Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
JACC Clin Electrophysiol. 2020 Nov;6(12):1499-1506. doi: 10.1016/j.jacep.2020.05.030. Epub 2020 Aug 12.
This study sought to evaluate the proportion of patients with atrial fibrillation (AF) who also have undiagnosed sleep apnea and examine the impact of its diagnosis on adherence to sleep apnea therapies.
Sleep apnea is a modifiable risk factor for AF. However, the proportion of patients with AF who also have undiagnosed sleep apnea and the impact of its diagnosis on therapy have not been well studied.
This prospective study included 188 consecutive patients with AF without a prior diagnosis of sleep apnea who were scheduled to undergo AF ablation. Participants underwent home sleep apnea testing, completed a sleep apnea screening questionnaire (STOP-BANG [Snoring; Tiredness, Fatigue, or Sleepiness During the Daytime; Observation of Apnea and/or Choking During Sleep; Hypertension; Body Mass Index >35 kg/m; Age >50 Years; Neck Circumference >40 cm; and Male Sex]) and were followed for ≥2 years to evaluate the impact of diagnosis on therapy.
Home sleep apnea testing was positive in 155 of 188 patients (82.4%); among those 155, 127 (82%) had a predominant obstructive component and 28 (18%) had mixed sleep apnea with a 15.2 ± 7.4% central component. Sleep apnea severity was mild in 43.8%, moderate in 32.9%, and severe in 23.2%. The sensitivity and specificity of a STOP-BANG questionnaire were 81.2% and 42.4%, respectively. In a multivariate analysis, STOP-BANG was not predictive for sleep apnea (odds ratio: 0.54; 95% confidence interval: 0.17 to 1.76; p = 0.31). Therapy with continuous positive airway pressure ventilators was initiated in 73 of 85 patients (85.9%) with moderate or severe sleep apnea, and 68 of the 73 patients (93.1%) remained complaint after a mean follow-up period of 21 ± 6.2 months.
Sleep apnea is exceedingly prevalent in patients with AF who are referred for ablation, with a large proportion being undiagnosed due the limited predictive value of sleep apnea symptoms in this AF population. Screening for sleep apnea resulted in high rate of long-term continuous positive airway pressure adherence.
本研究旨在评估患有心房颤动（AF）的患者中同时患有未确诊的睡眠呼吸暂停的比例，并研究其诊断对睡眠呼吸暂停治疗的影响。
睡眠呼吸暂停是 AF 的一个可改变的危险因素。然而，患有 AF 且同时患有未确诊的睡眠呼吸暂停的患者比例以及其诊断对治疗的影响尚未得到充分研究。
这项前瞻性研究纳入了 188 例未经诊断的睡眠呼吸暂停的连续 AF 患者，这些患者计划接受 AF 消融术。参与者进行家庭睡眠呼吸暂停测试，完成睡眠呼吸暂停筛查问卷（STOP-BANG [打鼾；白天嗜睡、疲劳或睡眠不足；观察睡眠中的呼吸暂停和/或窒息；高血压；体重指数>35kg/m²；年龄>50 岁；颈围>40cm；男性]），并随访至少 2 年，以评估诊断对治疗的影响。
188 例患者中，有 155 例（82.4%）的家庭睡眠呼吸暂停测试结果阳性；在这 155 例患者中，有 127 例（82%）存在主要的阻塞性成分，28 例（18%）存在混合性睡眠呼吸暂停，中枢成分占 15.2±7.4%。睡眠呼吸暂停严重程度为轻度占 43.8%，中度占 32.9%，重度占 23.2%。STOP-BANG 问卷的敏感性和特异性分别为 81.2%和 42.4%。多变量分析显示，STOP-BANG 对睡眠呼吸暂停无预测作用（比值比：0.54；95%置信区间：0.17 至 1.76；p=0.31）。在 85 例中-重度睡眠呼吸暂停患者中，有 73 例（85.9%）开始使用持续气道正压通气呼吸机治疗，73 例中有 68 例（93.1%）在平均 21±6.2 个月的随访后仍有抱怨。
在接受消融术的 AF 患者中，睡眠呼吸暂停非常普遍，由于该 AF 人群中睡眠呼吸暂停症状的预测价值有限，有很大一部分患者未被诊断。睡眠呼吸暂停筛查导致长期持续气道正压通气治疗的依从率较高。
