CHEST Guidelines-Rebuttal-From-Drs-Mehra-and-Wazni

Rebuttal-From-Drs-Mehra-and-Wazni_chest

Pdf Summary

Drs. Reena Mehra and Oussama Wazni argue for the evaluation of obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) planning to undergo pulmonary vein ablation. They stress the high prevalence of OSA in those with AF, citing that up to 50% of AF patients may have undiagnosed OSA. Although current standard OSA screening methods have limitations in the AF population, they highlight data showing the Berlin Questionnaire’s efficacy in identifying OSA. They underscore the significant association between OSA and AF, supported by multiple epidemiologic studies, which suggest a possible causal relationship, supported by experimental models. They call for randomized clinical trials to fully assess the impact of OSA treatment on AF outcomes.<br /><br />In contrast, Drs. Meghna Mansukhani, Virend Somers, and Sean Caples acknowledge the prevalence of both conditions and recognize the potential pathophysiological links between OSA and AF. However, they argue that the exact causal relationship remains unproven and likely multifactorial. They note conflicting evidence regarding untreated OSA as an independent risk factor for AF recurrence post-ablation. They further state that continuous positive airway pressure (CPAP) has only modest effects on blood pressure reduction, suggesting antihypertensive medications remain crucial for blood pressure management.<br /><br />Both groups agree on the association between OSA and AF but diverge in their interpretations of the evidence and the necessity for universal OSA screening in AF patients planning ablation. While Mehra and Wazni advocate for more aggressive screening, Mansukhani and colleagues emphasize the need for further research to confirm causation and better understand the relationship to guide clinical decisions more effectively. Both parties recognize the importance of additional clinical trials to clarify OSA treatment’s impact on AF management.

Keywords

obstructive sleep apnea

atrial fibrillation

pulmonary vein ablation

OSA screening

Berlin Questionnaire

causal relationship

randomized clinical trials

OSA treatment

CPAP

blood pressure management