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Role of arousal in diagnosing sleep apnea in atrial fibrillation patients

2025-08Artigo científico Acesso aberto
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dc.contributor.authorSousa, Susana
dc.contributor.authorVarela, Susana
dc.contributor.authorTeixeira, Carlos
dc.contributor.authorGrencho, Dina
dc.contributor.authorDias, Sara
dc.contributor.authorDias, Sara Simões
dc.contributor.authorDrummond, Marta
dc.contributor.authorBugalho, António
dc.contributor.authorBugalho, Antonio
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - pólo NMS
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer Verlag
dc.date.accessioned2025-09-16T21:47:28Z
dc.date.available2025-09-16T21:47:28Z
dc.date.issued2025-08
dc.descriptionFunding Information: Open access funding provided by FCT|FCCN (b-on). This work was supported by a PhD scholarship from CUF. The funder had no role in the design, data collection, data analysis, or reporting of this study. Publisher Copyright: © The Author(s) 2025.
dc.description.abstractIntroduction: Obstructive sleep apnea syndrome (OSAS) is highly prevalent in patients with atrial fibrillation (AF) and may influence rhythm control outcomes. Accurate diagnosis is essential but depends on the criteria used to define respiratory events. This study aimed to evaluate how the inclusion of EEG arousals in hypopnea scoring affects the diagnosis and severity classification of OSAS in patients with AF. Patients and methods: We conducted a prospective analysis of 88 consecutive patients with AF (paroxysmal or persistent) referred for sleep evaluation with ambulatory type II polysomnography (PSG). Hypopneas were scored according to two criteria: [1] ≥ 3% oxygen desaturation, and [2] ≥ 3% desaturation or EEG-defined arousal. Apnea–hypopnea index (AHI) and OSAS severity were compared across both definitions. Results: Participants had a mean age of 63 ± 9.7 years, were predominantly male (68%), and had a mean BMI of 30 ± 4.8 kg/m². OSAS was diagnosed in 100% of patients. Using the desaturation-only criterion, OSAS severity was classified as mild in 24.7%, moderate in 31.8%, and severe in 43.5% of patients. In contrast, scoring hypopneas based on desaturation or arousal led to reclassification: 5.7% mild, 17.0% moderate, and 77.3% severe. Thirty-one patients classified as severe OSAS were missed using desaturation-only scoring. The number of hypopneas detected was significantly higher when arousals were included (200.0 ± 105.6 vs. 81.9 ± 48.9; p < 0.001), with a moderate positive correlation between the two methods (r = 0.436). Conclusion: The use of arousal-inclusive criteria significantly increases OSAS detection and alters severity classification in patients with AF. Relying solely on oxygen desaturation may lead to underdiagnosis and misclassification, particularly in non-desaturating patients. Incorporating EEG arousals into hypopnea scoring provides a more accurate assessment of disease burden and may support more effective, individualized treatment strategies.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent672003
dc.identifier.doi10.1007/s11325-025-03435-8
dc.identifier.issn1520-9512
dc.identifier.otherPURE: 128580919
dc.identifier.otherPURE UUID: 37888615-8847-4bf7-963d-67de47412228
dc.identifier.otherScopus: 105012867275
dc.identifier.otherPubMed: 40773015
dc.identifier.urihttp://hdl.handle.net/10362/187970
dc.identifier.urlhttps://www.scopus.com/pages/publications/105012867275
dc.language.isoeng
dc.peerreviewedyes
dc.subjectArousal
dc.subjectAtrial fibrillation
dc.subjectHypopneas
dc.subjectPolysomnography
dc.subjectScoring
dc.subjectSleep apnea
dc.subjectOtorhinolaryngology
dc.subjectClinical Neurology
dc.titleRole of arousal in diagnosing sleep apnea in atrial fibrillation patientsen
dc.typejournal article
degois.publication.issue4
degois.publication.titleSleep and Breathing
degois.publication.volume29
dspace.entity.typePublication
person.familyNameVarela
person.familyNameDias
person.familyNameBugalho
person.givenNameSusana
person.givenNameSara
person.givenNameAntonio
person.identifier911254
person.identifier.ciencia-idAA1F-9375-B5E6
person.identifier.ciencia-id9E1E-D314-B3DF
person.identifier.orcid0000-0002-4963-9572
person.identifier.orcid0000-0001-6782-7481
person.identifier.orcid0000-0003-3951-1134
person.identifier.ridI-9965-2018
person.identifier.scopus-author-id33367487300
rcaap.rightsopenAccess
relation.isAuthorOfPublication630c86a0-432f-48ea-9161-f4fdd96edd0d
relation.isAuthorOfPublication273b0d8c-a5a2-475a-af78-161f8234f8f4
relation.isAuthorOfPublication68147e9d-ab3f-467a-8786-10b826de28f5
relation.isAuthorOfPublication.latestForDiscovery273b0d8c-a5a2-475a-af78-161f8234f8f4

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