Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

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  • Konstanze Betz
  • Dominique V.M. Verhaert
  • Monika Gawalko
  • Astrid N.L. Hermans
  • Zarina Habibi
  • Nikki A.H.A. Pluymaekers
  • Rachel M.J. van der Velden
  • Marloes Homberg
  • Suzanne Philippens
  • Maartje J.M. Hereijgers
  • Bianca Vorstermans
  • Sami O. Simons
  • Dennis W. den Uijl
  • Sevasti Maria Chaldoupi
  • Justin G.L.M. Luermans
  • Sjoerd W. Westra
  • Theo Lankveld
  • Reindert P. van Steenwijk
  • Bernard Hol
  • Ulrich Schotten
  • Kevin Vernooy
  • Jeroen M. Hendriks

Background: Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. Aim: We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. Methods: Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea–hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. Results: Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573–0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672–0.805) in the overall population. Conclusion: AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. Trial registration number: ISOLATION was registered NCT04342312, 13-04-2020. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish
JournalClinical Research in Cardiology
Volume112
Pages (from-to)834–845
ISSN1861-0684
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).

    Research areas

  • Ablation, Atrial fibrillation, mHealth, Sleep apnoea, Sleep-disordered breathing, STOP-Bang questionnaire

ID: 337585323