Cardiovascular Center, Sakurabashi-Watanabe Hospital.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.
Circ J. 2021 Feb 25;85(3):252-260. doi: 10.1253/circj.CJ-20-0782. Epub 2020 Dec 8.
Whether all atrial fibrillation (AF) patients should be evaluated for sleep apnea before catheter ablation (CA) remains controversial. Watch-type peripheral arterial tonometry (W-PAT) is a home sleep testing device and an easier tool for diagnosing sleep apnea than polysomnography. We investigated the prevalence and predictors of sleep apnea using W-PAT in unscreened sleep apnea patients with AF before CA.
The study was conducted under a retrospective, single-center, observational design. We included 776 consecutive patients who underwent both W-PAT and AF ablation. Sleep apnea assessments were successfully performed in 774 patients (99.7%; age 65±11 years, 73.3% male; body mass index [BMI] 24.1±3.5, 56.8% paroxysmal AF). The mean apnea-hypopnea index (AHI) was 20.1±15.6. Although 81.7% of the patients had normal Epworth sleepiness scores (mean 6.5), only 88 (11.4%) had a normal AHI (AHI <5) and 412 (53.2%) had moderate-severe sleep apnea (AHI ≥15). Obesity, male sex, nonparoxysmal AF, hypertension, and a left atrial diameter (LAd) ≥40 mm were predictors of moderate-severe sleep apnea. However, the prevalence of moderate-severe sleep apnea in patients without those predictors (i.e., non-obesity (44.2%), female sex (43.0%), paroxysmal AF (43.9%), no hypertension (45.5%)), and LAd <40 mm (41.0%) was considerably high.
Almost all patients successfully underwent W-PAT to diagnose sleep apnea. Patients undergoing AF ablation had a high prevalence of sleep apnea, and screening for sleep apnea was important in those patients even if they did not have sleepiness or risk factors.
在导管消融 (CA) 之前，是否所有心房颤动 (AF) 患者都应评估睡眠呼吸暂停，这一问题仍存在争议。手表式外周动脉张力计 (W-PAT) 是一种家庭睡眠测试设备，与多导睡眠图相比，它是一种更易于诊断睡眠呼吸暂停的工具。我们在接受 CA 治疗的未筛查睡眠呼吸暂停合并 AF 患者中，使用 W-PAT 调查睡眠呼吸暂停的患病率和预测因素。
该研究采用回顾性、单中心、观察性设计。我们纳入了 776 例连续接受 W-PAT 和 AF 消融的患者。774 例患者 (99.7%；年龄 65±11 岁，73.3%为男性；体重指数 [BMI] 24.1±3.5，56.8%为阵发性 AF) 成功进行了睡眠呼吸暂停评估。平均呼吸暂停低通气指数 (AHI) 为 20.1±15.6。尽管 81.7%的患者 Epworth 嗜睡评分正常 (平均 6.5)，但仅有 88 例 (11.4%) AHI 正常 (AHI<5)，412 例 (53.2%)存在中重度睡眠呼吸暂停 (AHI≥15)。肥胖、男性、非阵发性 AF、高血压和左心房直径 (LAd)≥40mm 是中重度睡眠呼吸暂停的预测因素。然而，在无上述预测因素的患者中 (即非肥胖 (44.2%)、女性 (43.0%)、阵发性 AF (43.9%)、无高血压 (45.5%) 和 LAd<40mm (41.0%))，中重度睡眠呼吸暂停的患病率相当高。
几乎所有患者都成功接受了 W-PAT 以诊断睡眠呼吸暂停。接受 AF 消融的患者睡眠呼吸暂停患病率较高，即使这些患者没有嗜睡或危险因素，筛查睡眠呼吸暂停也很重要。
