Sleep apnoea management in atrial fibrillation in clinical practice: key messages for health care professionals based on a joint survey by EHRA and ACNAP

Abstract

Obstructive sleep apnoea (OSA) is highly prevalent in patients with atrial fibrillation (AF) and associated with reduced response to rhythm control strategies. 1 Current international guidelines on AF management recommend a combined risk factor management (including OSA treatment), preferably delivered within an integrated care approach. 2 Previously, we described the potential for a multidisciplinary integrated approach to comprehensively manage OSA and AF, 3 but the implementation of OSA testing and treatment in daily AF care remains challenging ad inconsistent. A recent joint survey by the European Heart Rhythm Association (EHRA) and the Association of Cardiovascular Nurses and Allied Professions (ACNAP) 4 conducted in 186 nurses, cardiologists, and other health care professionals showed sub-optimal OSA management in AF patients. According to these professionals, OSA-related symptoms were ranked as the most important reason to test for OSA in AF patients. The majority of participants (67.7%) indicated that cardiologists perform 'ad hoc' referrals to sleep centres for OSA screening. Only 11.3% of respondents initiated systematic testing by a home sleep test or respiratory polygraphy, and 10.8% indicated to have a structured OSA assessment pathway in place at the cardiology department. Only 6.7% of the respondents indicated that they test >70% of their AF patients for OSA as a component of rhythm control therapy. Additionally, this survey identified various knowledge gaps and structural barriers currently preventing optimal implementation , which includes (i) the absence of an established collaboration between cardiology and sleep clinic (35.6%); (ii) the lack of skills and knowledge (23.6%); (iii) the lack of financial (23.6%) and workforce-related resources (21.3%). All these factors result in the fact that structured testing for OSA only occurs in the minority of AF patients. Education of patients and health care professionals is crucial. In the joint survey by EHRA and ACNAP, 4 lack in skills and knowledge related to OSA management has been identified as a barrier currently preventing structured implementation in the clinic. There is an urgent need for increased awareness and structured pathways to standardize OSA testing and treatment integration in the management of AF. Current international cardiology societies mainly focus on treatment recommendations in their AF guidelines. However, an interdiscipli-nary practice guide, providing hands-on instructions and guidance to implement and disseminate integrated OSA and AF management in clinical practice is not available yet. In addition to traditional communication media such as manuscripts and editorials published in journals , also social media, and in particular Twitter, has emerged as the leading and most widely used communication channel for science dissemination and professional exchanges. 5 Twitter is now regularly used by the European Society of Cardiology (ESC) to communicate about activities during conferences, with the appointment of dedicated Twitter ambassadors, and promote scientific content of the associated journals, which may be also important to disseminate approaches on why and how to test and manage OSA in AF patients. Increased awareness of OSA will then hopefully benefit patients and a comprehensive AF management approach implemented in clinical practice. A patient-centred approach with a focus on engagement and education of patients with AF will allow clarification of the role of OSA management as part of AF treatment. This also may lead to an