Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

Abstract

Background Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. Aim We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. Methods Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea–hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. Results Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573–0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672–0.805) in the overall population. Conclusion AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. Trial registration number ISOLATION was registered NCT04342312, 13-04-2020. Graphical Abstract

Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation

“…These findings indicate that relying solely on disease-specific questionnaires to assess symptoms may not be enough to rule out the presence of co-existing expiratory airflow limitation in patients with AF. Similar limitations are observed when using these questionnaires for other pulmonary comorbidities in AF patients, such as sleep apnea [14] , [37] , [38] . This may be explained by the shared risk factors and overlapping symptoms between AF and pulmonary comorbidities [14] .…”

Atrial fibrillation and obstructive sleep apnea syndrome: results of a retrospective study

“…Результаты нашего исследования согласуются с данными, полученными D. Zhang и соавторами (2022), свидетельствующими о том, p1,2 < 0,0001; p1,3 < 0,0001; p2,3 < 0,0001 ОХС, ммоль/л 4,3 ± 1,1 4,7 ± 1,6 4,1 ± 0,9 p1,2 = 0,436; p1,3 = 0,425; p2,3 = 0,119 XC ЛПНП, ммоль/л 2,2 ± 0,8 2,5 ± 1,3 2,1 ± 0,9 p1,2 = 0,366; p1,3 = 0,888; p2,3 = 0,245 ХС ЛПВП, ммоль/л Мужчины 1,2 ± 0,3 1,3 ± 0,4 1,1 ± 0,3 p1,2 = 0,777; p1,3 = 0,369; p2,3 = 0,264 Женщины 1,5 ± 0,3 1,4 ± 0,4 1,3 ± 0,4 p1,2 = 0,581; p1,3 = 0,228; p2,3 = 0,569 ТГ, ммоль/л 1,6 ± 0,7 1,7 ± 0,7 1,5 ± 0,6 p1,2 = 0,530; p1,3 = 0,713; p2,3 = 0,245 Глюкоза, ммоль/л 6,5 ± 1,9 7,4 ± 3,2 6,7 ± 1,5 p1,2 = 0,317; p1,3 = 0,692; p2,3 = 0,340 При оценке распространенности СОАС среди пациентов с ФП в нашей работе установлено, что нарушения дыхания во сне были диагностированы у 78,5 % больных, в том числе легкой степени тяжести -у 24,1 %, средней степени -у 20,2 % и тяжелой степени -у 34,2 % пациентов, что не противоречит литературным данным. Результаты исследования К. Betz и соавторов (2023) свидетельствуют о том, что в когорте пациентов с ФП, 58 % из которых составляли больные мужского пола, распространенность нарушений дыхания во сне умеренной и тяжелой степени достигала 51 % [17]. Согласно работе А. М. Mohammadieh с соавторами (2021), у 62,6 % больных с ФП при целенаправленном скрининге нарушений дыхания во сне впервые был диагностирован СОАС (31,8 % легкой степени, 18,7 % средней тяжести, 12,1 % тяжелой степени) [18].…”

“…При этом, по данным литературы, частота ожирения, АГ, в том числе резистентной к терапии, сахарного диабета увеличивается по мере нарастания тяжести СОАС [20]. Пациенты с нарушениями дыхания во сне средней и тяжелой степени имеют более высокий ИМТ, у них чаще отмечаются АГ, дислипидемия, сосудистые заболевания по сравнению с обследованными без нарушений дыхания во сне [17].…”

Obstructive sleep apnea in the patient with atrial fibrillation: current knowledge and remaining uncertainties

“…The BOSS-GAP score represents a refinement of the STOP-BANG with incorporation of a new BMI cut-off of at least 27 k/m 2 and a history of previous stroke or TIA, and the removal of daytime tiredness and neck circumference. This refinement led to a modest improvement in detecting OSA in an atrial fibrillation cohort compared with the traditional STOP-BANG with an increase in the receiver-operating characteristic curve from 0.647 [95% confidence interval (CI) 0.573–0.721] to 0.738 (95% CI 0.672–0.805) [38 ▪ ]. The NABS is a short-item screening questionnaire consisting of neck circumference, age, BMI (as a continuous variable), and snoring; in contrast to the STOP-BANG, it does not include sex or daytime tiredness.…”

“…It has also been shown that commonly used well validated screening questionnaires such as the Berlin and STOP-BANG questionnaires, do not perform well in identifying the presence of OSA in atrial fibrillation cohorts [36,37]. Recently, two distinct questionnaires have been developed and validated for the detection OSA specifically in atrial fibrillation cohorts [36,38 ▪ ]. The BOSS-GAP score represents a refinement of the STOP-BANG with incorporation of a new BMI cut-off of at least 27 k/m 2 and a history of previous stroke or TIA, and the removal of daytime tiredness and neck circumference.…”