; URL:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371024; Identifier: ACTRN12616001016426.
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Affiliation(s)
- Anna M Mohammadieh
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Logan B Kanagaratnam
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David W Whalley
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark J Gillett
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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20
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Abstract
Obstructive sleep apnea (OSA) creates a complex and dynamic substrate for atrial fibrillation (AF), which is characterized by structural remodeling as a result of long-term OSA as well as transient and acute apnea-associated transient atrial electrophysiological changes. OSA is present in 21% to 74% of patients with AF, and nonrandomized studies suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Management of OSA in patients with AF requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and sleep specialists.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, 3655 Prom. Sir Willian Osler, Montreal, Quebec H3G 1Y6, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, 300 Grattan Street, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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21
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Linz D, Malfertheiner MV, Werner N, Lerzer C, Gfüllner F, Linz B, Zeman F, McEvoy RD, Arzt M, Baumert M. Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies. Sleep Med 2021; 79:62-70. [PMID: 33482454 DOI: 10.1016/j.sleep.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Nocturnal hypoxemia is associated with increased cardiovascular mortality. Here, we assess whether positive airway pressure by adaptive servo-ventilation (ASV) reduces nocturnal hypoxemic burden in patients with primary central sleep apnea (primary CSA), or heart failure related central sleep apnea (CSA-HF) and treatment emergent central sleep apnea (TECSA). METHODS Overnight oximetry data from 328 consecutive patients who underwent ASV initiation between March 2010 and May 2018 were retrospectively analyzed. Patients were stratified into three groups: primary CSA (n = 14), CSA-HF (n = 31), TECSA (n = 129). Apnea hypopnea index (AHI) and time spent below 90% SpO2 (T90) was measured. Additionally, T90 due to acute episodic desaturations (T90Desaturation) and due to non-specific and non-cyclic drifts of SpO2 (T90Non-specific) were assessed. RESULTS ASV reduced the AHI below 15/h in all groups. ASV treatment significantly shortened T90 in all three etiologies to a similar extent. T90Desaturation, but not T90Non-specific, was reduced by ASV across all three patient groups. AHI was identified as an independent modulator for ΔT90Desaturation upon ASV treatment (B (95% CI: -1.32 (-1.73; -0.91), p < 0.001), but not for ΔT90 or ΔT90Non-specific. Body mass index was one independent predictor of T90. CONCLUSIONS Across different central sleep apnea etiologies, ASV reduced AHI, but nocturnal hypoxemic burden remained high due to a non-specific component of T90 not related to episodic desaturation. Whether adjunct risk factor management such as weight-loss can further reduce T90 warrants further study.
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Affiliation(s)
- Dominik Linz
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | | | - Nils Werner
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | | | | | - Benedikt Linz
- University of Copenhagen, Faculty of Health Science, Department of Biomedical Sciences, Copenhagen, Denmark
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre, Regensburg, Germany
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Mathias Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
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22
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Starkey SY, Jonasson DR, Alexis S, Su S, Johal R, Sweeney P, Brasher PMA, Fleetham J, Ayas N, Orenstein T, Ahmed IH. Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What's the Best Test? CJC Open 2020; 3:442-449. [PMID: 34027347 PMCID: PMC8129472 DOI: 10.1016/j.cjco.2020.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Among individuals with nonvalvular atrial fibrillation (AF), the prevalence of obstructive sleep apnea (OSA) can be as high as 85%. Continuous positive airway pressure treatment for moderate or severe OSA might improve AF outcomes and quality of life, so early identification of OSA might be of value. However, screening questionnaires for OSA are suboptimal because they are weighted toward tiredness and loud snoring, which might be absent in AF patients. NoSAS (Neck, Obesity, Snoring, Age, Sex) is a new OSA questionnaire that excludes these parameters. Acoustic pharyngometry (AP) is a potential novel screening technique that measures pharyngeal cross-sectional area, which is reduced in patients with OSA. Methods We prospectively compared the accuracy of the NoSAS, the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, blood Pressure, Body mass index, Age, Neck circumference and Gender), and AP with home sleep apnea testing (HSAT) in consecutive patients with nonvalvular AF. Results Of 188 participants, 86% had OSA and 49% had moderate or severe OSA. Mean Epworth Sleepiness Scale scores were low; 5.9 (SD, 3.9), indicating that most participants were not sleepy. Receiver operating characteristic curves for comparisons of screening tests with HSAT showed suboptimal accuracy. For moderate plus severe and severe only groups respectively, the area under the curve was 0.50 (95% confidence interval [CI], 0.42-0.58) and 0.42 (95% CI, 0.34-0.52) for AP, 0.65 (95% CI, 0.58-0.73) and 0.63 (95% CI, 0.52-0.74) for the STOP-BANG questionnaire, and 0.68 (95% CI, 0.60-0.75) and 0.69 (95% CI, 0.59-0.80) for the NoSAS. Conclusions AP and NoSAS are not sufficiently accurate for screening AF patients for OSA. Because of the high rates of OSA in this cohort, the potential benefits of OSA treatment, and the suboptimal accuracy of current screening questionnaires, cardiologists should consider HSAT for AF patients.
