Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

• Published in: Clinical research in cardiology Vol. 112; no. 6; pp. 834 - 845
• Main Authors: Betz, Konstanze, Verhaert, Dominique V. M., Gawalko, Monika, Hermans, Astrid N. L., Habibi, Zarina, Pluymaekers, Nikki A. H. A., van der Velden, Rachel M. J., Homberg, Marloes, Philippens, Suzanne, Hereijgers, Maartje J. M., Vorstermans, Bianca, Simons, Sami O., den Uijl, Dennis W., Chaldoupi, Sevasti-Maria, Luermans, Justin G. L. M., Westra, Sjoerd W., Lankveld, Theo, van Steenwijk, Reindert P., Hol, Bernard, Schotten, Ulrich, Vernooy, Kevin, Hendriks, Jeroen M., Linz, Dominik
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2023; Springer Nature B.V
• Subjects: Ablation; Apnea; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiology; Confidence intervals; Fibrillation; Humans; Ischemia; Medicine; Medicine & Public Health; NCT; NCT04342312; Original Paper; Polysomnography - methods; Questionnaires; Regression analysis; ROC Curve; Sleep; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - epidemiology; Sleep disorders; Statistical analysis; Surveys and Questionnaires; Transient ischemic attack; mHealth; Sleep apnoea; Ablation; Atrial fibrillation; Sleep-disordered breathing; STOP-Bang questionnaire
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-023-02157-9

Background Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. Aim We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. Methods Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea–hypopnoea index (AHI) of  ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening . Results Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573–0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m 2  and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672–0.805) in the overall population. Conclusion AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. Trial registration number ISOLATION was registered NCT04342312, 13-04-2020. Graphical Abstract