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Stafford PL, Harmon E, Patel P, Walker M, Akoum N, Park SJ, Cho Y, Bilchick K, Mehta N, Mazimba S, Cho Y, Kwon Y. Positional obstructive sleep apnea in patients with atrial fibrillation. Sleep Breath 2023; 27:487-494. [PMID: 35538180 PMCID: PMC10349247 DOI: 10.1007/s11325-022-02625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common, potentially modifiable condition implicated in the pathogenesis of atrial fibrillation (AF). The presence and severity of OSA is largely sleep position-dependent, yet there is high variability in positional dependence among patients with OSA. We investigated the prevalence of positional OSA (POSA) and examined associated factors in patients with AF. METHODS We recruited an equal number of patients with and without AF who underwent diagnostic polysomnography. Patients included had ≥ 120 min of total sleep time with 30 min of sleep in both supine and lateral positions. POSA was defined as an overall apnea hypopnea index (AHI) ≥ 5/h, supine AHI (sAHI) ≥ 5/h, and sAHI greater than twice the non-supine AHI. POSA prevalence was compared in patients with and without AF adjusting for age, sex, OSA severity, and heart failure. RESULTS A total of patients (male: 56%, mean age 62 years) were included. POSA prevalence was similar between the two groups (46% vs. 39%; p = 0.33). Obesity and severe OSA (AHI ≥ 30/h) were associated with low likelihood of POSA (OR [CI] of 0.17 [0.09-0.32] and 0.28 [0.12-0.62]). In patients with AF, male sex was associated with a higher likelihood of POSA (OR [CI] of 3.16 [1.06-10.4]). CONCLUSION POSA is common, affecting more than half of patients with AF, but the prevalence was similar in those without AF. Obesity and more severe OSA are associated with lower odds of POSA. Positional therapy should be considered in patients with mild OSA and POSA.
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Affiliation(s)
- Patrick L Stafford
- Department of Medicine, University of Virginia, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908, USA.
| | - Evan Harmon
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Paras Patel
- Department of Medicine, University of Virginia, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908, USA
| | - McCall Walker
- Department of Medicine, University of Texas - Southwestern, Dallas, TX, USA
| | - Nazem Akoum
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Seung-Jung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeilim Cho
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth Bilchick
- Department of Medicine, University of Virginia, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908, USA
| | - Nishaki Mehta
- Department of Cardiology, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908, USA
| | - Yoonsik Cho
- Department of Artificial Intelligence, Chung-Ang University, Seoul, Republic of Korea
| | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA
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