Polysomnography in AF patients without prior diagnosis of obstructive sleep apnea reveals significant sleep abnormality: A strong case for screening in all patients with atrial fibrillation?

BACKGROUND: Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are known to often coexist together. However, whether all patients with AF should be screened for sleep abnormalities is not clear. No previous study has examined the association of asymptomatic OSA with AF. OBJECTIVE: This study sought to determine the prevalence of asymptomatic OSA in patients with persistent AF and whether asymptomatic OSA is an independent risk factor for atrial fibrillation. METHOD: Patients with persistent AF without a prior diagnosis of OSA and asymptomatic for sleep abnormalities were prospectively enrolled over 12 months. All patients underwent polysomnography after informed consent. Patients without AF or OSA who underwent polysomnography during the same period served as controls. RESULTS: A total of 97 patients were studied; 50 were in the case group (patients with persistent AF) and 47 were in the control group (patients in sinus rhythm). Asymptomatic OSA was diagnosed on polysomnography in 72% of patients in the AF group and 17% of the control population. Multivariable analysis of factors including diabetes, hypertension, coronary artery disease, hypothyroidism, prior MI, and asymptomatic OSA, suggested asymptomatic OSA as an independent factor associated with AF. CONCLUSION: A significant proportion (72%) of patients with persistent AF have underlying asymptomatic OSA. Sleep abnormality thus has a strong association with AF even in patients who are asymptomatic for OSA. Screening for OSA may be advised for all patients with AF, as this may have significant implications for management.