Assessment of Sleep and Mood Symptoms in Patients with Undetected Obstructive Sleep Apnea and Atrial Fibrillation

Abstract

Introduction: Obstructive sleep apnea (OSA) is associated with serious cardiovascular consequences. We aimed to determine: • The percentage of patients in arrhythmia clinics who show symptoms suggestive of insomnia, non-refreshing sleep, excessive daytime sleepiness, fatigue, decreased alertness, and/or depression; • If these symptoms predict the severity or the presence of OSA in these patients. Methods: Non-selected consecutive patients were recruited from outpatient arrhythmia clinics. Patients with previously diagnosed and/or treated OSA were excluded. Validated screening tools were administered. Patients underwent ambulatory sleep testing for the diagnosis of OSA. Correlation and regression analyses were performed to detect the predictors of OSA. Results: 100 participants with atrial fibrillation were recruited (72% Males). The mean age was 64 ± 13 years. Sleep related instruments showed that: • Thirty-seven percent of patients have scores suggestive of excessive daytime sleepiness; • Fifty-four percent have excessive daytime fatigue; • Symptoms of non-restorative sleep are present in 57%; • Twenty-five percent have scores suggestive of depression; • Thirty-eight percent have mild insomnia, 14% moderate insomnia, and 5% severe insomnia; • Six percent show scores suggestive of decreased alertness. Eighty-five percent of patients had previously undetected OSA. Only age and male gender were predictors of OSA (p=0.009, p=0.008 respectively). Conclusion: Eighty-five percent of patients with atrial fibrillation have undetected OSA. Scores suggestive of daytime sleepiness, fatigue, insomnia, depression, and non-refreshing sleep do not predict OSA. Sleep studies may be applied routinely for detection of OSA in these patients.