STOP-Bang and Berlin questionnaire as predictors of sleep apnea in patients with paroxysmal atrial fibrillation

Abstract

Background: The association between sleep apnea (SA) and atrial fibrillation (AF) is strong. SA is probably underdiagnosed in AF patients. Polysomnography (PSG) is time consuming and costly and a valid screening tool is warranted. Aims and Objectives: The aim was to determine if the Berlin Questionnaire (BQ) and the STOP-Bang Questionnaire (SBQ) can be used as a screening tool in patients with paroxysmal atrial fibrillation (PAF). Methods: We prospectively studied 565 PAF patients. Risk for sleep apnea was assessed with the BQ and the SBQ. SA was defined as an apnea-hypopnea index (AHI) ≥15/h obtained by polygraphy (PG) two nights at home. Sleep studies were analyzed by an experienced specialist, using standard American Academy of Sleep Medicine definitions. A BQ high risk subject was defined as ≥2 of 3 risk factors: (I) snoring; (II) daytime somnolence; and (III) hypertension or a body mass index (BMI) > 30 kg/m². A SBQ high risk subject was defined as ≥5 affirmative answers to the 8 STOP-Bang items. Results: Mean age was 60 (9) years and mean BMI 29 (4) kg/m². 238 (42%) had an AHI ≥ 15/h. According to SBQ low, intermediate and high risk of SA was 7%, 14% and 21% respectively. The SBQ score ≥3 was 84% sensitive and 45 % specific for diagnosis of SA. For those with low risk and high risk according to the BQ score 19% and 23% had SA, respectively. The BQ performed with 56% sensitivity and 70% specificity. Conclusions: Of two commonly used questionnaires to screen for SA, neither the SBQ nor the BQ questionnaire discriminated well between those with or without SA in patients with PAF. Until better screening tools are available PG or PSG needs to be used to detect SA in these patients.