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. 2023 May;27(2):487-494.
doi: 10.1007/s11325-022-02625-y. Epub 2022 May 10.

Positional obstructive sleep apnea in patients with atrial fibrillation

Patrick L Stafford  1 , Evan Harmon  2 , Paras Patel  3 , McCall Walker  4 , Nazem Akoum  5 , Seung-Jung Park  6 , Yeilim Cho  5 , Kenneth Bilchick  3 , Nishaki Mehta  7 , Sula Mazimba  3 , Yoonsik Cho  8 , Younghoon Kwon  5
Affiliations

Positional obstructive sleep apnea in patients with atrial fibrillation

Patrick L Stafford et al. Sleep Breath. 2023 May.

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.

Keywords: Atrial fibrillation; Obstructive sleep apnea; Positional sleep apnea.

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Conflict of interest statement

Conflict of Interest: All authors confirm that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1
Figure 1
Patient group studied with exclusion criteria.
Figure 2
Figure 2
Apnea-hypopnea index (AHI) in the supine (dark grey) and lateral positions (white) in patients with and without atrial fibrillation (AF). The light grey bar marks the difference between the lateral and supine AHI. The overall height of the bar is the median value and the whisker bars demonstrate the lower and upper quartiles. There was a statistically significant difference between supine and lateral AHI in both the AF and no AF populations. When this difference was compared as stratified by AF, there was no significant difference (p=0.99).
See this image and copyright information in PMC

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