Obstructive sleep apnea assessment using a wearable medical device in patients post-catheter ablation for atrial fibrillation: Validation and predictive value

Background Several studies have identified obstructive sleep apnea (OSA) as a risk factor for atrial fibrillation (AF) recurrence following ablation, in addition to other cardiovascular complications. Although polysomnography (PSG) remains the gold standard for diagnosing OSA, its implementation poses challenges due to limited patient acceptance and healthcare resource availability. To overcome limitations, alternative diagnostic tools have been developed. Purpose To evaluate the diagnostic accuracy and real-world usability of a wearable device for OSA screening in AF patients after ablation and its impact on long-term AF recurrence. Methods OSA was assessed using Berlin and STOP-BANG screening questionnaires, a wearable device validated for automated diagnosis and ambulatory PSG. The wearable device attaches to the neck and works with an accompanying application running on a smartphone. Apnea-Hypopnea Index was used to diagnose OSA. Diagnostic reliability across the different methods and patient acceptance were evaluated. All patients were followed, and those diagnosed with OSA were also referred to specialized OSA units. Results Thirty-five patients with atrial fibrillation (AF) who underwent ablation were enrolled. Baseline characteristics are summarized in the Table. The Berlin questionnaire demonstrated sensitivity of 60% and specificity of 90%, while STOP-BANG showed sensitivity of 86% and specificity of 65%. The wearable medical device showed sensitivity 93%, specificity 85%, positive-predictive value 82% and negative-predictive value 94%. Figure. Patient-reported satisfaction for the wearable was higher. Fifteen patients were diagnosed with OSA using PSG, 10 moderate (AHI 15-30/h )and 5 severe (AHI > 30/h), and 8 received treatment or follow-up in specialized OSA units. After a mean follow-up of 14 ± 3 months, atrial fibrillation (AF) recurrences were documented in 4 patients (11%), 3 of whom had been diagnosed with OSA (2 with severe OSA, and 2 had not received any OSA-specific treatment). Conclusion This wearable device offers a reliable and easy solution for ambulatory screening of OSA in AF patients that may enhance early detection and optimize healthcare resources utilization. OSA is related with AF recurrences after ablation. Future studies should assess whether early management of OSA could reduce recurrence rates and improve clinical outcomes.TableFigure