Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What’s the Best Test?

Starkey, Samantha Y.; Jonasson, D.; Alexis, Stephanie; Su, Susan; Johal, R.; Sweeney, Paul; Brasher, Penelope M. A.; Fleetham, John A.; Ayas, Najib; Orenstein, T.; Ahmed, Iqbal

doi:10.1016/j.cjco.2020.09.026

Cited by 6 publications

(4 citation statements)

References 33 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As mentioned before, OSA is highly underdiagnosed in the AF population, despite a prevalence of up to 86% in AF patients recruited in a community cardiology clinic ( 14 ). Our study is in line with this finding, although our study patients had a higher pretest probability.…”

Section: Discussionmentioning

confidence: 96%

Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Delesie

Knaepen

Verbraecken

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (<5 = no OSA, 5–14 = mild, 15–30 = moderate, >30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

show abstract

Section: Discussionmentioning

confidence: 96%

Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Delesie

Knaepen

Verbraecken

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…This study is not the first to demonstrate the limited value of the STOP-Bang questionnaire as an SDB-screening tool in AF patients. Several studies reported its moderate to poor performance in detecting moderate-to-severe SDB in AF patients in different clinical settings [ 6 , 7 , 14 – 16 ]. The relatively high false negative rate and low sensitivity have been mentioned as factors limiting the usefulness of the STOP-Bang questionnaire [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Originally, the questionnaire was not developed specifically for AF patients. Due to interrelations between SDB and AF, the shared risk factor profile, and the fact that symptoms of SDB and AF are often overlapping, the STOP-Bang items might have limited predictive value [ 6 , 7 , 14 – 19 ]. Indeed, in our cohort, some overlapping characteristics could be revealed with correlation analysis of the STOP-Bang items, for example, between the item neck circumference and observed apnoea/snoring, high blood pressure or male gender.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

et al. 2023

View full text Add to dashboard Cite

Background Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. Aim We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. Methods Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea–hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. Results Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573–0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672–0.805) in the overall population. Conclusion AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. Trial registration number ISOLATION was registered NCT04342312, 13-04-2020. Graphical Abstract

show abstract

“…These questionnaires will be a good starting point to identify patients with AF who have OSA but more objective test, such as the home sleep apnea testing, is encouraged for those with AF to rule out OSA. [77][78][79][80] Metoprolol has been shown to prevent AF in animal models with chronic OSA by inhibiting atrial structural, sympathetic nervous and metabolic remodeling 81,82 studies to demonstrate this effect in humans will be valuable. OSA has been associated with increased incidence of extra-PV triggers of AF, and elimination of these triggers reduces arrhythmia recurrence.…”

Section: The Relationship Of Therapy Of Osa and Afmentioning

confidence: 99%

Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea

Ifedili

Ingram

Blount

et al. 2022

Exp Biol Med (Maywood)

View full text Add to dashboard Cite

Atrial fibrillation is the most common cardiac arrhythmia with its prevalence expected to increase to 12.1 million people in the United States by 2030. Chronic underlying conditions that affect the heart and lungs predispose patients to develop atrial fibrillation. Obstructive sleep apnea is strongly associated with atrial fibrillation. Several pathophysiological mechanisms have been proposed to elucidate this relationship which includes electrophysiological substrate modification and the contribution of the autonomic nervous system. In this comprehensive review, we highlight important relationships and plausible causality between obstructive sleep apnea and atrial fibrillation which will improve our understanding in the evaluation, management, and prevention of atrial fibrillation. This is the most updated comprehensive review of the relationship between obstructive sleep apnea and atrial fibrillation.

show abstract

Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What’s the Best Test?

Cited by 6 publications

References 33 publications

Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea

Contact Info

Product

Resources

About