Prevalence of Undiagnosed Sleep Apnea in Patients With Atrial Fibrillation and its Impact on Therapy

Ayelet Shapira-Daniels; Sanghamitra Mohanty; Fernando M Contreras-Valdes; Hieu Tieu; Robert J Thomas; Andrea Natale; Elad Anter

doi:10.1016/j.jacep.2020.05.030

Prevalence of Undiagnosed Sleep Apnea in Patients With Atrial Fibrillation and its Impact on Therapy

JACC Clin Electrophysiol. 2020 Nov;6(12):1499-1506. doi: 10.1016/j.jacep.2020.05.030. Epub 2020 Aug 12.

Authors

Ayelet Shapira-Daniels¹, Sanghamitra Mohanty², Fernando M Contreras-Valdes¹, Hieu Tieu¹, Robert J Thomas³, Andrea Natale², Elad Anter⁴

Affiliations

¹ Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
² Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
³ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: antere@ccf.org.

PMID: 33213809
DOI: 10.1016/j.jacep.2020.05.030

Abstract

Objectives: This study sought to evaluate the proportion of patients with atrial fibrillation (AF) who also have undiagnosed sleep apnea and examine the impact of its diagnosis on adherence to sleep apnea therapies.

Background: Sleep apnea is a modifiable risk factor for AF. However, the proportion of patients with AF who also have undiagnosed sleep apnea and the impact of its diagnosis on therapy have not been well studied.

Methods: This prospective study included 188 consecutive patients with AF without a prior diagnosis of sleep apnea who were scheduled to undergo AF ablation. Participants underwent home sleep apnea testing, completed a sleep apnea screening questionnaire (STOP-BANG [Snoring; Tiredness, Fatigue, or Sleepiness During the Daytime; Observation of Apnea and/or Choking During Sleep; Hypertension; Body Mass Index >35 kg/m²; Age >50 Years; Neck Circumference >40 cm; and Male Sex]) and were followed for ≥2 years to evaluate the impact of diagnosis on therapy.

Results: Home sleep apnea testing was positive in 155 of 188 patients (82.4%); among those 155, 127 (82%) had a predominant obstructive component and 28 (18%) had mixed sleep apnea with a 15.2 ± 7.4% central component. Sleep apnea severity was mild in 43.8%, moderate in 32.9%, and severe in 23.2%. The sensitivity and specificity of a STOP-BANG questionnaire were 81.2% and 42.4%, respectively. In a multivariate analysis, STOP-BANG was not predictive for sleep apnea (odds ratio: 0.54; 95% confidence interval: 0.17 to 1.76; p = 0.31). Therapy with continuous positive airway pressure ventilators was initiated in 73 of 85 patients (85.9%) with moderate or severe sleep apnea, and 68 of the 73 patients (93.1%) remained complaint after a mean follow-up period of 21 ± 6.2 months.

Conclusions: Sleep apnea is exceedingly prevalent in patients with AF who are referred for ablation, with a large proportion being undiagnosed due the limited predictive value of sleep apnea symptoms in this AF population. Screening for sleep apnea resulted in high rate of long-term continuous positive airway pressure adherence.

Keywords: atrial fibrillation; epidemiology; home sleep testing; risk factors; sleep apnea.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Humans
Male
Middle Aged
Polysomnography
Prevalence
Prospective Studies
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / diagnosis
Sleep Apnea Syndromes* / epidemiology
Sleep Apnea, Obstructive* / epidemiology