CHEST Guidelines-Rebuttal-From-Drs-Mansukhani,-Somers,-and-Caples

Rebuttal-From-Drs-Mansukhani,-Somers,-and-Caples_c

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The document is a rebuttal by Drs. Mansukhani, Somers, and Caples, addressing the association between obstructive sleep apnea (OSA) and atrial fibrillation (AF), and the implications for clinical treatment. They concur with Drs. Mehra and Wazni that both conditions are prevalent and have significant adverse effects. The authors acknowledge the experimental and epidemiological evidence suggesting a link between OSA and AF, but highlight the lack of conclusive evidence proving causality. They note that while OSA has been associated with predictors of pulmonary vein ablation failure, such as hypertension, it has not been definitively shown to predict post-ablation AF independently.<br /><br />The authors emphasize the limitations of current evidence on the benefits of continuous positive airway pressure (CPAP) treatment to prevent AF recurrence, cautioning against assuming efficacy without more robust data. They point out that reductions in blood pressure due to CPAP are modest, and antihypertensive medications remain the primary treatment for hypertension.<br /><br />Drs. Mansukhani and colleagues argue against routine CPAP screening for all AF patients undergoing ablation due to the lack of randomized controlled trials demonstrating clear benefits of OSA treatment on AF recurrence. They express concerns about potential harm, as seen in previous studies like the SERVE-HF trial. The authors advocate for individualized patient evaluations rather than universal screening, stressing the need for definitive proof of benefit from interventions.<br /><br />Overall, they caution against expanding clinical procedures without solid evidence of effectiveness, emphasizing the importance of treatment effect size on outcomes when considering causality in clinical settings.

Keywords

obstructive sleep apnea

atrial fibrillation

clinical treatment

causality

CPAP treatment

hypertension

pulmonary vein ablation

randomized controlled trials

individualized evaluations

treatment effectiveness