<p>Watch-PAT is Useful in the Diagnosis of Sleep Apnea in Patients with Atrial Fibrillation</p>

Abstract

Background: Early diagnosis and treatment of sleep apnea in patients with atrial fibrillation (AF) is critical. The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea; however, studies using the WatchPAT device have thus far excluded patients with arrhythmias due to the potential effect of arrhythmias on the peripheral arterial tonometry (PAT) amplitude and pulse rate changes. Purpose: To examine the accuracy of the WP in detecting sleep apnea in patients with AF. Patients and Methods: Patients with AF underwent simultaneous WP and PSG studies in 11 sleep centers. PSG scoring was blinded to the automatically analyzed WP data. Results: A total of 101 patients with AF (70 males) were recruited. Forty-six had AF episodes during the overnight sleep study. A significant correlation was found between the PSG-derived AHI and the WP-derived AHI (r=0.80, p<0.0001). There was a good agreement between PSG-derived AHI and WP-derived AHI (mean difference of AHI:-0.02 ±13.2). Using a threshold of AHI ≥15 per hour of sleep, the sensitivity and specificity of the WP were 0.88 and 0.63, respectively. The overall accuracy in sleep staging between WP and PSG was 62% with Kappa agreement of 0.42. Conclusion: WP can detect sleep apnea events in patients with AF. AF should not be an exclusion criterion for using the device. This finding may be of even greater importance in the era of the COVID19 epidemic, when sleep labs were closed and most studies were home based.

Pulse Arterial Tonometry Evaluation of Reliability study

“…If one compares the mean/median/interquartile range/90th percentile of the hypoxic burden (percentage of total sleep time with SpO 2 < 90%), the results show 11/2/0-10/40% vs 4/0.2/0-2/10% using PSG vs PAT, respectively, or a significantly higher value using PSG (Wilcoxon signed rank test, P < .0001). Overall, we found that the sources of error were multiple and were represented by several major categories: (1) epochs of discordance between actual sleep and PAT-derived sleep (not a surprise because other studies have showed low accuracy for epoch-by-epoch sleep staging, eg, 62% in the study by Tauman et al 8 ), (2) periods excluded from analyses by the WatchPAT200 device because of various artifactual signals, (3) pulse oximetry artifacts, and (4) under-or overscored PAT respiratory events, 9 the latter leading clinically to either under-or overestimation.…”

Impact of undiagnosed obstructive sleep apnea on atrial fibrillation recurrence following catheter ablation (OSA-AF study)

“…Screening for SDB was performed using the WatchPAT-200U (WP) (Itamar Medical, Caesarea, Israel). The WP system is a home sleep apnea testing (HSAT) device which has been shown to be accurate for diagnosing SDB, also in patients with AF [16] . It consists of a wrist-worn device with a finger probe that obtains peripheral arterial tonometry (PAT) signals and oxygen saturation levels, a snoring and body position sensor that is positioned under the sternal notch and accelerometer that is embedded in the wrist unit ( Fig.…”

Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study

“…The WP provides accurate sleep/ wake and REM/NREM discrimination together with non-REM categorization into deep and light sleep. In addition, the WP provides accurate measurements of snoring and body position [14]. The device is attached to the patient's wrist, like a watch [15].…”