Sleep-Disordered Breathing Associated With Atrial Fibrillation Recurrence

Undiagnosed sleep-disordered breathing (SDB) is common among patients who are undergoing catheter ablation for atrial fibrillation (AF) and is associated with a 2-fold higher risk of AF recurrence, according to a study in IJC Heart & Vasculature.

The cross-sectional Effect of undiagnosed Obstructive Sleep Apnea in patients undergoing Atrial Fibrillation catheter ablation (OSA-AF) study included consecutive patients from a center in the Netherlands from December 2018 to February 2020. Eligible participants were adults with a first catheter ablation of AF 12 to 18 months before SDB screening.

Screening for SDB was conducted with use of the WatchPAT-200U (Itamar Medical, Caesarea, Israel). SDB was defined as having an apnea-hypopnea index (AHI) of 15 or higher. The participants were also asked to complete the STOP-BANG and Epworth Sleepiness Scale (ESS) questionnaires.

A total of 104 patients (aged mean, 59±10 years; 33% women) were included, of whom 38% had AF recurrence in the first year following catheter ablation. The median AHI based on the WatchPAT-200U for the full cohort was 11.5 (IQR, 6.8-21.9), and 39 patients had undiagnosed SDB with an AHI of 15 or higher.

The risk for AF recurrence was increased in patients with undiagnosed SDB compared with the risk in patients without undiagnosed SDB (51% vs 31%; odds ratio [OR], 2.37; 95% CI, 1.04-5.38; P =.04). Patients with AF recurrence trended toward a higher median AHI value, 14.7 (IQR, 7.5-28.0) vs 10.6 (IQR, 6.6-16.5), P =.09.

Patients with undiagnosed SDB and those with previously diagnosed SDB had a comparable risk for AF recurrence (51% vs 50%; OR 1.05; 95% CI, 0.41-2.73; P =.92).

A total of 95 participants completed the STOP-BANG questionnaire, of whom 64% had an abnormal score (intermediate or high-risk). A higher proportion of patients with SDB had an abnormal STOP-BANG score compared with patients without SDB (79% vs 56%, P =.02). An abnormal STOP-Bang score had a sensitivity of 79% and specificity of 44% for detecting SDB (AHI ≥15), with a positive predictive value (PPV) of 44% and negative predictive value (NPV) of 79%. The diagnostic accuracy was 57%.

In addition, 98% of patients completed the ESS questionnaire. No difference was observed in excessive daytime sleepiness between patients with and without SDB (8% vs 6%, P =.75). With use of an ESS score of 11 or higher, the sensitivity was 8% and the specificity was 94% for detecting SDB (AHI ≥15), with a PPV of 43% and NPV of 63%. The diagnostic accuracy of an ESS score of 11 or higher was 62%.

Study limitations include the potential influence of catheter ablation on the prevalence and severity of SDB. Also, the WatchPAT-200U was used instead of polysomnography to diagnose SDB.

“Screening for SDB in patients eligible for catheter ablation of AF may improve patient counselling with respect to the efficacy of catheter ablation,” wrote the study authors. “A home sleep apnea testing device may be a useful and easy to implement tool to screen for SDB.”

Reference

de Heide J, Kock-Cordeiro DBM, Bhagwandien RE, et al. Impact of undiagnosed obstructive sleep apnea on atrial fibrillation recurrence following catheter ablation (OSA-AF study). Int J Cardiol Heart Vasc. Published online March 24, 2022. https://doi.org/10.1016/j.ijcha.2022.101014