Felipe N Albuquerque1, Andrew D Calvin2, Fatima H Sert Kuniyoshi2, Tomas Konecny2, Francisco Lopez-Jimenez2, Gregg S Pressman3, Thomas Kara4, Paul Friedman2, Naser Ammash2, Virend K Somers2, Sean M Caples5. 1. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT. 2. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN. 3. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Division of Cardiology, Albert Einstein Medical Center, Philadelphia, PA. 4. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; ICRC-Department of Cardiovascular Diseases, St. Anne's University Hospital, Brno, Czech Republic. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN. Electronic address: caples.sean@mayo.edu.
Abstract
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/m(2), 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 (R(2) = 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.
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/m(2), 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 (R(2) = 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.
Authors: Stephen L Wasmund; Jian-Ming Li; Richard L Page; Jose A Joglar; Robert C Kowal; Michael L Smith; Mohamed H Hamdan Journal: Circulation Date: 2003-04-07 Impact factor: 29.690
Authors: Apoor S Gami; Gregg Pressman; Sean M Caples; Ravi Kanagala; Joseph J Gard; Diane E Davison; Joseph F Malouf; Naser M Ammash; Paul A Friedman; Virend K Somers Journal: Circulation Date: 2004-07-12 Impact factor: 29.690
Authors: Justin C T Pepperell; Nick A Maskell; David R Jones; Beverley A Langford-Wiley; Nicky Crosthwaite; John R Stradling; Robert J O Davies Journal: Am J Respir Crit Care Med Date: 2003-08-19 Impact factor: 21.405
Authors: Lien Desteghe; Jeroen M L Hendriks; R Doug McEvoy; Ching Li Chai-Coetzer; Paul Dendale; Prashanthan Sanders; Hein Heidbuchel; Dominik Linz Journal: Clin Res Cardiol Date: 2018-04-12 Impact factor: 5.460
Authors: Johanna Strotmann; Henrik Fox; Thomas Bitter; Odile Sauzet; Dieter Horstkotte; Olaf Oldenburg Journal: Clin Res Cardiol Date: 2017-09-23 Impact factor: 5.460
Authors: Victoria M Pak; Lisa Strouss; Henry K Yaggi; Nancy S Redeker; Vahid Mohsenin; Barbara Riegel Journal: J Sleep Res Date: 2018-11-13 Impact factor: 3.981
Authors: Narat Srivali; Anwar C Chahal; Meghna P Mansukhani; Jay Mandrekar; Virend K Somers; Sean M Caples Journal: J Clin Sleep Med Date: 2019-10-15 Impact factor: 4.062
Authors: Chi-Hang Lee; Wai-Yee Ng; William Hau; Hee-Hwa Ho; Bee-Choo Tai; Mark Y Chan; A Mark Richards; Huay-Cheem Tan Journal: J Clin Sleep Med Date: 2013-12-15 Impact factor: 4.062
Authors: Usaid K Allahwala; Peter A Cistulli; Hasthi U Dissanayake; Michael Ward; James C Weaver; Ravinay Bhindi Journal: Lung Date: 2021-08-10 Impact factor: 2.584