Assessment of CHADS(2) and CHA(2)DS(2)-VASc scores in obstructive sleep apnea patients with atrial fibrillation

PURPOSE: Assessment of stroke risk and implementation of appropriate antithrombotic therapy is an important issue in atrial fibrillation patients. Current risk scores do not take into consideration the comorbidities associated with elevated thromboembolic like obstructive sleep apnea (OSA). The aim of the study was to establish whether atrial fibrillation patients with coexisting OSA have higher stroke risk according to CHADS(2) and CHA(2)DS(2)-VASc scores. METHODS: Two hundred fifty-four consecutive patients hospitalized with a primary diagnosis of atrial fibrillation participated in the study. All patients underwent whole night polygraphy and were scored in both CHADS(2) and CHA(2)DS(2)-VASc according to their medical records or de novo diagnosis. RESULTS: The study population was predominantly male (65.4 %; mean age, 57.5 ± 10.0 years) with a high prevalence of hypertension (73.6 %), dyslipidemia (63.4 %), and obesity (42.9 %). OSA was present in 47.6 % of patients, who more often had history of stroke (p = 0.0007). Stroke risk profile assessed by both CHADS(2) and CHA(2)DS(2)-VASc scores was higher in patients with OSA (1.2 ± 0.9 vs. 0.8 ± 0.6; p < 0.0001 and 2.2 ± 1.7 vs. 1.5 ± 1.1; p = 0.001) than without it. Differences in the stroke risk remained significant across different age strata, and the trend for point values in CHADS(2) and CHA(2)DS(2)-VASc scores rose along with OSA severity according to the apnea–hypopnea index (AHI; p for trend <0.001). CONCLUSIONS: OSA was highly prevalent in atrial fibrillation patients. Patients with OSA have higher CHADS(2) and CHA(2)DS(2)-VASc scores. Mean CHADS(2) and CHA(2)DS(2)-VASc scores rise with OSA severity. Future studies should prospectively research on potential inclusion of OSA to stroke prediction models.