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Affiliation(s)
- Samantha Y Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Stephanie Alexis
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Su
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Ravinder Johal
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Paul Sweeney
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John Fleetham
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib Ayas
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teddi Orenstein
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Iqbal H Ahmed
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Hermans ANL, van der Velden RMJ, Gawalko M, Verhaert DVM, Desteghe L, Duncker D, Manninger M, Heidbuchel H, Pisters R, Hemels M, Pison L, Sohaib A, Sultan A, Steven D, Wijtvliet P, Tieleman R, Gupta D, Dobrev D, Svennberg E, Crijns HJGM, Pluymaekers NAHA, Hendriks JM, Linz D. On-demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation. Clin Cardiol 2020; 43:1232-1239. [PMID: 33030259 PMCID: PMC7661648 DOI: 10.1002/clc.23469] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although novel teleconsultation solutions can deliver remote situations that are relatively similar to face-to-face interaction, remote assessment of heart rate and rhythm as well as risk factors remains challenging in patients with atrial fibrillation (AF). HYPOTHESIS Mobile health (mHealth) solutions can support remote AF management. METHODS Herein, we discuss available mHealth tools and strategies on how to incorporate the remote assessment of heart rate, rhythm and risk factors to allow comprehensive AF management through teleconsultation. RESULTS Particularly, in the light of the coronavirus disease 2019 (COVID-19) pandemic, there is decreased capacity to see patients in the outpatient clinic and mHealth has become an important component of many AF outpatient clinics. Several validated mHealth solutions are available for remote heart rate and rhythm monitoring as well as for risk factor assessment. mHealth technologies can be used for (semi-)continuous longitudinal monitoring or for short-term on-demand monitoring, dependent on the respective requirements and clinical scenarios. As a possible solution to improve remote AF care through teleconsultation, we introduce the on-demand TeleCheck-AF mHealth approach that allows remote app-based assessment of heart rate and rhythm around teleconsultations, which has been developed and implemented during the COVID-19 pandemic in Europe. CONCLUSION Large scale international mHealth projects, such as TeleCheck-AF, will provide insight into the additional value and potential limitations of mHealth strategies to remotely manage AF patients. Such mHealth infrastructures may be well suited within an integrated AF-clinic, which may require redesign of practice and reform of health care systems.
