Obstructive sleep apnea screening performance of the STOP-BANG questionnaire and a home sleep apnea test device in atrial fibrillation ablation candidates.

Abstract

Background: Obstructive sleep apnea (OSA) contributes to the onset and progression of atrial fibrillation (AF) and negatively affects AF ablation outcomes. OSA screening in AF patients is often conducted with the STOP-BANG questionnaire, although its validation is lacking. This study aims to evaluate the screening value of the STOP-BANG questionnaire and a home sleep apnea test (HSAT) device for OSA in patients referred for AF ablation.

Methods: Patients referred for their first AF ablation and without prior OSA diagnosis underwent both the STOP-BANG questionnaire and a HSAT device based on peripheral arterial tonometry (PAT). Patients with a PAT-derived apnea-hypopnea index (pAHI) of 5 or more events per hour subsequently underwent clinical polysomnography (PSG). This PSG was used for definitive OSA diagnosis and to determine the diagnostic values of the STOP-BANG and HSAT.

Results: Of 67 patients initially screened with the STOP-BANG and HSAT, 58 completed PSG after excluding those with pAHI < 5/hour or who declined further testing. Among these 58 patients, STOP-BANG (score ≥ 3) correctly screened 84% of cases, while HSAT was more accurate (97%, P-value < 0.002). Among the 67 initially screened patients, 56 (84%) received a new OSA diagnosis. Of these, 21 (38%) had mild OSA, 17 (30%) moderate OSA and 18 (32%) severe OSA.

Conclusion: The high OSA prevalence highlights the importance of OSA screening in patients referred for AF ablation. In this cohort, HSAT demonstrated superior accuracy, compared to the STOP-BANG questionnaire and may be considered the preferred OSA screening tool in outpatient AF clinics.