Author + information
- Received April 13, 2020
- Revision received May 25, 2020
- Accepted May 25, 2020
- Published online August 12, 2020.
- Ayelet Shapira-Daniels, MDa,∗,
- Sanghamitra Mohanty, MDb,∗,
- Fernando M. Contreras-Valdes, MDa,
- Hieu Tieu, FNP-BC, MBAa,
- Robert J. Thomas, MDd,
- Andrea Natale, MDb and
- Elad Anter, MDc,∗ ()
- aHarvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- bTexas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, Texas
- cCardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- dthe Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Elad Anter, Cardiac Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-133, Cleveland, Ohio 44195.
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.
↵∗ Drs. Shapira-Daniels and Mohanty contributed equally to this work and are joint first authors.
The study was partially supported by a research grant from Itamar Medical, Ltd., which provided the home sleep apnea testing devices used in this study. Dr. Thomas has received royalties through Beth Israel Deaconess Medical Center from MyCardio, LLC, for a licensed patent (ECG-spectrogram); and has consulted for Jazz Pharmaceuticals, Guidepoint Global, and GLG Councils. Dr. Natale has received consulting and speaking honoraria from Biosense Webster, Boston Scientific, Stereotaxis, and Abbott Medical. Dr. Anter has received research grants and speaking honoraria from Biosense Webster, Boston Scientific, Affera Inc., and Itamar Medical; and holds stock options in Affera Inc. and Itamar Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 13, 2020.
- Revision received May 25, 2020.
- Accepted May 25, 2020.
- 2020 American College of Cardiology Foundation
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