The following are key points to remember about this American Heart Association (AHA) Scientific Statement on obstructive sleep apnea (OSA) and cardiovascular disease (CVD):

1. OSA is characterized by recurrent complete and partial upper airway obstruction resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation.
2. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disturbances are common and underdiagnosed among middle-aged and older adults, and the prevalence varies by race/ethnicity, sex, and obesity status.
3. Furthermore, OSA prevalence is as high as 40-80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke.
4. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse CV outcomes, OSA is often under-recognized and undertreated in clinical practice.
5. This Scientific Statement recommends screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation. In patients with New York Heart Association class II-IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable.
6. In patients with tachy-brady syndrome or ventricular tachycardia or survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, evaluation for sleep apnea needs to be considered.
7. Clinical equipoise exists with respect to screening and treatment after a stroke.
8. Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have sleep apnea.
9. All patients with OSA should be considered for treatment, including behavioral modifications and weight loss as indicated. Continuous positive airway pressure (CPAP) should be offered to patients with severe OSA, whereas oral appliances can be considered for those with mild to moderate OSA or for CPAP-intolerant patients. In addition, follow-up sleep testing should be performed to assess the effectiveness of treatment.
10. Future studies on the use of artificial intelligence and machine learning are indicated for processing and identifying actionable data in patients with OSA and developing personalized individualized therapies.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Atherosclerotic Disease (CAD/PAD), Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Pulmonary Hypertension, Hypertension, Sleep Apnea

Keywords: Airway Obstruction, Arrhythmias, Cardiac, Artificial Intelligence, Atrial Fibrillation, Cardiovascular Diseases, Continuous Positive Airway Pressure, Coronary Artery Disease, Death, Sudden, Cardiac, Defibrillators, Electric Countershock, Heart Failure, Hypertension, Hypertension, Pulmonary, Hypoxia, Brain, Myocardial Infarction, Obesity, Primary Prevention, Sleep Apnea, Obstructive, Sleep Deprivation, Stroke, Tachycardia, Ventricular, Weight Loss

< Back to Listings