Abstract
Introduction: Sleep apnea is recognized as a predictor of incident atrial fibrillation (AF); it has been associated with decreased response to antiarrhythmic drugs, and higher rates of AF recurrence after cardioversion and catheter ablation. However, it is not known whether widespread screening for sleep apnea in patients with AF affects arrhythmia outcomes. Objective: to evaluate the effect of universal sleep apnea screening on AF outcomes. Methods: We conducted a prospective study of all patients referred to electrophysiology clinic at our center for management of AF and referred for sleep apnea testing between March 2018 and March 2021. Screening was performed using home sleep testing (HST) and polysomnography (PSG). Patients were assessed for progression of AF as defined by any of the following: change from paroxysmal to persistent AF, change in antiarrhythmic drug, ablation, or cardioversion. Results: Among 321 patients evaluated for atrial fibrillation, 78% (251) of patients were tested for sleep apnea with HST or PSG. Of these, 6% (16) had no sleep apnea, 83% (208) had either obstructive or mixed apnea, and 11% (27) were inconclusive. Among those with sleep apnea, 56% (116) had OSA, 42% (87) had mixed apnea, and 2% (5) had pure central apnea.As the time from AF diagnosis to sleep apnea testing increased, the risk of AF progression also increased (p <0.0001). This effect was observed even when stratified by obstructive versus mixed apnea(OSA p= 0.04, mixed p=0.0005). Conclusions: Sleep apnea was present in the vast majority of patients with AF. Of those with sleep apnea, almost half had mixed central and obstructive sleep apnea. Duration of greater than 24 months from atrial fibrillation diagnosis to sleep apnea testing was associated with higher rates of AF progression. Thus, early, universal screening for sleep apnea may improve outcomes in patients with AF. Table I. The relationship between time from AF diagnosis to sleep apnea (SA) testing on AF outcomes.
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