Systematic and opportunistic screening for atrial fibrillation and other arrhythmias in patients with obstructive sleep apnea: a prospective, single-center, cross-sectional study

Background: Patients with obstructive sleep apnea (OSA) may be at high risk for atrial fibrillation (AF), but data on the benefits of early AF screening in this population, including the prevalence of AF detected through such screening, remain limited. Objectives: This study evaluates the prevalence of AF in OSA patients using three screening methods and aims to identify the most effective approach, as well as the potential benefits of early AF detection in this population. Design: Prospective, single-center, cross-sectional study. Methods: This study assessed AF prevalence using three screening methods: opportunistic screening via pulse taking during a routine visit, systematic screening with a handheld electrocardiogram (EKG), and EKG during polysomnography. The analysis also included the proportion of patients with positive screenings who were indicated for anticoagulation and the prevalence of other non-AF arrhythmias. Results: A total of 201 OSA patients were enrolled, with a mean age of 46 years and a mean CHA 2 DS 2 -VASc score of 1. The prevalence of AF was 1.5%, 2.5%, and 2.0% when detected by pulse taking, handheld EKG, and EKG during polysomnography, respectively, with no statistically significant difference ( p = 0.933). All patients with positive screenings were indicated for oral anticoagulant therapy. The prevalence of other non-AF arrhythmias was higher than in the general population, and detecting arrhythmias during sleep appeared to be more effective than detecting them while awake, particularly for atrial tachycardia. Conclusion: The prevalence of AF in OSA patients ranged from 1.5% to 2.5%, with the highest rate observed in handheld EKG systematic screening, though the difference was not statistically significant. Non-AF arrhythmias were also more common than in the general population, highlighting the need for broader arrhythmia surveillance. Further large-scale studies in higher-risk OSA populations are needed to confirm the benefits of systematic AF screening.