Home Sleep Tests and the Challenge of Detecting Sleep Apnea in AFib Patients
Chelsie Rohrscheib, Ph.D. Neuroscientist and Head Sleep Expert, Wesper
August 25, 2023
Quick Summary
Atrial fibrillation (AFib) is a common type of heart arrhythmia that affects approximately 12 million Americans, although it’s estimated that 6.6 million remain undiagnosed. AFib is comorbid with conditions like obesity and sleep apnea, and rates increase dramatically with age.
The American Academy of Sleep Medicine estimates that sleep apnea impacts 26% of men and 10% of women. Studies have shown that the prevalence of SA is in up to 74% of patients with AFib, and that SA patients have a 2-4 fold higher odds of having the condition [5, 6].
The Heart Rhythm Society estimates that at least half of patients with AFib have SA, and conversely, a large percentage of SA sufferers have AFib. Not all diagnostic tools are capable of diagnosing SA in AFib patients, therefore it is important to use the appropriate tools to avoid misdiagnosis in heart disease patients.
Long Summary
Arrhythmias are a common group of cardiovascular disorders that cause an abnormal heartbeat. Atrial fibrillation (AFib) is the most common type of arrhythmia and causes fast, irregular beats from the upper chambers of the heart. Current estimates suggest that AFib affects 12 million Americans [1, 2], although rates of AFib are likely to be higher since a large percentage of AFib patients remain undiagnosed [3]. AFib rates increase dramatically with age, and are comorbid with conditions like obesity and sleep apnea (SA). Large population studies have shown that the lifetime risk for developing AFib is 36% in white men, 30% in white women, 21% in African American men, and 22% in African American women [4].
AFib sufferers have very high rates of SA, a group of sleep disorders that causes consistent, long pauses in breathing during sleep, resulting in periods of low blood oxygen. SA can lead to the development of AFib, increase AFib severity, and make AFib very difficult to treat. Studies have shown that the prevalence of SA is in up to 74% of patients with AFib, and that SA patients have a 2-4 fold higher odds of having the condition [5, 6]. The Heart Rhythm Society estimates that at least half of patients with AFib have SA, and conversely, a large percentage of SA sufferers have AFib.
The American Academy of Sleep Medicine estimates that approximately 26% of men and 10% of women have SA, and diagnostic rates increase yearly. Half of all sleep studies conducted in the U.S. are by home sleep tests (HSTs). Cardiac rhythm disturbances, such as AFib and other arrhythmias may affect the performance of certain diagnosis tools. For example, recent studies show that AFib and arrhythmias preclude or degrade cardiopulmonary coupling analysis, making the technology inappropriate for diagnosing SA patients with arrhythmias [7-11].
Population studies have found that as many as 23% of 5.6 million to 6.6 million presumptive AFib cases are undiagnosed, which means a significant number of SA patients have undiagnosed AFib [2]. It is important to understand the risks and the benefits of choosing the appropriate HST for your population to provide accurate and reliable diagnosis.
References
- https://www.ajconline.org/article/S0002-9149(13)01288-5/fulltext
- https://pubmed.ncbi.nlm.nih.gov/25960110/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896911/
- https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000140263.20897.42
- https://pubmed.ncbi.nlm.nih.gov/19578392/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662909/
- https://link.springer.com/chapter/10.1007/978-3-031-06413-5_11
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276128/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018901/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018901/
- https://www.atsjournals.org/doi/10.1513/AnnalsATS.202005-510OC