Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
Clin Res Cardiol. 2018 Aug;107(8):617-631. doi: 10.1007/s00392-018-1248-9. Epub 2018 Apr 12.
Sleep apnea is associated with increased cardiovascular risk and may be important in atrial fibrillation (AF) management. It is present in up to 62% of the AF population and is highly under-recognized and underdiagnosed. Obstructive sleep apnea (OSA) is strongly associated with AF and non-randomized trials have shown that its treatment can help to reduce AF recurrences and maintain sinus rhythm. The 2016 European Society of Cardiology guidelines for the management of AF recommend that AF patients should be questioned regarding the symptoms of OSA and that OSA-treatment should be optimized to improve AF treatment results. However, strategies on how to implement OSA testing in the standard work-up of AF patients are not provided in the guidelines. Additionally, overnight OSA monitoring rather than interrogation for OSA-related clinical signs alone may be necessary to reliably identify OSA in the majority of AF patients. This review summarizes the available clinical data on OSA in AF patients, and discusses the following key questions: Why and When is testing for OSA needed in AF patients? How and Where should it be performed and coordinated? and Who should test for OSA? To implement OSA testing in a cardiology or electrophysiology clinic, we propose a multidisciplinary integrated care approach based on a chronic care model. We describe the tools, infrastructure and coordination needed to test for OSA in the standard workup of patients with symptomatic AF prior to the initiation of directed invasive or pharmacological rhythm control management.
睡眠呼吸暂停与心血管风险增加相关，在心房颤动（AF）的管理中可能很重要。它存在于高达 62%的 AF 人群中，并且高度被低估和漏诊。阻塞性睡眠呼吸暂停（OSA）与 AF 强烈相关，非随机试验表明其治疗可以帮助减少 AF 复发并维持窦性心律。2016 年欧洲心脏病学会（ESC）AF 管理指南建议，AF 患者应被询问 OSA 的症状，并且应优化 OSA 治疗以改善 AF 治疗效果。然而，指南中并未提供关于如何在 AF 患者的标准评估中实施 OSA 测试的策略。此外，为了在大多数 AF 患者中可靠地识别 OSA，可能需要进行夜间 OSA 监测，而不仅仅是询问 OSA 相关的临床体征。
这篇综述总结了 AF 患者中 OSA 的现有临床数据，并讨论了以下关键问题：为什么和何时需要在 AF 患者中进行 OSA 测试？应该如何以及在哪里进行和协调？谁应该进行 OSA 测试？为了在心脏病学或电生理学诊所中实施 OSA 测试，我们基于慢性病管理模型提出了一种多学科综合护理方法。我们描述了在启动有针对性的侵入性或药物节律控制管理之前，在有症状的 AF 患者的标准评估中测试 OSA 所需的工具、基础设施和协调。
