Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2022 Nov 1;182:25-31. doi: 10.1016/j.amjcard.2022.07.034. Epub 2022 Sep 6.
Sleep apnea (SA) is recognized as a predictor of incident atrial fibrillation (AF) and AF recurrence after treatment. However, data on the prevalence of SA phenotypes in patients with AF and the effect of widespread SA screening on AF outcomes are scarce. We conducted a retrospective study of patients with AF referred for SA testing between March 2018 and April 2020. The screening was performed using home sleep testing or polysomnography. AF outcomes were examined by assessment of AF progression as defined by a change from paroxysmal AF to persistent AF, change in antiarrhythmic drug, having an ablation or cardioversion. Of 321 patients evaluated for AF, 251 patients (78%) completed SA testing. A total of 185 patients with complete follow-up data and SA testing were included in our analysis: 172 patients (93%) had SA; 90 of those (49%) had primarily obstructive sleep apnea, 77 patients (42%) had mixed apnea, and 5 patients (3%) had pure central apnea. Time from AF diagnosis to SA testing was associated with AF progression; after 2 years, the risk of AF progression increased (p <0.008). Continuous positive airway pressure treatment did not affect AF progression (p = 0.99). In conclusion, SA is highly prevalent in an unselected population of patients with AF, with mixed apnea being present in over 40% of the population. Early SA testing was associated with decreased rates of AF progression, likely because of earlier and potentially more aggressive pursuit of rhythm control.
睡眠呼吸暂停（SA）被认为是心房颤动（AF）事件和治疗后 AF 复发的预测因素。然而，关于 AF 患者中 SA 表型的患病率以及广泛的 SA 筛查对 AF 结局的影响的数据很少。我们对 2018 年 3 月至 2020 年 4 月间因 SA 检查而转介的 AF 患者进行了回顾性研究。筛查采用家庭睡眠测试或多导睡眠图进行。通过评估 AF 进展情况来检查 AF 结局，AF 进展定义为阵发性 AF 转变为持续性 AF、抗心律失常药物变化、消融或电复律。在评估 AF 的 321 名患者中，有 251 名患者（78%）完成了 SA 检查。共有 185 名患者具有完整的随访数据和 SA 检查结果，包括在我们的分析中：172 名患者（93%）患有 SA；其中 90 名（49%）患有原发性阻塞性睡眠呼吸暂停，77 名（42%）患有混合性呼吸暂停，5 名（3%）患有单纯性中枢性呼吸暂停。从 AF 诊断到 SA 检查的时间与 AF 进展有关；2 年后，AF 进展的风险增加（p <0.008）。持续气道正压通气治疗不会影响 AF 进展（p=0.99）。总之，SA 在未经选择的 AF 患者人群中患病率很高，其中混合性呼吸暂停占 40%以上。早期 SA 检查与降低 AF 进展率相关，这可能是因为更早且可能更积极地进行节律控制。
