Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association

Grande, Michael Le; Neubeck, Lis; Murphy, Barbara; McIvor, D.; Lynch, Dianna; McLean, Helen; Jackson, Alun C

doi:10.1177/2047487316652975

Cited by 20 publications

(17 citation statements)

References 71 publications

(76 reference statements)

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“…In our sample, 40.5% of patients had a high OSA risk, a prevalence similar to previous studies showing that close to a half of patients with ACS have moderate or severe OSA (apnea-hypopnea index ≥15) [ 55 ]. Also comparable to a previous study showing that 37.3% of hospitalized patients with ACS have clinically relevant insomnia symptoms [ 56 ], 27.4% of our patients were poor sleepers.…”

Section: Discussionsupporting

confidence: 86%

Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction

Känel

Princip

Schmid

et al. 2018

BMC Cardiovasc Disord

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BackgroundObstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of OSA as well as insomnia symptoms are associated with neuroendocrine hormones and coagulation factors in patients admitted with acute myocardial infarction.MethodsWe assessed 190 patients (mean age 60 years, 83% men) in terms of OSA risk (STOP screening tool for the assessment of high vs. low OSA risk) and severity of insomnia symptoms (Jenkins Sleep Scale for the assessment of subjective sleep difficulties) within 48 h of an acute coronary intervention. Circulating concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured the next morning. The association of OSA risk and insomnia symptoms with neuroendocrine hormones and coagulation factors was computed using multivariate models adjusting for demographic factors, health behaviors, somatic and psychiatric comorbidities, cardiac disease-related variables, and OSA risk in the model for insomnia symptoms, respectively, for insomnia symptoms in the model for OSA risk.ResultsHigh OSA risk was identified in 41% of patients and clinically relevant insomnia symptoms were reported by 27% of patients. Compared to those with low OSA risk, patients with high OSA risk had lower levels of epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001). More severe insomnia symptoms were associated with higher levels of fibrinogen (p = 0.037), driven by difficulties initiating sleep, and with lower levels of norepinephrine (p = 0.024), driven by difficulties maintaining sleep.ConclusionsIn patients with acute myocardial infarction, sleep problems are associated with neuroendocrine hormones and coagulation activity. The pattern of these relationships is not uniform for patients with a high risk of OSA and those with insomnia symptoms, and whether they contribute to adverse cardiovascular outcomes needs to be established.Trial registrationClinicalTrials.gov NCT01781247.

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Section: Discussionsupporting

confidence: 86%

Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction

Känel

Princip

Schmid

et al. 2018

BMC Cardiovasc Disord

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“…Нарушение дыхания во сне в форме синдрома обструктивного апноэ во сне (ОАС), или апноэ центрального происхождения, -важный фактор сердечно-сосудистого риска, который характеризуется повторяющимися эпизодами коллапса верхних дыхательных путей во время сна. В целом 53% пациентов, попадающих в программы КР, имеют либо ОАС, либо высокий риск развития ОАС [35]. Пациенты с нарушением дыхания во сне имеют значительно больший объем инфарктной зоны миокарда и менее выраженное уменьшение размера инфаркта в течение 3 мес после острого инфаркта миокарда.…”

Section: нарушение дыхания во снеunclassified

Cardiac Rehabilitation

Sarana¹,

Kamilova

Lebedeva

et al. 2021

Physical and rehabilitation medicine, medical rehabilitation

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Cardiac rehabilitation based on exercise therapy is a valuable treatment for patients with a broad spectrum of cardiovascular diseases. Current guidelines support its use in patients with stable chronic heart failure and coronary artery disease, after myocardial infarction, acute coronary syndrome, coronary artery bypass grafting, coronary stent placement, and valve surgery. Its use in these conditions is supported by a robust body of research demonstrating improved clinical outcomes. The significant clinical improvement obtained through the regular training in patients with cardiovascular diseases is the result of a complex interplay of different effects: 1) improved cardiopulmonary efficiency and pulmonary functional capacity; 2) amelioration of myocardial perfusion by reducing endothelial dysfunction and by inducing new vessel formation; 3) improved myocardial contractility; 4) counteract the muscle wasting and cachexia; 5) reduction of the systemic inflammation; 6) attenuation of the sympathoexcitation, a typical feature of CHF, even in the persistence of cardiac dysfunction. Despite this evidence, cardiac rehabilitation referral and attendance remains low and interventions to increase its use need to be developed.

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“…Secondary analysis of CR patient data has indicated that sleep disorders such as OSA have the potential to hamper rehabilitation efforts by affecting treatment adherence, self-efficacy and psychological wellbeing [18]. Until recently [19,20], OSA has rarely been mentioned as a risk factor to be managed among cardiac patients. The widespread absence of OSA as a target for screening in CR may be due to the relative paucity of prevalence data in this population.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis

Grande

Beauchamp

Driscoll

et al. 2020

BMC Cardiovasc Disord

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Background Obstructive Sleep Apnoea (OSA) has been recognised as a risk factor for cardiovascular diseases such as hypertension and cardiovascular events such as acute coronary syndrome (ACS). Since it is also known to reduce exercise tolerance, it is important to establish the prevalence of OSA in ACS patients, particularly in those who are commencing cardiac rehabilitation (CR) programs. Methods Using PRISMA guidelines a systematic search was conducted in order to identify studies that objectively measured (using polysomnography or portable monitoring) the prevalence of OSA in ACS patients following hospital admission. A data extraction table was used to summarise study characteristics and the quality of studies were independently assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analysis of the selected studies was conducted in order to estimate OSA prevalence as a function of the two main methods of measurement, the severity of OSA, and timing of the OSA assessment following ACS hospital admission. Results Pooled prevalence estimates of OSA using the “gold standard” polysomnography ranged from 22% for severe OSA to 70% for mild OSA, at any time after hospital admission. Similar prevalence estimates were obtained using portable monitoring, but interpretation of these results are limited by the significant heterogeneity observed among these studies. Conclusions Prevalence of OSA following ACS is high and likely to be problematic upon patient entry into CR programs. Routine screening for OSA upon program entry may be necessary to optimise effectiveness of CR for these patients.

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Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association

Cited by 20 publications

References 71 publications

Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction

Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction

Cardiac Rehabilitation

Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis

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