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Affiliation(s)
| | | | - Monika Gawalko
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Dominique V. M. Verhaert
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
- Department of CardiologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Lien Desteghe
- Faculty of Medicine and Life SciencesHasselt UniversityHasseltBelgium
- Heart Center HasseltJessa HospitalHasseltBelgium
- Department of CardiologyAntwerp University Hospital and Antwerp UniversityAntwerpBelgium
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Martin Manninger
- Department of CardiologyMedizinische Universität GrazGrazAustria
| | - Hein Heidbuchel
- Department of CardiologyAntwerp University Hospital and Antwerp UniversityAntwerpBelgium
| | - Ron Pisters
- Department of CardiologyRijnstate HospitalArnhemThe Netherlands
| | - Martin Hemels
- Department of CardiologyRadboud University Medical CentreNijmegenThe Netherlands
- Department of CardiologyRijnstate HospitalArnhemThe Netherlands
| | - Laurent Pison
- Department of CardiologyHospital East LimburgGenkBelgium
| | - Afzal Sohaib
- Department of CardiologySt Bartholomew's Hospital, Bart's Health NHS TrustLondonUK
- Department of CardiologyKing George HospitalLondonUK
| | - Arian Sultan
- Department of Electrophysiology, Heart CenterUniversity Hospital CologneCologneGermany
| | - Daniel Steven
- Department of Electrophysiology, Heart CenterUniversity Hospital CologneCologneGermany
| | - Petra Wijtvliet
- Department of CardiologyMartini HospitalGroningenThe Netherlands
| | - Robert Tieleman
- Department of CardiologyMartini HospitalGroningenThe Netherlands
| | - Dhiraj Gupta
- Department of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular CentreUniversity Duisburg‐EssenEssenGermany
| | - Emma Svennberg
- Department of Clinical Sciences, Division of Cardiovascular MedicineKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | - Harry J. G. M. Crijns
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Nikki A. H. A. Pluymaekers
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Jeroen M. Hendriks
- Centre for Heart Rhythm DisordersUniversity of Adelaide and Royal Adelaide HospitalAdelaideAustralia
- College of Nursing and Health SciencesFlinders UniversityAdelaideAustralia
| | - Dominik Linz
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
- Department of CardiologyRadboud University Medical CentreNijmegenThe Netherlands
- Centre for Heart Rhythm DisordersUniversity of Adelaide and Royal Adelaide HospitalAdelaideAustralia
- Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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24
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Mashaqi S, Staebler D, Mehra R. Combined nocturnal pulse oximetry and questionnaire-based obstructive sleep apnea screening – A cohort study. Sleep Med 2020; 72:157-163. [DOI: 10.1016/j.sleep.2020.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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Watanabe M, Shinohara H, Kodama H. Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late-onset gestational hypertension. J Obstet Gynaecol Res 2020; 46:1735-1743. [PMID: 32715551 DOI: 10.1111/jog.14362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/29/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to determine whether 1-night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late-onset gestational hypertension (GH) after 37 weeks of gestation. METHODS We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2 ) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. RESULTS Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow-up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26-0.67) for ODI ≥5.0, 0.29 (0.10-0.35) for minimum SpO2 <90%, and 0.07 (0.02-0.07) for BMI ≥25.0. CONCLUSION For the prediction of late-onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.
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Affiliation(s)
- Minako Watanabe
- The Japanese Red Cross Akita College of Nursing, Akita, Japan
| | - Hitomi Shinohara
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, School of Health Science, Akita, Japan
| | - Hideya Kodama
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, School of Health Science, Akita, Japan
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26
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Linz D, Loffler KA, Sanders P, Catcheside P, Anderson CS, Zheng D, Quan W, Barnes M, Redline S, McEvoy RD, Baumert M. Low Prognostic Value of Novel Nocturnal Metrics in Patients With OSA and High Cardiovascular Event Risk: Post Hoc Analyses of the SAVE Study. Chest 2020; 158:2621-2631. [PMID: 32679239 DOI: 10.1016/j.chest.2020.06.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. RESEARCH QUESTION Do novel nocturnal oxygen saturation (Spo2) metrics have prognostic value in patients with OSA and high cardiovascular event risk? STUDY DESIGN AND METHODS We conducted post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial. In 2687 individuals, Cox proportional hazards models that were stratified for treatment allocation were used to determine the associations between clinical characteristics, pulse oximetry-derived metrics that were designed to quantify sustained and episodic features of hypoxemia, and cardiovascular outcomes. Metrics included oxygen desaturation index, time <90% Spo2, average Spo2 for the entire recording (mean Spo2), average Spo2 during desaturation events (desaturation Spo2), average baseline Spo2 interpolated across episodic desaturation events (baseline Spo2), episodic desaturation event duration and desaturation/resaturation-time ratio, and mean and SD of pulse rate. RESULTS Neither apnea-hypopnea index, oxygen desaturation index, nor any of the novel Spo2 metrics were associated with the primary SAVE composite cardiovascular outcome. Mean and baseline Spo2 were associated with heart failure (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .009; and HR, 0.78; 95% CI, 0.67-0.90; P = .001, respectively) and myocardial infarction (HR, 0.86; 95% CI, 0.77-0.95; P = .003; and HR, 0.81; 95% CI, 0.73-0.90; P < .001, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted future heart failure (area under the curve, 0.86; 95% CI, 0.79-0.93). INTERPRETATION Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
