1111 Relationship Between Positional Obstructive Sleep Apnea and Excessive DaytimeSleepiness in Patients with Atrial Fibrillation

Abstract

Abstract Introduction Obstructive sleep apnea (OSA) is highly prevalent in patients with atrial fibrillation (AF). Prior studies have suggested that OSA-related excessive daytime sleepiness symptom (EDS) is less pronounced in patients with AF. Positional obstructive sleep apnea (POSA) is common, affecting nearly half of the patients with OSA, including patients with AF. However, symptomatic manifestation of OSA by POSA status is unknown. We investigated whether POSA affected the likelihood of EDS differently in patients with AF compared to those without AF. Methods We reviewed and included patients with and without (1:1 match) a history of AF who underwent clinically indicated in-lab sleep study at a single academic sleep center. Patients with OSA (apnea-hypopnea index [AHI] ≥ 5 events/hour), who achieved at least 30 minutes in both supine and non-supine positions were included. POSA was defined as OSA patients with a supine/non-supine AHI ratio ≥ 2. EDS was determined using an Epworth Sleepiness Scale score of 11 or higher. We performed multiple logistic regression separately for AF and non-AF groups to examine the relationship between POSA and EDS. Analyses were adjusted for age, sex, body mass index, AHI, total sleep time, and cardiovascular risk factors including hypertension and type 2 diabetes. Results Among 223 adult patients (mean age 62 ±14 years, 55% male, 51% with a history of AF [n = 114]) included, 55% were identified to have POSA. EDS was present in 43% of the entire group and 42% and 45% in the AF and non-AF subgroups, respectively. In patients with AF, POSA was associated with a lower likelihood of EDS (adjusted odds ratio [aOR]: 0.29; 95% confidence interval [CI]: 0.10-0.81). In contrast, no significant association was observed (aOR: 0.78; 95%CI: 0.31-2.00) in patients without AF. Conclusion We identified different symptomatic manifestation of POSA by AF status. OSA patients with AF and POSA were less likely to have EDS than OSA patients with AF and no POSA. Given that EDS is an important determinant of clinical decision making in OSA treatment and potentially a critical cardiovascular risk marker, consideration of POSA status may be useful in AF patients with a comorbid OSA. Support (if any)