Undiagnosed sleep apnea in patients with atrial fibrillation: An underutilized opportunity for antiarrhythmic management

Hereijgers, M J M; Betz, Konstanze; Simons, Sami O.; Linz, Dominik

doi:10.1016/j.ijcha.2022.101050

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Detection of SDB is by use of the STOP-BANG questionnaire [ 15 ]. Nevertheless impact of this questionnaire is limited due to its restricted validity to detect SDB in AF patients [ 16 , 17 ]. Most patients with AF do not report daytime sleepiness, a typical SDB- related symptom [ 14 ▪ ].…”

Section: Patient Evaluationmentioning

confidence: 99%

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Homberg

Bouman

Joosten

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThis mini-review is aimed to provide an overview and discuss procedural sedation and analgesia for atrial fibrillation (AF) ablation with focus at qualification of staff, patient evaluation, monitoring, medication and postprocedural care.Recent findingsSleep-disordered breathing is highly prevalent in patients with AF. Impact of often used STOP-BANG questionnaire to detect sleep-disordered breathing in AF patients is limited due to its restricted validity. Dexmedetomidine is a commonly used drug in sedation, but is shown not to be superior to propofol in sedation during AF-ablation. Alternatively use of remimazolam has characteristics that makes it a promising drug for minimal to moderate sedation for AF-ablation. High flow nasal oxygen (HFNO) has shown to reduce the risk of desaturation in adults receiving procedural sedation and analgesia.SummaryAn optimal sedation strategy during AF ablation should be based on AF patient characteristics, the level of sedation needed, the procedure (duration and type of ablation) and the education and experience of the sedation provider. Patient evaluation and post procedural care are part of sedation care. More personalized care based on use of various sedation strategies and types of drugs as related to the type of AF-ablation is the way to further optimize care.

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Section: Patient Evaluationmentioning

confidence: 99%

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Homberg

Bouman

Joosten

2023

Current Opinion in Anaesthesiology

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“…Although the importance of comprehensive treatment of AF has been proposed, undiagnosed OSA is a modifiable risk factor, and appropriate therapeutic intervention is expected to enhance the effectiveness of AF treatments, including catheter ablation. 58 Recently, various smartphone applications or mobile devices for self‐screening of OSA have been available and reported to be useful tool as a screening for moderate to severe OSA. 59 Although physician should be cautions for making clinical diagnosis of OSA based on these devices, the novel technology will be able to facilitate screening of OSA.…”

Section: Future Direction Of Osa Screening and Man...mentioning

confidence: 99%

“…In addition, some physicians as well as patients are less aware of the negative prognostic impact of OSA. Although the importance of comprehensive treatment of AF has been proposed, undiagnosed OSA is a modifiable risk factor, and appropriate therapeutic intervention is expected to enhance the effectiveness of AF treatments, including catheter ablation 58 . Recently, various smartphone applications or mobile devices for self‐screening of OSA have been available and reported to be useful tool as a screening for moderate to severe OSA 59 .…”

Section: Future Direction Of Osa Screening and Management As A Compre...mentioning

confidence: 99%

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Iwasaki

2022

Journal of Arrhythmia

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Obstructive sleep apnea (OSA) is a highly prevalent disorder in patients with atrial fibrillation (AF). Although there has been an increase in the incidence of AF due to the aging population, it has been reported that OSA is still underdiagnosed because many patients remain asymptomatic or unaware of the symptoms associated with OSA, such as daytime sleepiness. Untreated OSA reduces the effectiveness of AF treatment, regardless of pharmacological or non‐pharmacological modes of therapy, such as catheter ablation. Experimental and clinical studies have shown that OSA pathophysiology is multifactorial, comprising of hypoxemia, hypercapnia, autonomic dysfunction, negative intrathoracic pressure changes, and arousals of OSA, and lead to AF. Both the acute and long‐term effects of obstructive apnea episodes are involved in the development of an arrhythmogenic substrate of AF. Undiagnosed OSA causes underutilized opportunities for more effective AF management. Therefore, it is important to screen for OSA in all patients being considered for rhythm control therapy. However, regardless of the growing evidence of the negative prognostic impact of OSA, there is a lack of awareness regarding this connection not only among patients but also among cardiologists and arrhythmia specialists. There is a barrier to performing a systemic screening for OSA in clinical practice. Therefore, it is important to establish a comprehensive OSA care team for the efficient diagnosis and treatment of OSA. This review provides the current understanding of OSA and its relationship to AF and the importance of the diagnosis and management of OSA in AF.

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“…Observational studies and meta -analyses showed that appropriate SDB treatment may improve rhythm control in AF patients [28] . Therefore, undiagnosed SDB in patients with AF is an underutilized opportunity for arrhythmia treatment, although SDB management in patients with AF requires a multidisciplinary and personalized management approach [29] , [30] . Besides this, SDB, together with concomitant obesity and chronic obstructive pulmonary disease [31] , increases the risk of periprocedural hypoxia and carbon dioxide accumulation in AF patients undergoing AF ablation with deep conscious sedation [32] , [33] .…”

mentioning

confidence: 99%

Recent highlights on the prevalence and role of sleep disordered breathing in cardiovascular diseases from the International Journal of Cardiology Heart & Vasculature

Linz,

Dobrev

2023

IJC Heart & Vasculature

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Undiagnosed sleep apnea in patients with atrial fibrillation: An underutilized opportunity for antiarrhythmic management

Cited by 4 publications

References 10 publications

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Recent highlights on the prevalence and role of sleep disordered breathing in cardiovascular diseases from the International Journal of Cardiology Heart & Vasculature

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