Structured Testing and Treatment for Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Atrial fibrillation (AF) is the most prevalent arrhythmia globally. Research has shown that AF is associated with various risk factors such as hypertension, diabetes, obesity, and obstructive sleep apnea. Obstructive sleep apnea is a sleep-disordered breathing condition that is highly prevalent in AF patients, contributing to the development and progression of AF.

Despite the high prevalence of obstructive sleep apnea in AF patients (about 62%), it often goes underrecognized and underdiagnosed. Lack of symptom reporting and easily accessible screening tools and strategies contribute to this underdiagnosis. The standard diagnostic method is through polysomnography, which, while effective, has drawbacks such as high costs, labor intensity, and time-consuming nature, making it challenging to use as a screening tool. (Cardio)respiratory polygraphy devices, such as the NOX-T3s, are gaining interest for obstructive sleep apnea detection due to their user-friendly nature, comfort, convenience, and home useability. A previous validation study showed that the NOX-T3s polygraphy device had high accuracy, sensitivity, and specificity and was also the most user-friendly for obstructive sleep apnea detection in AF patients.

Besides the screening, retrospective research has shown that obstructive sleep apnea treatment with the gold standard method, continuous positive airway pressure (CPAP), positively influences AF recurrence through improved antiarrhythmic therapy. Current literature suggests early obstructive sleep apnea diagnosis, followed by early CPAP treatment, could reduce AF recurrence. However, prospective studies supporting this are lacking. Therefore, additional information on the heart rhythm of AF patients, monitored in a (semi)-continuous manner before and after treatment initiation, would be valuable to investigate if treatment (mostly CPAP) leads to a reduction in AF events.

However, implementing a care pathway using the NOX T3s for structured obstructive sleep apnea testing and the Fitbit Versa smartwatch with the FibriCheck algorithm for the follow-up of AF recurrence in standard clinical care in an AF population still needs to be evaluated.

• Obstructive sleep apnea severity agreement between polygraphy and polysomnography [Time frame: Result known after polysomnography examination, on average 6 weeks after the polysomnography examination]
• False positive rate of polygraphy [Time frame: Result known after polysomnography examination, on average 6 weeks after the polysomnography examination]
• Total sleep apnea burden [Time frame: On average 3 months after initiation of obstructive sleep apnea treatment]
• CPAP/BiPAP/ASV compliance [Time frame: On average 3 months after initiation of obstructive sleep apnea treatment]
• Sleep score [Time frame: 3 months after first and after second period of semi-continuous monitoring with Fitbit smartwatch]
• Patients' AF-related symptom burden, assessed by the Leuven ARrhythmia Questionnaire (LARQ) [Time frame: Right after the polysomnography examination and 3 months after obstructive sleep apnea treatment]
• Patients' obstructive sleep apnea-related symptom burden, assessed by the Berlin Questionnaire (BQ) [Time frame: Right after the polysomnography examination and 3 months after obstructive sleep apnea treatment]
• Patients' obstructive sleep apnea-related symptom burden, assessed by the Epworth Sleepiness Scale (ESS) [Time frame: Right after the polysomnography examination and 3 months after obstructive sleep apnea treatment]
• Polygraphy negative patients [Time frame: 24 hours after the one-time use of the polygraphy device]
• Patients' alcohol consumption assessed by the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) supplemented with four additional questions related to alcohol consumption [Time frame: Right after the polysomnography examination and 3 months after obstructive sleep apnea treatment]