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Affiliation(s)
- Dominik Linz
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Prashanthan Sanders
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Craig S Anderson
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Danni Zheng
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - WeiWei Quan
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mary Barnes
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
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27
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Linz D, Linz B, Heijman J. Sleep Apnea, Intermittent Hypoxemia, and Effects on Ischemic Myocardial Damage: Friend or Foe? Can J Cardiol 2020; 36:809-812. [PMID: 32376343 DOI: 10.1016/j.cjca.2020.02.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Dominik Linz
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands; Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
| | - Benedikt Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
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28
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Gawałko M, Elliott A, Kadhim K, Sanders P, Linz D. A call for a more objective and longitudinal reporting of lifestyle components in cardiovascular research. IJC HEART & VASCULATURE 2020; 27:100506. [PMID: 32310240 PMCID: PMC7154293 DOI: 10.1016/j.ijcha.2020.100506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kadhim Kadhim
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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29
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Kadhim K, Lau DH, Sanders P, Linz D. Sleep apnea in atrial fibrillation - Highly prevalent, highly relevant, but most patients are not somnolent! IJC HEART & VASCULATURE 2020; 26:100463. [PMID: 32142068 PMCID: PMC7046562 DOI: 10.1016/j.ijcha.2019.100463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kadhim Kadhim
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
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30
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Abstract
Overnight pulse oximetry (OPO) has proven to be an effective and beneficial technique to determine the cardiorespiratory status of patients in both the inpatient and outpatient settings. It is a cheap, safe, reliable, simple, and accurate method of patient monitoring as compared to the expensive and labor-intensive method of multichannel polysomnography for detecting sleep-disordered breathing. It provides accurate information about patient's oxygenation status and also helps in monitoring the response to continuous positive airway pressure and in the surgical treatment of obstructive sleep apnea (OSA). Nocturnal hypoxemia portends a poor prognosis in patients of chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and neuromuscular diseases. OPO can help its early detection and management.
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Affiliation(s)
- Shruti Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sara Z Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Dilbagh Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sameer Verma
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
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31
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Kadhim K, Middeldorp ME, Elliott AD, Jones D, Hendriks JM, Gallagher C, Arzt M, McEvoy RD, Antic NA, Mahajan R, Lau DH, Nalliah C, Kalman JM, Sanders P, Linz D. Self-Reported Daytime Sleepiness and Sleep-Disordered Breathing in Patients With Atrial Fibrillation: SNOozE-AF. Can J Cardiol 2019; 35:1457-1464. [DOI: 10.1016/j.cjca.2019.07.627] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
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32
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Linz D, Baumert M, Desteghe L, Kadhim K, Vernooy K, Kalman JM, Dobrev D, Arzt M, Sastry M, Crijns HJ, Schotten U, Cowie MR, McEvoy RD, Heidbuchel H, Hendriks J, Sanders P, Lau DH. Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring. IJC HEART & VASCULATURE 2019; 24:100424. [PMID: 31763438 PMCID: PMC6859526 DOI: 10.1016/j.ijcha.2019.100424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF. In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for longitudinal assessment of nightly SDB-severity and clinical implications for screening and management of SDB in AF patients.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Mathias Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
| | - Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kadhim Kadhim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
| | - Manu Sastry
- Academic Sleep Centre (CIRO+), Horn, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Martin R. Cowie
- National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, England, UK
| | - R. Doug McEvoy
- 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, Australia
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H. Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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