Sleeping Beauty unravelled – Detection of sleep apnoea in patients with atrial fibrillation

Contemporary treatment of atrial fibrillation (AF) goes beyond the management of the arrhythmia and prevention of thromboembolic complications such as stroke, and includes comprehensive risk factor management and lifestyle modification. Nowadays it is well known that concomitant risk factors significantly contribute to the burden of AF. Obstructive sleep apnoea (OSA) is highly prevalent in patients with AF and considered a crucial risk factor for development or worsening of AF. At the same time OSA and AF share important risk factors such as age, gender and obesity, amongst others. In certain situations, cardiac arrhythmias such as AF can develop based on the comorbid risk attributable to OSA, because of e.g., hemodynamic alterations or sympathetic changes affecting underlying electrophysiology. Understanding these interactions may contribute to personalised risk factor assessment and treatment. International guidelines recommend comprehensive risk factor management which may include the assessment and treatment of OSA to reduce symptoms, recurrences, and progression of AF. However, OSA management in clinical practice is often sub-optimal, frequently overlooked, and numerous diagnostic and therapeutic challenges in the treatment of patients with OSA and AF exists. A European survey of 186 health care professionals has confirmed that OSA assessment and testing is often not integrated in the treatment of AF. Only 11% of respondents initiated systematic OSA testing, either using a home sleep test or a respiratory polygraphy, and another 11% reported structured OSA pathways implemented in their cardiology clinic. Crucial barriers exist and prevent structured OSA care being integrated into standard management, examples are a lack of knowledge, non-availability of sleep labs, and the absence of established collaboration between the cardiology department and the sleep laboratories. Although multiple studies have investigated the association between OSA and AF and confirm the importance of diagnosing OSA in patients with AF, further research is needed to inform clinical practice guidelines.