Elsevier

The American Journal of Cardiology

Volume 182, 1 November 2022, Pages 25-31
The American Journal of Cardiology

Effect of Widespread Sleep Apnea Screening on Progression of Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2022.07.034Get rights and content

Sleep apnea (SA) is recognized as a predictor of incident atrial fibrillation (AF) and AF recurrence after treatment. However, data on the prevalence of SA phenotypes in patients with AF and the effect of widespread SA screening on AF outcomes are scarce. We conducted a retrospective study of patients with AF referred for SA testing between March 2018 and April 2020. The screening was performed using home sleep testing or polysomnography. AF outcomes were examined by assessment of AF progression as defined by a change from paroxysmal AF to persistent AF, change in antiarrhythmic drug, having an ablation or cardioversion. Of 321 patients evaluated for AF, 251 patients (78%) completed SA testing. A total of 185 patients with complete follow-up data and SA testing were included in our analysis: 172 patients (93%) had SA; 90 of those (49%) had primarily obstructive sleep apnea, 77 patients (42%) had mixed apnea, and 5 patients (3%) had pure central apnea. Time from AF diagnosis to SA testing was associated with AF progression; after 2 years, the risk of AF progression increased (p <0.008). Continuous positive airway pressure treatment did not affect AF progression (p = 0.99). In conclusion, SA is highly prevalent in an unselected population of patients with AF, with mixed apnea being present in over 40% of the population. Early SA testing was associated with decreased rates of AF progression, likely because of earlier and potentially more aggressive pursuit of rhythm control.

Section snippets

Methods

Beginning in March 2018, patients referred to the Arrhythmia Clinic for management of AF were referred for SA evaluation. To facilitate widespread SA screening, a clinical pathway was developed in conjunction with Sleep Medicine. This included the creation of an order set for sleep testing in the electronic medical record and automatic notification of referrals and results to select individuals within Sleep Medicine and Electrophysiology. Entry of this order set would alert a designated

Results

From March 2018 to April 2020, 251 of 321 patients with AF referred for SA evaluation successfully completed SA testing. Of these, 212 had complete follow-up information, and 27 of these 212 patients had inconclusive results on HST and were excluded from the final analysis. Thus, our final cohort included 185 patients with AF with conclusive SA testing and complete follow-up information (Figure 1).

Of the 185 patients, 93% had some form of SA, 49% had OSA primarily, and 42% had mixed apnea. Only

Discussion

In this study, we found an exceedingly high prevalence of SA in an unselected population of patients with AF who underwent SA screening as part of a general management strategy for AF. Overall, 93% of patients in our cohort had some form of SA. Traaen et al20 reported a prevalence of >80% in their cohort of patients with AF. A meta-analysis found a pooled prevalence of 78%, with individual prevalence ranging from 46% to 92%.3 Kadhim et al3 characterized the prevalence of sleep-disordered

Disclosures

The authors have no conflicts of interest to declare.

References (29)

  • D Linz et al.

    Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review

    JAMA Cardiol

    (2018)
  • R. Mehra

    Sleep apnea and the heart

    Cleve Clin J Med

    (2019)
  • R Mehra et al.

    Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study

    Am J Respir Crit Care Med

    (2006)
  • R Kanagala et al.

    Obstructive sleep apnea and the recurrence of atrial fibrillation

    Circulation

    (2003)

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