0508 SLEEP APNEA AND ATRIAL FIBRILLATION - PHENOTYPE AND OUTCOMES

Abstract

Sleep apnea, especially central (CSA), is associated with atrial fibrillation (AF). We hypothesized that AF patients are at high risk for treatment-emergent/complex apnea, and residual disease during long-term therapy with positive airway pressure. The sleep laboratory database at the Beth Israel Deaconess Medical center and affiliated services was queried, focusing on patients with AF, to extract polysomnographic information. The BIDMC Online Medical Records was used to collect co-morbid information. Residual apnea and related information was extracted from the EnocreAnywhere database; at the BIDMC, tracking is life-long, enabling assessment of outcomes beyond 6 months. Three hundred and eighteen patients had complete clinical/polysomnographic data, and 212 were reviewed in EncoreAnywhere. Split night was 31%. Summary statistics: age 68.3 ± 11.1 years, 69.1% male, BMI 33.6 ± 8 Kg/M2, ejection fraction 53.5 ± 10.8 (22% less than 50%), hypertension 68.6%. Baseline total sleep time (TST): 181.4 ± 116.3 minutes, sleep efficiency 62.9 ± 19.3 %, N1 24.3 ± 21.5% TST, N3: 9.7 ± 13.9 % TST, RDI: 39.4 ± 21.7, AHI4% 8.2 ± 11.9, minimum saturation 81.8 ± 10 %. Titration data: TST: 242 ± 98.9 minutes, sleep efficiency 66.9 ± 19.8 %, N1: 18 ± 15.2 %, RDI 27 ± 21.6, AHI4% 5 ± 8.5, minimum saturation 85.4 ± 6.9 %. CSA was noted in 4% on baseline, and treatment-emergent/complex apnea in 30%. The mean duration of use of positive airway pressure (93% continuous) was 21 ± 3 months, mean use 4.1 ± 2.1 hours. Residual AHI-flow was 11.6 ± 7.8 / hour of use, and periodic breathing of at least 10 minutes duration on visual waveforms inspection in 76.4 %. Patients with AF have highly fragmented sleep during diagnostic and titration polysomnograms. Complex sleep apnea is common, as is residual sleep apnea and periodic breathing on waveforms. This likely reflects persistently elevated loop gain. AF patients with sleep apnea are at high risk for reduced treatment effectiveness, and may require a dedicated phenotype-driven clinical pathway for optimal management. Beth Israel Deaconess Medical Center Chief Academic Officer’s Innovation Grant.