Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
Can J Cardiol. 2019 Nov;35(11):1457-1464. doi: 10.1016/j.cjca.2019.07.627. Epub 2019 Aug 1.
Atrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF.
A total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm control and underwent polysomnography comprised the study population. The utility of daytime sleepiness (quantified by the Epworth Sleepiness Scale [ESS]) to predict any (apnea-hypopnea index [AHI] ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB on polysomnography was tested.
Mean age was 60 ± 11 years and 69% patients were men. SDB was present in two-thirds of the population with 33% having moderate-to-severe SDB. Daytime sleepiness was low (median ESS = 8/24) and the ESS poorly predicted SDB, regardless of the degree of SDB tested (area under the curve: 0.48-0.56). Excessive daytime sleepiness (ESS ≥ 11) was present in 11.9% of the SDB population and had a negative predictive value of 43.1% and a positive predictive value of 67.5% to detect moderate-to-severe SDB. Male gender (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.8, P = 0.001), obesity (OR: 3.5, 95% CI: 2.3-5.5, P < 0.001), diabetes (OR: 2.3, 95% CI: 1.2-4.4, P = 0.08), and stroke (OR: 4.6, 95% CI: 1.7-12.3, P = 0.002) were independently associated with an increased likelihood of moderate-to-severe SDB.
In an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB.
心房颤动（AF）管理指南建议筛查睡眠呼吸紊乱（SDB）的症状。我们旨在评估自我报告的日间嗜睡在检测 SDB 和 AF 患者中的作用。
共纳入 442 例连续接受 AF 门诊治疗且被认为适合节律控制并接受多导睡眠图检查的患者作为研究对象。使用日间嗜睡（通过 Epworth 嗜睡量表[ESS]量化）来预测多导睡眠图上任何（呼吸暂停-低通气指数[AHI]≥5）、中重度（AHI≥15）和重度（AHI≥30）SDB 的能力进行了测试。
平均年龄为 60±11 岁，69%的患者为男性。人群中有三分之二存在 SDB，其中 33%存在中重度 SDB。日间嗜睡程度较低（中位 ESS=8/24），ESS 对 SDB 的预测能力较差，无论测试的 SDB 程度如何（曲线下面积：0.48-0.56）。11.9%的 SDB 患者存在日间嗜睡（ESS≥11），其对中重度 SDB 的阴性预测值为 43.1%，阳性预测值为 67.5%。男性（比值比[OR]：2.3，95%置信区间[CI]：1.4-3.8，P=0.001）、肥胖（OR：3.5，95%CI：2.3-5.5，P<0.001）、糖尿病（OR：2.3，95%CI：1.2-4.4，P=0.08）和中风（OR：4.6，95%CI：1.7-12.3，P=0.002）与中重度 SDB 的可能性增加独立相关。
在 AF 门诊患者中，SDB 很常见，但大多数患者报告的日间嗜睡水平较低。临床特征，而不是日间嗜睡，是预测中重度 SDB 患者的指标。缺乏过度的日间嗜睡不应排除患者对潜在合并 SDB 的调查。
