Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT

doi:10.1016/j.ijcha.2022.101085

Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT

Metabolism and Systems Research

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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Original language	English
Article number	101085
Number of pages	10
Journal	International journal of cardiology. Heart & vasculature
Volume	42
Early online date	19 Jul 2022
DOIs	https://doi.org/10.1016/j.ijcha.2022.101085
Publication status	Published - Oct 2022

Bibliographical note

Funding Information:
Funding: INCOSACT is supported by grants provided from ResMed Foundation and Phillips Respironics. No such funds were used in support of this project or manuscript. Disclosures: Dr. Tahrani reports grants, personal fees and non-financial support from Novo Nordisk, personal fees and non-financial support from Eli Lilly, AZ, BI, BMS, NAPP, and MSD, personal fees from Janssen, Nestle and Gilead, non-financial support from Impeto medical, ResMed and Aptiva, grants and personal fees from Sanofi outside the submitted work. Dr. Tahrani is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee and Novo Nordisk had no role in this project. Dr. Patel has received grant funding through his institution from Bayer Pharmaceuticals, Philips Respironics, Respicardia, and Sommetrics; and has served as a consultant to Bayer Pharmaceuticals and NovaResp Technologies. Dr. Arzt has received consulting fees from ResMed, Philips Respironics, Boehringer Ingelheim, NRI, Novartis, JAZZ Pharmaceuticals, Bayer, Inspire and Bresotec, and grant support from ResMed Foundation, ResMed, Philips Respironics and Else-Kroehner Fresenius Foundation (2018_A159), outside the submitted work.

Publisher Copyright:
© 2022 The Authors

Keywords

Atrial fibrillation
Clinical equipoise
International
Sleep apnea
Survey

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT (2022). Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists. International journal of cardiology. Heart & vasculature, 42, Article 101085. https://doi.org/10.1016/j.ijcha.2022.101085

@article{805013d259a74a04ac407492d9b5f42d,

title = "Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists",

abstract = "Background: 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.Methods: 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.Results: 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.Conclusions: 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.",

keywords = "Atrial fibrillation, Clinical equipoise, International, Sleep apnea, Survey",

author = "{International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT} and Faulx, {Michael D} and Reena Mehra and {Reis Geovanini}, Glaucylara and Shin-Ichi Ando and Michael Arzt and Luciano Drager and Michael Fu and Camilla Hoyos and Jo Hai and Juey-Jen Hwang and Remzi Karaoguz and John Kimoff and Pei-Lin Lee and Olga Mediano and Patel, {Sanjay R} and Y{\"u}ksel Peker and {Louis Pepin}, Jean and Manuel Sanchez-de-la-Torre and Fr{\'e}d{\'e}ric S{\'e}ri{\`e}s and Stefan Stadler and Patrick Strollo and Tahrani, {A A} and Erik Thunstr{\"o}m and Motoo Yamauchi and Susan Redline and Phillips, {Craig L}",

note = "Funding Information: Funding: INCOSACT is supported by grants provided from ResMed Foundation and Phillips Respironics. No such funds were used in support of this project or manuscript. Disclosures: Dr. Tahrani reports grants, personal fees and non-financial support from Novo Nordisk, personal fees and non-financial support from Eli Lilly, AZ, BI, BMS, NAPP, and MSD, personal fees from Janssen, Nestle and Gilead, non-financial support from Impeto medical, ResMed and Aptiva, grants and personal fees from Sanofi outside the submitted work. Dr. Tahrani is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee and Novo Nordisk had no role in this project. Dr. Patel has received grant funding through his institution from Bayer Pharmaceuticals, Philips Respironics, Respicardia, and Sommetrics; and has served as a consultant to Bayer Pharmaceuticals and NovaResp Technologies. Dr. Arzt has received consulting fees from ResMed, Philips Respironics, Boehringer Ingelheim, NRI, Novartis, JAZZ Pharmaceuticals, Bayer, Inspire and Bresotec, and grant support from ResMed Foundation, ResMed, Philips Respironics and Else-Kroehner Fresenius Foundation (2018_A159), outside the submitted work. Publisher Copyright: {\textcopyright} 2022 The Authors ",

year = "2022",

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doi = "10.1016/j.ijcha.2022.101085",

language = "English",

volume = "42",

journal = "International journal of cardiology. Heart & vasculature",

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International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT 2022, 'Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists', International journal of cardiology. Heart & vasculature, vol. 42, 101085. https://doi.org/10.1016/j.ijcha.2022.101085

Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists. / International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT.
In: International journal of cardiology. Heart & vasculature, Vol. 42, 101085, 10.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Obstructive sleep apnea and its management in patients with atrial fibrillation

T2 - an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

AU - International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT

AU - Faulx, Michael D

AU - Mehra, Reena

AU - Reis Geovanini, Glaucylara

AU - Ando, Shin-Ichi

AU - Arzt, Michael

AU - Drager, Luciano

AU - Fu, Michael

AU - Hoyos, Camilla

AU - Hai, Jo

AU - Hwang, Juey-Jen

AU - Karaoguz, Remzi

AU - Kimoff, John

AU - Lee, Pei-Lin

AU - Mediano, Olga

AU - Patel, Sanjay R

AU - Peker, Yüksel

AU - Louis Pepin, Jean

AU - Sanchez-de-la-Torre, Manuel

AU - Sériès, Frédéric

AU - Stadler, Stefan

AU - Strollo, Patrick

AU - Tahrani, A A

AU - Thunström, Erik

AU - Yamauchi, Motoo

AU - Redline, Susan

AU - Phillips, Craig L

N1 - Funding Information: Funding: INCOSACT is supported by grants provided from ResMed Foundation and Phillips Respironics. No such funds were used in support of this project or manuscript. Disclosures: Dr. Tahrani reports grants, personal fees and non-financial support from Novo Nordisk, personal fees and non-financial support from Eli Lilly, AZ, BI, BMS, NAPP, and MSD, personal fees from Janssen, Nestle and Gilead, non-financial support from Impeto medical, ResMed and Aptiva, grants and personal fees from Sanofi outside the submitted work. Dr. Tahrani is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee and Novo Nordisk had no role in this project. Dr. Patel has received grant funding through his institution from Bayer Pharmaceuticals, Philips Respironics, Respicardia, and Sommetrics; and has served as a consultant to Bayer Pharmaceuticals and NovaResp Technologies. Dr. Arzt has received consulting fees from ResMed, Philips Respironics, Boehringer Ingelheim, NRI, Novartis, JAZZ Pharmaceuticals, Bayer, Inspire and Bresotec, and grant support from ResMed Foundation, ResMed, Philips Respironics and Else-Kroehner Fresenius Foundation (2018_A159), outside the submitted work. Publisher Copyright: © 2022 The Authors

PY - 2022/10

Y1 - 2022/10

N2 - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

AB - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

KW - Atrial fibrillation

KW - Clinical equipoise

KW - International

KW - Sleep apnea

KW - Survey

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DO - 10.1016/j.ijcha.2022.101085

M3 - Article

C2 - 35879970

SN - 2352-9067

VL - 42

JO - International journal of cardiology. Heart & vasculature

JF - International journal of cardiology. Heart & vasculature

M1 - 101085

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International Collaboration of Sleep Apnea Cardiovascular Trialists INCOSACT. Obstructive sleep apnea and its management in patients with atrial fibrillation: an International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists. International journal of cardiology. Heart & vasculature. 2022 Oct;42:101085. Epub 2022 Jul 19. doi: 10.1016/j.ijcha.2022.101085