Assessment of Wesper Accuracy in Patients with Atrial Fibrillation

Assessment of Wesper Accuracy in Patients with Atrial Fibrillation
Chelsie Rohrscheib, Ph.D. Neuroscientist and Head Sleep Expert, Wesper
January 31, 2024

Atrial fibrillation (AFib), a prevalent cardiac arrhythmia affecting millions worldwide, frequently coexists with comorbidities such as obesity and obstructive sleep apnea (OSA). The intricate relationship between AFib and OSA underscores the critical need for accurate diagnostic tools, particularly in patients with cardiovascular conditions. In this context, the Wesper Home Sleep Apnea Test (HSAT) emerges as a promising solution, offering a non-invasive and reliable approach to diagnosing sleep apnea even in individuals with AFib. This study aims to evaluate the efficacy of Wesper HSAT in diagnosing sleep apnea among a cohort of AFib patients, assessing metrics such as the apnea/hypopnea index (AHI) and oxygen desaturation index (ODI). By comparing results with a control group, this research not only highlights the diagnostic accuracy of Wesper HSAT but also underscores its potential to enhance clinical management and improve patient outcomes in cardiovascular care settings.

This investigation fills a crucial gap by providing insights into how Wesper HSAT performs in diagnosing sleep apnea specifically in AFib patients, demonstrating comparable diagnostic rates and metrics with a general population. Despite inherent study limitations such as the inability to ascertain undiagnosed AFib in the control group and the pre-screened nature of participants, these findings offer valuable support for the utility of Wesper HSAT in broader clinical practice. By validating its reliability in diverse patient demographics, this study reinforces the importance of accessible and accurate sleep apnea diagnosis in AFib management, advocating for enhanced utilization of Wesper HSAT to optimize treatment strategies and patient care pathways.
AFib is frequently associated with comorbidities such as obesity and obstructive sleep apnea (OSA). The intricate relationship between AFib and OSA underscores the importance of accurate and accessible diagnostic tools, particularly for individuals with cardiovascular conditions. In this context, Wesper Home Sleep Apnea Test (HSAT) emerges as a promising solution, offering a non-invasive and reliable approach to sleep apnea diagnosis, even in patients with AFib. This study endeavors to elucidate the efficacy of Wesper HSAT in diagnosing sleep apnea among individuals with AFib, shedding light on its diagnostic accuracy and utility in clinical practice.


Drawing from a cohort of 26 individuals formally diagnosed with AFib, the study rigorously assessed the diagnostic performance of Wesper HSAT in detecting sleep apnea, employing metrics such as the apnea/hypopnea index (AHI), respiratory event index (REI), and oxygen desaturation index (ODI). Notably, the analysis revealed comparable rates of sleep apnea diagnosis between AFib patients and a control group, showcasing the consistency and reliability of Wesper HSAT across diverse patient demographics. These findings not only underscore the importance of accurate sleep apnea diagnosis in AFib management but also reaffirm the utility of Wesper HSAT as a valuable diagnostic tool in cardiovascular care settings.

While the study provides valuable insights into the diagnostic capabilities of Wesper HSAT in AFib patients, certain limitations necessitate cautious interpretation of the results. The inability to ascertain undiagnosed AFib within the control group and the pre-screened nature of the study population underscore the need for further research to validate these findings in broader patient cohorts. Nonetheless, the study's outcomes instill confidence in the clinical utility of Wesper HSAT, offering healthcare providers a reliable means to diagnose sleep apnea in patients with AFib, thereby enhancing overall treatment efficacy and patient outcomes.
 
What is Atrial Fibrillation?
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 (SA), and rates increase dramatically with age. 
The American Academy of Sleep Medicine (AASM) 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]. Not all diagnostic tools are appropriate for diagnosing SA in AFib patients.


Wesper Home Sleep Apnea Test for AFib Patients

Wesper is an FDA cleared home sleep apnea test (HSAT) that is 95% correlated to PSG and not contraindicated for patients with cardiovascular conditions, including AFib. Wesper does not rely on technology that is affected by heart rhythm during the diagnosis of SA.

To further emphasize Wesper’s reliability in all SA patients, an analysis was conducted on individuals that identified themselves as having been formally diagnosed with AFib and subsequently tested for SA by Wesper. 
The AFib group (n = 26) included Wesper users (mean age: 63.5 years old; males: 14, females: 12) that identified themselves as having been diagnosed by a cardiologist.The AFib group was directly compared to a randomly generated sample of Wesper patients (n = 100) with similar demographics (mean age: 61.9 years old; males: 50, females: 50), to determine if results remained consistent. 
Metrics commonly used for the diagnosis of SA were compared, including apnea/hypopnea index (AHI), respiratory event index (REI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean SPO2, and minimum SPO2. The analysis was performed using a Mann-Whitney U test for non-parametric data. 
Results 
The percentage of AFib-patients positive for SA (77%) was comparable to the control group (82%; Figure 1). Results showed that there was no significant difference in average AHI 3% (AFib AHI 3%: 17.7; Control AHI 3%: 21.9; Mann-Whitney U = 647.5; p = 0.87; Figure 2). Both groups had a mean AHI that fell within the moderate severity range, as per AASM scoring guidelines
 

Figure 1: The percent of patients that were positive for sleep apnea in the AFib and control group.
 

Figure 2: Average AHI 3% for patients within the AFib and control group 


There was no significant difference in REI 3% between the AFib group (REI 3%: 13.7) and the control (REI 3%: 16.34; Mann-Whitney U = 1167; p = 0.42; Figure 3).
 

Figure 3: Average REI 3% for patients within the AFib and control group

There was no significant difference in RDI 3% between the AFib group (RDI 3%: 18.31) and the control (RDI 3%: 21.71; Mann-Whitney U = 1190; p = 0.50; Figure 4).
 

Figure 4: Average RDI 3% for patients within the AFib and control group
 
There was no significant difference in ODI 3% between the AFib group (ODI 3%: 19.92) and the control (ODI 3%: 22.07; Mann-Whitney U = 1219; p = 0.62; Figure 5).
 

Figure 5: Average ODI 3% for patients within the AFib and control group

There was no significant difference in mean SPO2 between the AFib group (Mean SPO2: 92.58%) and the control (Mean SPO2: 93.02%; Mann-Whitney U = 1249; p = 0.75; Figure 6).
 

Figure 6: Average mean SPO2 for patients within the AFib and control group
 
There was no significant difference in minimum SPO2 between the AFib group (Minimum SPO2: 82.14%) and the control (Minimum SPO2: 83.24%; Mann-Whitney U = 1282; p = 0.91; Figure 7).
 

Figure 7: Average minimum SPO2 for patients within the AFib and control group

Conclusion 
The analysis comparing Wesper test results between patients diagnosed with AFib and the general Wesper user population showed no difference in SA diagnostic rates or test results, indicating that the presence of AFib has no effect on Wesper Lab’s performance. 
Important to note is that this study aimed to compare AFib patients to a general population, however it is impossible to determine if patients included in the control group have undiagnosed AFib. In addition, the patient population is already screened for SA and referred for a sleep study, so the prevalence of SA in the AFib patients may be different from the one in the general, unscreened population. Despite these limitations, the results we presented here provide additional confidence for providers that use Wesper Lab for SA testing with broad patient characteristics.

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