改善心房颤动患者的阻塞性睡眠呼吸暂停筛查（SLEEP-AF项目）

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）会导致不良心脏重构并恶化心房颤动（AF）的结局，然而尽管有指南推荐，筛查仍不理想。
目的： 本质量改进项目旨在改善AF患者的OSA筛查、诊断和治疗。
方法： 采用干预前后设计，在3个月内评估了一项针对电生理（EP）门诊新发AF患者的OSA筛查方案，包括家庭睡眠呼吸暂停检测（HSAT）和气道正压（PAP）治疗的启动。患者接受OSA问卷筛查；评分升高者接受由EP门诊协调的HSAT。中度至重度OSA患者开始PAP治疗。
结果： 样本包括141例患者（干预前n=81；干预后n=60），基线无显著差异。OSA筛查率从49.3%提高至96.7%（P<.001），3个月内睡眠检查完成率从2%提高至25%（P<.001）。平均诊断时间从151.5天缩短至22天。15例患者被诊断为OSA；3例开始PAP治疗。
结论： 由EP门诊实施的包含HSAT和PAP的方案改善了OSA的检出和治疗。需要进一步研究以了解其对患者结局的影响。

英文摘要

BACKGROUND: Obstructive sleep apnea (OSA) contributes to negative cardiac remodeling and worsened atrial fibrillation (AF) outcomes, yet screening remains suboptimal despite guideline recommendations.
OBJECTIVE: This quality improvement project aimed to improve screening, diagnosis, and treatment of OSA in patients with AF.
METHODS: A pre- and postintervention design evaluated an OSA screening protocol with home sleep apnea testing (HSAT) and positive airway pressure (PAP) initiation for new patients with AF in the electrophysiology (EP) clinic over 3 months. Patients were screened with an OSA questionnaire; those with elevated scores underwent HSAT coordinated by the EP clinic. Patients with moderate to severe OSA were initiated on PAP therapy.
RESULTS: The sample included 141 patients (pre, n = 81; post, n = 60) with no significant baseline differences. The OSA screening rate increased from 49.3% to 96.7% (P < .001), and the sleep study completion rate increased from 2% to 25% over 3 months (P < .001). The mean time to diagnosis decreased from 151.5 to 22 days. 15 patients were diagnosed as having OSA; 3 initiated PAP therapy.
CONCLUSION: This protocol with HSAT and PAP delivered by the EP clinic improved OSA detection and treatment. Further study is needed to understand the impact on patient outcomes.