Difference in Obstructive Sleep Apnea Measures Between In-Lab Vs. Home in Patients With Atrial Fibrillation
American Journal of Respiratory and Critical Care Medicine
Introduction Many patients with atrial fibrillation (AF) have obstructive sleep apnea (OSA). Home sleep apnea test (HSAT) device has become a mainstay tool for OSA screening. Typical HSAT without EEG yields total recording time (vs. total sleep time (TST)).Moreover, since it cannot detect arousal, one criterion to score hypopnea, the results of the two tests, apnea hypopnea index(AHI) can be inconsistent. Watch-PAT (WP) HSAT modality detects arousal and estimates TST through their propriety algorithm. We compared the results of the standard in-lab polysomnography (PSG) with that of the 1) WP concurrently obtained with PSG in the lab and 2) WP obtained in home in patients with AF. Methods Patients with history of AF underwent clinically indicated PSG with concurrent WP. Patients then underwent WP at home. We assessed the agreement of the OSA severity category (no OSA:AHI<5/hr, mild 5-15, moderate 15-30 and severe >30]) and ‘good’ sleep (>6 hours) 1) between the in-lab PSG and in-lab WP as well as 2) in-lab PSG and home-WP using Cohen’s Kappa(K). Both hypopnea scoring rule 1a (honoring arousal and 3>=%desaturation) and 1b (solely honoring >= 4% desaturation) were used. Results A total of 24 patients with AF were included (80%male, mean age 68y). Most patients (90%) had clinically defined OSA(AHI≥5) by in-lab PSG study. 1) In-lab PSG vs. In-lab WP(N=24): Mean AHI was similar between the two (1a: 31 vs. 38; 1b: 30 vs. 28, P=NS). However, agreement of the OSA severity category with In-lab WP was variable depending on the hypopnea rule used (K of AHI using rule 1a: 0.22 and 1b :0.68). WP overestimated TST by average 62 min (319 min vs. 381, p=0.005). Agreement of good sleep was minimal (K=0.3). 2) In-lab PSG vs. Home WP (N=20): Mean AHI was similar between the two (1a: 38 vs. 38; 1b: 26 vs. 28, P=NS). Agreement of the OSA severity category was weak to moderate (K of AHI using rule 1a: 0.48 and K of AHI rule 1b :0.65) (Figure: Bland-Altman). TST was similar (393 min vs. 381, p=NS). Agreement of good sleep was weak (K=0.57). Conclusion In patients with AF, OSA evaluation is subject to sleep testing modality. The agreements of OSA severity category between in-lab PSG vs. in-lab WP as well as in-lab PSG vs. home WP were overall poor. Our finding highlights the diagnostic dilemma in OSA evaluation in the HSAT era.
Cho Y, Stafford PL, Ferguson JD, Mehta NK, Bilchik KC, Mazimba S, et al. Difference in obstructive sleep apnea measures between in-lab vs. home in patients with atrial fibrillation. Am J Respir Crit Care Med. 2023 May;207(Suppl.):A2383. doi:10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A2383