■在国际心脏病专家中,尚不清楚在诊断和管理阻塞性睡眠呼吸暂停(OSA)以改善房颤(AF)结局方面是否存在平衡,以及临床实践和平衡是否相关。
在2019年1月至2020年6月期间,我们向16个国家的执业心脏病专家分发了一份基于网络的关于OSA和AF管理的12个问题调查。
■美国,Japan,瑞典,土耳其占答复的三分之二。863名心脏病专家回应;一半是普通心脏病专家,四分之一的电生理学家。关于用CPAP治疗OSA以改善AF终点的反应是混合的。33%的受访者推荐AF患者进行OSA筛查。在48%的转诊患者中诊断出OSA,并为其中59%的患者规定了持续气道正压通气(CPAP)。近70%的受访者认为房颤患者接受OSA治疗的随机对照试验(RCTs)是必要的,并表示愿意参与此类试验。
■在接受调查的心脏病专家中没有临床上的平衡;大多数人表示肯定OSA和AF联合治疗在改善AF结局方面优于单独的AF治疗。然而,少数接受调查的心脏病专家将AF患者转诊为OSA检测,虽然一半的房颤筛查患者患有OSA,其中一半以上是开的CPAP,反映了需要更好的临床试验证据来支持这一实践的观点。我们的结果强调了对更大,OSA治疗和AF结局的多国家前瞻性研究,以提供更统一的社会指南建议。
UNASSIGNED: Among international cardiologists it is unclear whether equipoise exists regarding the benefit of diagnosing and managing obstructive sleep apnea (OSA) to improve atrial fibrillation (AF) outcomes and whether clinical practice and equipoise are linked.
UNASSIGNED: Between January 2019 and June 2020 we distributed a web-based 12-question survey regarding OSA and AF management to practicing cardiologists in 16 countries.
UNASSIGNED: The United States, Japan, Sweden, and Turkey accounted for two-thirds of responses. 863 cardiologists responded; half were general cardiologists, a quarter electrophysiologists. Responses regarding treating OSA with CPAP to improve AF endpoints were mixed. 33% of respondents referred AF patients for OSA screening. OSA was diagnosed in 48% of referred patients and continuous positive airway pressure (CPAP) was prescribed for 59% of them. Nearly 70% of respondents believed randomized controlled trials (RCTs) of OSA treatment in AF patients were necessary and indicated willingness to contribute to such trials.
UNASSIGNED: There was no clinical equipoise among surveyed cardiologists; a majority expressed certainty that combined OSA and AF treatment is superior to AF treatment alone for improving AF outcomes. However, a minority of surveyed cardiologists referred AF patients for OSA testing, and while half of screened AF patients had OSA, CPAP was prescribed in little more than half of them, reflecting the view that better clinical trial evidence is needed to support this practice. Our results underscore the need for larger, multi-national prospective studies of OSA treatment and AF outcomes to inform more uniform society guideline recommendations.