TY - JOUR
T1 - Sleep-disordered breathing and excessive daytime sleepiness in patients with atrial fibrillation
AU - Albuquerque, Felipe N.
AU - Calvin, Andrew D.
AU - Sert Kuniyoshi, Fatima H.
AU - Konecny, Tomas
AU - Lopez-Jimenez, Francisco
AU - Pressman, Gregg S.
AU - Kara, Thomas
AU - Friedman, Paul
AU - Ammash, Naser
AU - Somers, Virend K.
AU - Caples, Sean M.
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Sert Kuniyoshi became a full-time employee for Philips Respironics Inc after the collection of the data provided in this article. Dr Pressman has received research grant support from Phillips Respironics Inc. Dr Friedman has been an investigator or coinvestigator on research grants funded by Medtronic, Inc, and Pfizer, Inc, and has served as a consultant to Medtronic, Inc; Boston Scientific Corporation; St. Jude Medical, Inc; and C.R. Bard, Inc. Dr Somers has served as a consultant for Respironics Inc; ResMed Corp; Cardiac Concepts, Inc; GlaxoSmithKline plc; Sepracor; and Medtronic, Inc, and has been a principal investigator or coinvestigator on research grants funded by the Respironics Foundation, the ResMed Foundation, and the Sorin Corporation. Dr Caples has received research support from the ResMed Foundation; Ventus Medical, Inc; and Restore Medical, Inc. Drs Albuquerque, Calvin, Konecny, Lopez-Jimenez, Kara, and Ammash have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Funding Information:
Funding/Support: This work was supported by the Mayo Clinic Clinician-Investigator Training Program; Mayo Foundation; American Heart Association [Grant 04-50103Z] ; National Heart, Lung, and Blood Institute [Grants HL65176, HL70302, HL73211, and HL099534] ; the National Center for Research Resources (NCRR) [Grant 1ULI RR024150] , a component of the National Institutes of Health (NIH); IGA of Ministry of Health No. NS10098-4/2008 ; European Regional Development Fund-Project FNUSA-ICRC [No. CZ.1.05/1.1.00/02.0123] ; and the NIH Roadmap for Medical Research.
PY - 2012/4
Y1 - 2012/4
N2 - Background: An important consequence of sleep-disordered breathing (SDB) is excessive daytime sleepiness (EDS). EDS often predicts a favorable response to treatment of SDB, although in the setting of cardiovascular disease, particularly heart failure, SDB and EDS do not reliably correlate. Atrial fibrillation (AF) is another highly prevalent condition strongly associated with SDB. We sought to assess the relationship between EDS and SDB in patients with AF. Methods: We conducted a prospective study of 151 patients referred for direct current cardioversion for AF who also underwent sleep evaluation and nocturnal polysomnography. The Epworth Sleepiness Scale (ESS) was administered prior to polysomnography and considered positive if the score was ≥ 11. The apnea-hypopnea index (AHI) was tested for correlation with the ESS, with a cutoff of ≥ 5 events/h for the diagnosis of SDB. Results: Among the study participants, mean age was 69.1 ± 11.7 years, mean BMI was 34.1 ± 8.4 kg/m2, and 76% were men. The prevalence of SDB in this population was 81.4%, and 35% had EDS. The association between ESS score and AHI was low (R2 = 0.014, P = .64). The sensitivity and specificity of the ESS for the detection of SDB in patients with AF were 32.2% and 54.5%, respectively. Conclusions: Despite a high prevalence of SDB in this population with AF, most patients do not report EDS. Furthermore, EDS does not appear to correlate with severity of SDB or to accurately predict the presence of SDB. Further research is needed to determine whether EDS affects the natural history of AF or modifies the response to SDB treatment.
AB - Background: An important consequence of sleep-disordered breathing (SDB) is excessive daytime sleepiness (EDS). EDS often predicts a favorable response to treatment of SDB, although in the setting of cardiovascular disease, particularly heart failure, SDB and EDS do not reliably correlate. Atrial fibrillation (AF) is another highly prevalent condition strongly associated with SDB. We sought to assess the relationship between EDS and SDB in patients with AF. Methods: We conducted a prospective study of 151 patients referred for direct current cardioversion for AF who also underwent sleep evaluation and nocturnal polysomnography. The Epworth Sleepiness Scale (ESS) was administered prior to polysomnography and considered positive if the score was ≥ 11. The apnea-hypopnea index (AHI) was tested for correlation with the ESS, with a cutoff of ≥ 5 events/h for the diagnosis of SDB. Results: Among the study participants, mean age was 69.1 ± 11.7 years, mean BMI was 34.1 ± 8.4 kg/m2, and 76% were men. The prevalence of SDB in this population was 81.4%, and 35% had EDS. The association between ESS score and AHI was low (R2 = 0.014, P = .64). The sensitivity and specificity of the ESS for the detection of SDB in patients with AF were 32.2% and 54.5%, respectively. Conclusions: Despite a high prevalence of SDB in this population with AF, most patients do not report EDS. Furthermore, EDS does not appear to correlate with severity of SDB or to accurately predict the presence of SDB. Further research is needed to determine whether EDS affects the natural history of AF or modifies the response to SDB treatment.
UR - http://www.scopus.com/inward/record.url?scp=84859484075&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859484075&partnerID=8YFLogxK
U2 - 10.1378/chest.11-0975
DO - 10.1378/chest.11-0975
M3 - Article
C2 - 21903736
AN - SCOPUS:84859484075
SN - 0012-3692
VL - 141
SP - 967
EP - 973
JO - Chest
JF - Chest
IS - 4
ER -