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Is sleep apnoea unrecognised in patients with atrial fibrillation? Free

Introduction: There is a recognised association between atrial fibrillation and obstructive sleep apnoea, and consequent worse outcomes and poor rate control with antiarrhythmic drugs, cardio-version and ablation. (1,2) There have been several studies looking at the prevalence of this association (3) and we have reviewed the incidence of this at our institution and the relation to self-reported sleepiness.

Methodology: All new patients with atrial fibrillation attending a nurse led AF clinic were referred for assessment of possible obstructive sleep apnoea. Patients were invited to attend on 2 occasions for limited home based multi-channel sleep studies (Alice). Self-reported sleepiness was assessed using the Epworth questionnaire. Results were interpreted by a qualified sleep physiologist and patients with significant sleep disordered breathing invited to attend a sleep clinic.

Results: Over a 10 week period 41 patients were referred into the sleep service, of which 37 attended for investigations. Their mean (SD) age was 69 (12.8) years and 27 were male. 21 (56%) had significant sleep apnoea with an apnoea/hypopnoea index of 15 or greater, of which only 5 patients had predominant central events. Of the 37 patients. 34 patients had both a sleep study and an accurately completed Epworth score which was elevated in only 3 of the 21 with sleep apnoea: (X2 P = 0.4).

Conclusion: In a group of patients with atrial fibrillation attending a nurse led cardiac clinic who were unsuspected by their primary care physician or other referring physicians to have sleep apnoea had this diagnosis confirmed in 21 of the 37 patients. There was no relationship with self-reported sleepiness, as assessed by the Epworth questionnaire, and sleep apnoea. So, in patients with atrial fibrillation, even if they are relatively asymptomatic referral for sleep studies should be considered.

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