The American Heart Association releases a scientific statement urging awareness of obstructive sleep apnea in patients with cardiovascular disease.
By Sree Roy
Sleep specialists have long recognized the links between sleep apnea and cardiovascular events. But convincing cardiologist colleagues to prioritize the screening and treating of sleep apnea has proved more challenging. So I applaud a new scientific statement from the American Heart Association, published in the journal Circulation, that specifically urges increased awareness of obstructive sleep apnea (OSA) among people with cardiovascular disease or risk factors such as high blood pressure.
“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,” says chair of the scientific statement writing group 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 release.
What’s more, the statement comments on different diagnostic options for OSA, stressing that in-lab polysomnography (PSG) isn’t the only option. “Screening advances have changed how we diagnose and treat obstructive sleep apnea,” Yeghiazarians says. “For example, many patients do not have to go to an overnight sleep study center anymore. There are now sleep devices approved by the FDA that patients use at home and send back to their doctor for assessment.” A table details differences between in-lab PSG, standard home sleep apnea testing, peripheral arterial tonometry, and wearable devices.
“And, while 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 someone’s OSA.”
Dentists in particular will laud the references to oral appliances as an appropriate therapy for some patients. For example, the statement cites a metaanalysis finding oral appliances achieve blood pressure reductions in
hypertensive patients similar to reductions found in CPAP trials.
But sleep professionals may disagree with a premise put forth in the statement that no consensus exists that screening for OSA alters clinical outcomes. The authors point to mixed and inconsistent findings, as well as a lack of randomized controlled trials. For example, trials such as SAVE, RICCADSA, and CERCAS “have not provided a high level of evidence to support the benefits of CPAP for primary stroke prevention,” the paper states. But it leaves the door open to additional research that results in consensus. For example, “The ongoing Sleep for Stroke Management and Recovery Trial will likely inform the need for CPAP to improve stroke recovery and to prevent recurrence.”
Still, the statement is overwhelming positive for sleep medicine. As Yeghiazarians says, “The overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors.”
Sree Roy is editor of Sleep Review.
- Yeghiazarians Y, Jneid H, Tietjens JR, et al; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Stroke Council; and Council on Cardiovascular Surgery and Anesthesia. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 Jun 21; Epub ahead of print.