https://doi.org/10.1007/s00392-025-02625-4
1CARIM – School for Cardiovascular Diseases Maastricht University Maastricht, Niederlande; 2Radboud University and University Medical Center Department of Cardiology Nijmegen, Niederlande; 3Maastricht University Medical Center + Department of Anaesthesiology Maastricht, Niederlande; 4Netherlands Sleep Institute Amersfoort, Niederlande; 5Maastricht University Medical Center + Department of Nursing Maastricht, Niederlande; 6Maastricht UMC+Heart+Vascular Center Dept. of Physiology Maastricht, Niederlande; 7Maastricht UMC+Heart+Vascular Center Department of Cardiology Maastricht, Niederlande
Background: Sleep disordered breathing (SDB), including obstructive sleep apnoea, is highly prevalent among patients with atrial fibrillation (AF). Accurate detection and treatment of SDB are essential to improve rhythm control strategies in these patients.
Purpose: We previously implemented a virtual pathway for the detection and management of SDB in patients with AF (Virtual-SAFARI). Here, we present follow-up results on the initiation and progression of SDB treatment in this cohort.
Methods: Consecutive patients with AF scheduled for AF ablation were prospectively enrolled. Patients were referred digitally to a virtual pathway for sleep apnoea screening and management, which involved an overnight home sleep test and initiation of SDB treatment at the patients’ homes, if indicated. SDB diagnosis was based on the apnoea-hypopnea index (AHI), categorized as none-to-mild SDB (AHI <15) and moderate-to-severe SDB (AHI ≥ 15).
Results: A total of 396 patients were analyzed (38.4% female, median age 64 [58-70] years). Among them, 196 (49.5%) patients were newly diagnosed with moderate-to-severe SDB and 200 (50.5%) patients had none-to-mild SDB. Patients with moderate-to-severe SDB were older (65 [59-71] vs 64 [56-69] years, p = 0.018), less likely female (32.7% vs 44.0%, p=0.023) and had a higher CHA2DS2-VASc Score (2 [1-3] vs 1 [0-2], p < 0.001). Of the 196 patients with moderate-to-severe SDB, 174 patients (88.8%) received SDB treatment, with 90 (45.9%) patients receiving positive airway pressure (PAP) therapy, 65 (33.2%) mandibular repositioning appliances (MRA), and 19 (9.7%) undergoing sleep position training (SPT). Median PAP compliance was 5:50 hours per night (3:44 – 6:55 hours). In the overall group of 231 patients who received SDB treatment (including 57 with none-to-mild SDB), treatment was stopped in 23 (10.0%) patients and SDB treatment was further adjusted in 33 (14.3%) patients. The median time from SDB diagnosis to AF ablation was 66 (28-120) days, with a longer time to ablation observed in patients with moderate-to-severe SDB compared to those with none or mild SDB (82 [48-157] days vs 61 [33-95] days, p < 0.001). Additionally, patients with moderate-to-severe SDB were more likely to receive general anesthesia during AF ablation than patients with none and mild SDB (83 [58.0%] vs 23 [16.2%] p < 0.001).
Conclusions: The virtual pathway for sleep-disordered-breathing diagnosis and management in patients scheduled for AF ablation (Virtual-SAFARI) led to new diagnosis of moderate-to-severe SDB in nearly half of the patients. SDB treatment was initiated in a majority of diagnosed patients, with overall high PAP compliance. Only in a minority of patients, SDB treatment was either stopped or further adapted. Patients with moderate-to-severe SDB were more likely to receive general anesthesia for AF ablation and had a significantly longer time to ablation. Future research will focus on assessing the impact of SDB therapy on AF ablation outcomes.