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Sleep Apnea Screening for Patients with Atrial Fibrillation (SAFARI), a Prospective Diagnostic Accuracy Trial
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A3966 - Sleep Apnea Screening for Patients with Atrial Fibrillation (SAFARI), a Prospective Diagnostic Accuracy Trial
Author Block: A. Mohammadieh1, K. Sutherland1, L. Kanagaratnam2, D. Whalley2, M. Gillett3, P. A. Cistulli1; 1Center for Sleep Health and Research, Royal North Shore Hospital, Charles Perkins Centre, University of Sydney, Sydney, Australia, 2Department of Cardiology, Royal North Shore Hospital, Sydney, Australia, 3Department of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia.
RATIONALE: There is a known association between Obstructive Sleep Apnea (OSA) and atrial fibrillation (AF). AF-related outcomes are worse for untreated OSA patients. In particular, OSA increases the risk of AF recurrence following ablative procedures. However, full in-laboratory polysomnograpy (PSG) is resource intensive. Therefore there is a need for a simple, cost effective OSA screening method in AF patients.
AIMS: 1- To examine the epidemiology of OSA in a hospital cohort with AF. 2- To evaluate the validity and reliability of a level 3 portable sleep study device for the diagnosis of OSA in patients with AF.
METHODS: AF patients were recruited via two pathways: 1. a tertiary hospital emergency department and 2. Pulmonary Vein Isolation (PVI) waitlists. All patients had a history of ≥1 episode of AF in the last 12M. All patients underwent both a level 3 diagnostic sleep study (ApneaLinkTM, ResMed Ltd) and in-laboratory polysomnography (PSG) within a week of one another (in random order). Demographic and phenotypic data were collected. Test characteristics of ApneaLink (sensitivity, specificity, ROC, positive and negative predictive values) were compared to results from polysomnography (considered the gold standard for OSA diagnosis).
RESULTS: Data on 38 patients have been analysed to date. 23 (60.5%) were male. Mean age was 59.0 years (range 31 to 82). Average BMI was 26.8 (SD 3.3). Average Epworth Sleepiness Score (ESS) was 6.5 (SD 3.7). A total of 25 patients (65.8%) had OSA (34.2% mild, 18.4% moderate, 13.2% severe). There was a moderate relationship between BMI and PSG AHI (R = 0.488, p= 0.002). There was no relationship between ESS and PSG AHI (R = -0.088, p= 0.6). Using an AHI cut-off of 9.2/hr, ApneaLink had a sensitivity of 85.0% and a specificity of 94.1% to detect an AHI >10 as determined by in-laboratory PSG (AUC 0.904, PPV 94.4%, NPV 84.2%).
CONCLUSIONS: OSA is highly prevalent among AF patients in a hospital cohort. AF patients do not have traditional symptoms and/or risk factors for OSA. A level 3 device shows good sensitivity and specificity, and may be useful as a screening tool in an AF population.
Author Block: A. Mohammadieh1, K. Sutherland1, L. Kanagaratnam2, D. Whalley2, M. Gillett3, P. A. Cistulli1; 1Center for Sleep Health and Research, Royal North Shore Hospital, Charles Perkins Centre, University of Sydney, Sydney, Australia, 2Department of Cardiology, Royal North Shore Hospital, Sydney, Australia, 3Department of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia.
RATIONALE: There is a known association between Obstructive Sleep Apnea (OSA) and atrial fibrillation (AF). AF-related outcomes are worse for untreated OSA patients. In particular, OSA increases the risk of AF recurrence following ablative procedures. However, full in-laboratory polysomnograpy (PSG) is resource intensive. Therefore there is a need for a simple, cost effective OSA screening method in AF patients.
AIMS: 1- To examine the epidemiology of OSA in a hospital cohort with AF. 2- To evaluate the validity and reliability of a level 3 portable sleep study device for the diagnosis of OSA in patients with AF.
METHODS: AF patients were recruited via two pathways: 1. a tertiary hospital emergency department and 2. Pulmonary Vein Isolation (PVI) waitlists. All patients had a history of ≥1 episode of AF in the last 12M. All patients underwent both a level 3 diagnostic sleep study (ApneaLinkTM, ResMed Ltd) and in-laboratory polysomnography (PSG) within a week of one another (in random order). Demographic and phenotypic data were collected. Test characteristics of ApneaLink (sensitivity, specificity, ROC, positive and negative predictive values) were compared to results from polysomnography (considered the gold standard for OSA diagnosis).
RESULTS: Data on 38 patients have been analysed to date. 23 (60.5%) were male. Mean age was 59.0 years (range 31 to 82). Average BMI was 26.8 (SD 3.3). Average Epworth Sleepiness Score (ESS) was 6.5 (SD 3.7). A total of 25 patients (65.8%) had OSA (34.2% mild, 18.4% moderate, 13.2% severe). There was a moderate relationship between BMI and PSG AHI (R = 0.488, p= 0.002). There was no relationship between ESS and PSG AHI (R = -0.088, p= 0.6). Using an AHI cut-off of 9.2/hr, ApneaLink had a sensitivity of 85.0% and a specificity of 94.1% to detect an AHI >10 as determined by in-laboratory PSG (AUC 0.904, PPV 94.4%, NPV 84.2%).
CONCLUSIONS: OSA is highly prevalent among AF patients in a hospital cohort. AF patients do not have traditional symptoms and/or risk factors for OSA. A level 3 device shows good sensitivity and specificity, and may be useful as a screening tool in an AF population.
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