Diagnosis and management of sleep Apnea in CVD patients: APSC issues consensus statements

The consensus recommendations are as follows:

Screening and Diagnosis

Recommendation 1: Any one of the following conditions should prompt the clinician to screen patients for OSA: hypertension, type 2 diabetes, obesity, stroke, heart failure, coronary artery disease, and arrhythmia.

Recommendation 2: Symptoms of OSA or screening questionnaires, such as STOP-Bang, may be used to screen for OSA in patients with CVD.

Recommendation 3: Patients with the following conditions should be referred to a sleep specialist for sleep testing: resistant hypertension, AF requiring cardioversion/ablation; or unexplained pulmonary hypertension.

Recommendation 4: In patients suspected of OSA after screening with significant cardiopulmonary disease (HF, congenital heart disease, or complicated valvular disease), polysomnography (Level I) should be used to diagnose OSA. Level III or Level IV sleep studies should not be used to diagnose OSA in these patients because of the complexity of the clinical scenario, which may lead to misdiagnosis.

Recommendation 5: In patients with a high pre-test probability of moderate to severe OSA without significant cardiopulmonary disease or stroke, home sleep apnoea testing (Level III or IV) or polysomnography (Level I/II) may be used to diagnose OSA.

Recommendation 6: Sleep studies conducted on patients with CVD should be scored and reported by an adequately trained sleep specialist.

Recommendation 7: All patients undergoing OSA treatment should also undergo lifestyle modification and educational and behavioral interventions for OSA, as well as for weight loss if they are classified as overweight or obese.

Recommendation 8: OSA treatment improves daytime sleepiness and cognitive function. In observational studies, continuous positive airway pressure (CPAP) therapy for OSA is strongly associated with reduced rates of adverse cardiovascular events, but randomized control trial evidence to support CPAP therapy in non-sleepy OSA patients with CVD is inconclusive.

Recommendation 9: Patients with HF and OSA may undergo CPAP therapy, which has been shown to improve ventricular function, symptoms, and quality of life.

Recommendation 10: Patients undergoing rhythm control for AF who have moderate to severe OSA should undergo CPAP therapy to reduce the risk of AF recurrence.

Recommendation 11: Patients with CVD and OSA whose OSA symptoms persist despite treatment or who are non-adherent to OSA therapy should be reviewed by a sleep specialist.

The APSC Working Group concluded, "Management of patients with CVD and OSA should be individualized and should consider the patient's symptoms, clinical characteristics, and comorbidities, as well as patients' and caregivers' concerns and preferences."

"Also, clinicians should be aware of the challenges that may limit the applicability of these consensus recommendations, such as limited access to specific interventions and technologies, limited availability of resources, accepted local standards of care, cultural factors, and individualized expertise in OSA management."