Cargando…

Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population

Standard sleep apnea (SA) screening instruments perform suboptimally in the atrial fibrillation (AF) population. We evaluated and optimized common OSA screening tools in the AF population. Participants of the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFE...

Descripción completa

Detalles Bibliográficos
Autores principales: May, Anna M., Wang, Lu, Kwon, Deborah H., Van Wagoner, David R., Chung, Mina K., Dalton, Jarrod E., Mehra, Reena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752750/
https://www.ncbi.nlm.nih.gov/pubmed/33364332
http://dx.doi.org/10.1016/j.ijcha.2020.100624
_version_ 1783625933589053440
author May, Anna M.
Wang, Lu
Kwon, Deborah H.
Van Wagoner, David R.
Chung, Mina K.
Dalton, Jarrod E.
Mehra, Reena
author_facet May, Anna M.
Wang, Lu
Kwon, Deborah H.
Van Wagoner, David R.
Chung, Mina K.
Dalton, Jarrod E.
Mehra, Reena
author_sort May, Anna M.
collection PubMed
description Standard sleep apnea (SA) screening instruments perform suboptimally in the atrial fibrillation (AF) population. We evaluated and optimized common OSA screening tools in the AF population. Participants of the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT, NCT02576587) age (±5 years)-, sex-, body mass index (BMI ± 5 kg/m(2))-matched case control study (n = 150 each group) completed concurrent questionnaires and overnight polysomnography. Models based on STOP, STOP-BANG, Berlin, NoSAS and Epworth Sleepiness Scale and also models with STOP-BANG predictors with resting heart rate or left atrial volume were constructed. “Best subset” analysis was used to select a predictor subset for evaluation. We assessed test performance for two outcome thresholds: apnea-hypopnea index (AHI) ≥ 5 and AHI ≥ 15. Paroxysmal AF participants were: 61.3 ± 12.1 years, BMI = 31.2 ± 6.6 kg/m(2) with median AHI = 11.8(IQR: 3.8, 24.5); 65 (43.3%) with AHI ≥ 15. Only STOP and STOP-BANG did not perform worse in AF relative to controls. For AHI ≥ 15, STOP-BANG (AUC 0.71, 95%CI:0.55–0.85) did not perform as well as NABS – a composite of neck circumference, age, and BMI as continuous variables and snoring (AUC 0.88, 95%CI:0.76–0.96). Optimal model for AHI ≥ 15 was NABS (sensitivity = 45%, specificity = 97%). For AHI ≥ 5, NABS was also the best performing (AUC 0.82, 95%CI:0.68–0.92, sensitivity = 78%, specificity = 67%). We identify a novel, short-item SA screening instrument for use in paroxysmal AF, i.e. NABS, with improved discriminative ability compared to commonly-used instruments. Further validation studies are needed to assess utility in other AF subtypes. Trial registration: clinicaltrials.gov NCT02576587.
format Online
Article
Text
id pubmed-7752750
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-77527502020-12-23 Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population May, Anna M. Wang, Lu Kwon, Deborah H. Van Wagoner, David R. Chung, Mina K. Dalton, Jarrod E. Mehra, Reena Int J Cardiol Heart Vasc Original Paper Standard sleep apnea (SA) screening instruments perform suboptimally in the atrial fibrillation (AF) population. We evaluated and optimized common OSA screening tools in the AF population. Participants of the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT, NCT02576587) age (±5 years)-, sex-, body mass index (BMI ± 5 kg/m(2))-matched case control study (n = 150 each group) completed concurrent questionnaires and overnight polysomnography. Models based on STOP, STOP-BANG, Berlin, NoSAS and Epworth Sleepiness Scale and also models with STOP-BANG predictors with resting heart rate or left atrial volume were constructed. “Best subset” analysis was used to select a predictor subset for evaluation. We assessed test performance for two outcome thresholds: apnea-hypopnea index (AHI) ≥ 5 and AHI ≥ 15. Paroxysmal AF participants were: 61.3 ± 12.1 years, BMI = 31.2 ± 6.6 kg/m(2) with median AHI = 11.8(IQR: 3.8, 24.5); 65 (43.3%) with AHI ≥ 15. Only STOP and STOP-BANG did not perform worse in AF relative to controls. For AHI ≥ 15, STOP-BANG (AUC 0.71, 95%CI:0.55–0.85) did not perform as well as NABS – a composite of neck circumference, age, and BMI as continuous variables and snoring (AUC 0.88, 95%CI:0.76–0.96). Optimal model for AHI ≥ 15 was NABS (sensitivity = 45%, specificity = 97%). For AHI ≥ 5, NABS was also the best performing (AUC 0.82, 95%CI:0.68–0.92, sensitivity = 78%, specificity = 67%). We identify a novel, short-item SA screening instrument for use in paroxysmal AF, i.e. NABS, with improved discriminative ability compared to commonly-used instruments. Further validation studies are needed to assess utility in other AF subtypes. Trial registration: clinicaltrials.gov NCT02576587. Elsevier 2020-09-04 /pmc/articles/PMC7752750/ /pubmed/33364332 http://dx.doi.org/10.1016/j.ijcha.2020.100624 Text en http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Paper
May, Anna M.
Wang, Lu
Kwon, Deborah H.
Van Wagoner, David R.
Chung, Mina K.
Dalton, Jarrod E.
Mehra, Reena
Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title_full Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title_fullStr Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title_full_unstemmed Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title_short Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
title_sort sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752750/
https://www.ncbi.nlm.nih.gov/pubmed/33364332
http://dx.doi.org/10.1016/j.ijcha.2020.100624
work_keys_str_mv AT mayannam sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT wanglu sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT kwondeborahh sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT vanwagonerdavidr sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT chungminak sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT daltonjarrode sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation
AT mehrareena sleepapneascreeninginstrumentevaluationandnovelmodeldevelopmentandvalidationintheparoxysmalatrialfibrillationpopulation