New AHA Statement Urges Attention to Sleep Apnea

Megan Brooks

June 22, 2021

Obstructive sleep apnea (OSA) is common in patients with cardiovascular disease (CVD), yet it is often under-recognized and treated in cardiovascular practice, the American Heart Association (AHA) says in a new scientific statement.

"Obstructive sleep apnea can negatively impact patients' health and increase the risk of cardiovascular events and death. This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnea," writing group chair Yerem Yeghiazarians, MD, University of California, San Francisco, says in a statement.

"Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment," Yeghiazarians adds.

The statement was published online June 21 in Circulation.

OSA occurs in about 34% of middle-aged men and 17% of middle-aged women, and the prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, or stroke.

Signs and symptoms of OSA include excessive daytime sleepiness, morning headaches, memory impairment, irritability and/or changes in affect, trouble concentrating, nocturia, decreased libido, and erectile dysfunction.

Exam findings include obesity, increased neck circumference, a Mallampati score of at least 3, and craniofacial abnormalities.

The AHA recommends screening for OSA in patients with resistant or poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation.

In patients with New York Heart Association (NYHA) class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is "reasonable," the AHA says.

Evaluation for sleep apnea should be considered in patients with tachy-brady syndrome or ventricular tachycardia, or in survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, they advise.

"After stroke, clinical equipoise exists with respect to screening and treatment. Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have comorbid sleep apnea," the statement notes.

Treatment for OSA should be considered in all patients determined to have the condition, the AHA advises.

This can include behavioral modifications and weight loss, as indicated. In patients with severe OSA, continuous positive airway pressure (CPAP) should be offered.

Oral appliances can be considered in patients with mild to moderate OSA or who cannot tolerate CPAP.

Follow-up sleep testing should be performed to assess the effectiveness of treatment.

Looking ahead, Yeghiazarians says, "improvements in home diagnostic tools and more research on ways to identify cardiovascular risk in people with OSA are needed. Still, the overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors."

This scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Clinical Cardiology; the Council on Peripheral Vascular Disease; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; the Stroke Council; and the Council on Cardiovascular Surgery and Anesthesia.

The research had no commercial funding. Yeghiazarians has disclosed no relevant financial relationships.

Circulation. Published online June 21, 2021. Abstract


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