Sleep apnea severity in patients undergoing atrial fibrillation ablation: Home sleep apnea‐test and polysomnography comparison

BACKGROUND: Sleep apnea (SA) is highly prevalent and should be treated in patients referred for catheter ablation (CA) of atrial fibrillation (AF). Watch‐type peripheral arterial tonometry (WP) for home SA testing has demonstrated a high correlation of the apnea‐hypopnea index (AHI) with Polysomnography (PSG), but the evidence of its accuracy in AF patients is not adequate. METHODS: This study was conducted under a retrospective, single‐center, observational design. We included 464 consecutive AF patients (age 65 ± 11 years, 76.5% male, 45.0% paroxysmal‐AF) who received both WP and PSG during the periprocedural period of the CA. We compared the AHI using the WP (WP‐AHI) to that using PSG (PSG‐AHI). RESULTS: The WP‐AHI was 25.9 ± 12.7 and PSG‐AHI 31.4 ± 18.9 (r = .48). Among 325 patients with a WP‐AHI < 30, 116 (35.7%) exhibited a PSG‐AHI ≥ 30. Only 12.5% of the patients were indicated for continuous positive airway pressure (CPAP) treatment only by the WP‐AHI, while 70.9% were indicated for CPAP by the PSG‐AHI according to the Japanese health insurance system. The best cut‐off value of the WP‐AHI was 18.1 to predict a PSG‐AHI ≥ 20 with an area under the curve of 0.72 (95% confidence interval, 0.67–0.76). CONCLUSIONS: The WP‐AHI and PSG‐AHI were weakly correlated in AF patients receiving CA. About one‐third of the patients with moderate SA using the WP was diagnosed with severe SA evaluated by PSG. The majority required PSG for the CPAP indication.