Severe obstructive sleep apnea in Tunisian population with atrial fibrillation: Prevalence and predictive factors

Abstract

Severe obstructive sleep apnea (OSA) has been incriminated in atrial fibrillation (AF) initiation and maintenance, and would be responsible for worsening its morbi-mortality hence the importance of screening them to propose the appropriate therapeutic strategy. To our knowledge, no study has been interested in predictors of severe OAS in AF patients. The aim of this study was to determine the prevalence of severe OSA in a population followed for non-valvular AF, and to identify its predictive factors. We performed a cross-sectional study, including non-valvular AF patients. All patients underwent a polygraphic study. We included 100 patients in our study. The mean age was 66.4 ± 9.7 years. Severe OSA prevalence was 31%. Patients with severe OSA had more snoring (100% versus 81%, P = 0.008), more moderate to severe daytime sleepiness (71% versus 16%, P < 0.001) with a significantly higher mean Epworth score in severe apneics (12 ± 4 versus 9.6 ± 4, P = 0.006). ROC curve's analysis showed that a waist circumference > 107 cm in men and greater than 104 cm in women, was significantly more associated with severe OSA (47.3% versus 11.1%, P < 0.001). Multivariate analysis concluded that moderate to severe somnolence ( P = 0.004), waist circumference greater than 107 cm in men and greater than 104 cm in women ( P = 0.011), as well as desaturation time (SaO2 < 90%) during sleep over 6 minutes and 40 seconds ( P = 0.036), were independent predictive factors of severe OSA. In our study, moderate to severe somnolence and android obesity have been shown to be independent clinical predictive factors of severity of OAS in non-valvular AF patients. Our study highlights the possibility of creating more relevant clinical scores to screen severe OSA in AF patients which is a very important parameter to determine as it intervenes in the therapeutic decision by continuous positive pressure.