Take sleep to heart (message from the editor)

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Sleep Health | Sleep Review

The American Heart Association publishes a scientific statement urging awareness of obstructive sleep apnea in patients with cardiovascular disease.

From Sree Roy

Sleep specialists have long recognized the link between sleep apnea and cardiovascular events. But convincing cardiologist colleagues to prioritize screening and treating sleep apnea has proven to be more difficult. Therefore, I welcome a new scientific opinion from the American Heart Association published in Circulation magazine that is aimed specifically at raising awareness of obstructive sleep apnea (OSA) in people with cardiovascular disease or risk factors such as high blood pressure.

“Obstructive sleep apnea can adversely affect patient health and increase the risk of cardiovascular events and death. The purpose of this statement is to promote increased awareness, screening, and appropriate treatment for sleep apnea, ”says Scientific Statement Group Chair Yerem Yeghiazarians, MD, FAHA, Professor of Medicine and the Leone-Perkins Family Endowed Chair in Cardiology at the University of California , San Francisco, in a press release.

The opinion also comments on various diagnostic options for OSA and stresses that laboratory polysomnography (PSG) is not the only option. “Advances in screening have changed the way we diagnose and treat obstructive sleep apnea,” says Yeghiazarians. “For example, many patients no longer have to go to a night sleep study center. There are now FDA-approved sleep devices that patients can use at home and send back to their doctor for evaluation. ”A table shows the differences between laboratory PSG, standard home sleep apnea testing, peripheral arterial tonometry, and wearable devices.

“And although a continuous positive airway pressure (CPAP) machine is one form of treatment,” Yeghiazarians continues, “there are numerous therapeutic options – from positional therapy and weight loss to oral appliances and surgery – depending on the cause and severity of the OSA condition . “

Dentists in particular will praise the advice given to oral appliances as a suitable therapy for some patients. For example, a meta-analysis is cited in the opinion, in which it was found that oral devices reduce blood pressure in
Hypertensive patients similar to reductions found in CPAP studies.

But sleep professionals disagree with a premise contained in the statement that there is no consensus that screening for OSA changes clinical outcomes. The authors point to mixed and contradicting findings and the lack of randomized controlled trials. For example, studies such as SAVE, RICCADSA and CERCAS “have not produced a high level of evidence of the benefits of CPAP for primary stroke prevention,” the paper says. But it opens the door for additional research that leads to consensus. For example: “The ongoing study” Sleep for Stroke Management and Recovery “is likely to provide guidance on the need for CPAP to improve stroke recovery and prevent recurrence.”

Nevertheless, the statement for sleep medicine is overwhelmingly positive. As Yeghiazarians says, “The general message is clear: we need to raise awareness about OSA screening and treatment, especially in those with pre-existing cardiovascular risk factors.”

Sree Roy is the editor of Sleep Review.

Sree Roy is the editor of Sleep Review.

reference

  1. Yeghiazarians Y, Jneid H, Tietjens JR, et al .; on behalf of the American Heart Association Council on Clinical Cardiology; Peripheral Vascular Disease Council; Council on Atherosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Reanimation; Stroke advice; and advice on cardiovascular surgery and anesthesia. Obstructive sleep apnea and cardiovascular disease: a scientific opinion from the American Heart Association. Traffic. June 21, 2021; Epub before printing.

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