Effect of Widespread Sleep Apnea Screening on Progression of Atrial Fibrillation.

Sleep apnea (SA) is recognized as a predictor of incident atrial fibrillation (AF) and AF recurrence after treatment. However, data on the prevalence of SA phenotypes in patients with AF and the effect of widespread SA screening on AF outcomes are scarce. We conducted a retrospective study of patients with AF referred for SA testing between March 2018 and April 2020. The screening was performed using home sleep testing or polysomnography. AF outcomes were examined by assessment of AF progression as defined by a change from paroxysmal AF to persistent AF, change in antiarrhythmic drug, having an ablation or cardioversion. Of 321 patients evaluated for AF, 251 patients (78%) completed SA testing. A total of 185 patients with complete follow-up data and SA testing were included in our analysis: 172 patients (93%) had SA; 90 of those (49%) had primarily obstructive sleep apnea, 77 patients (42%) had mixed apnea, and 5 patients (3%) had pure central apnea. Time from AF diagnosis to SA testing was associated with AF progression; after 2 years, the risk of AF progression increased (p <0.008). Continuous positive airway pressure treatment did not affect AF progression (p = 0.99). In conclusion, SA is highly prevalent in an unselected population of patients with AF, with mixed apnea being present in over 40% of the population. Early SA testing was associated with decreased rates of AF progression, likely because of earlier and potentially more aggressive pursuit of rhythm control.

A protocol for mitigating safety events in a sleep laboratory.

STUDY OBJECTIVES: Polysomnography is a common outpatient procedure and the rate of adverse events is considered low. Due to the emergence and use of home sleep apnea testing, the patient population presenting for in-laboratory testing may have greater medical complexity, suggesting greater risk for in-laboratory adverse events. We believe that there is a greater need for standardized protocols to triage medically vulnerable populations and for formalized training of sleep technicians to respond to safety events. METHODS: The sleep laboratories affiliated with the Beth Israel Deaconess Medical Center system developed a referral triage protocol for patients undergoing polysomnography and a training protocol for sleep technicians with a formalized response to medical incidents. Safety events occurring from January 2016 to January 2020 were documented and patient demographics, referral characteristics, event characteristics, and outcomes were analyzed. RESULTS: Sixty-five safety events occurred over this period, with a rate of 1:147 studies. The most common events were chest pain (20/65, 31%), shortness of breath (13/65, 20%), and vital sign abnormalities (12/65, 18%). Patients experiencing events were 49% (32/65) female, with a median age of 57 years (range, 19-91 years); 60 of 65 (92%) had documented medical comorbidities, with a median of 3 documented medical or psychiatric comorbidities (range, 0-9). With the formalized response protocol, the time from incident identification to activation of the appropriate response was a median of 3 minutes (range, 0-47 minutes). CONCLUSIONS: The incidence of in-laboratory safety events may be greater than previously described due to the widespread use of home sleep apnea testing. Implementation of formalized response protocols and sleep technician training may be necessary to meet the needs of an increasingly medically complex population.